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Epstein SE, Longbrake EE. Shifting our attention earlier in the multiple sclerosis disease course. Curr Opin Neurol 2024; 37:212-219. [PMID: 38546031 DOI: 10.1097/wco.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. RECENT FINDINGS MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. SUMMARY Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.
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Klíčová K, Mareš J, Sobek O, Rous Z, Rous M, Raška M, Hartung HP. Prognostic relevance of the C-X-C motif chemokine ligand 13 and interleukin-8 in predicting the transition from clinically isolated syndrome to multiple sclerosis. Eur J Neurosci 2024. [PMID: 38453679 DOI: 10.1111/ejn.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
The initial phase of multiple sclerosis (MS), often known as clinically isolated syndrome (CIS), is a critical period for identifying individuals at high risk of progressing to full-blown MS and initiating timely treatment. In this study, we aimed to evaluate the prognostic value of C-X-C motif chemokine ligand 13 (CXCL13) and interleukin-8 (IL-8) as potential markers for CIS patients' conversion to MS. Our study encompassed patients with CIS, those with relapsing-remitting MS (RRMS), and control subjects, with sample analysis conducted on both cerebrospinal fluid (CSF) and serum. Patients were categorized into four groups: CIS-CIS (no MS development within 2 years), CIS-RRMS (conversion to RRMS within 2 years), RRMS (already diagnosed), and a control group (CG) with noninflammatory central nervous system disorders. Results showed significantly elevated levels of CXCL13 in CSF across all patient groups compared with the CG (p < 0.0001, Kruskal-Wallis test). Although CXCL13 concentrations were slightly higher in the CIS-RRMS group, statistical significance was not reached. Similarly, significantly higher levels of IL-8 were detected in CSF samples from all patient groups compared with the CG (p < 0.0001, Kruskal-Wallis test). Receiver operating characteristic analysis in the CIS-RRMS group identified both CXCL13 (area under receiver operating characteristic curve = .959) and IL-8 (area under receiver operating characteristic curve = .939) in CSF as significant predictors of CIS to RRMS conversion. In conclusion, our study suggests a trend towards elevated CSF IL-8 and CSF CXCL13 levels in CIS patients progressing to RRMS. These findings emphasize the importance of identifying prognostic markers to guide appropriate treatment strategies for individuals in the early stages of MS.
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Affiliation(s)
- Kateřina Klíčová
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Jan Mareš
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Ondřej Sobek
- Laboratory for Cerebrospinal Fluid, Neuroimmunology, Pathology and Special Diagnostics, Topelex, Prague, Czech Republic
| | - Zuzana Rous
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Matouš Rous
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Milan Raška
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Hans-Peter Hartung
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, New South Wales, Australia
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Stavropoulou De Lorenzo S, Bakirtzis C, Konstantinidou N, Kesidou E, Parissis D, Evangelopoulos ME, Elsayed D, Hamdy E, Said S, Grigoriadis N. How Early Is Early Multiple Sclerosis? J Clin Med 2023; 13:214. [PMID: 38202221 PMCID: PMC10780129 DOI: 10.3390/jcm13010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
The development and further optimization of the diagnostic criteria for multiple sclerosis (MS) emphasize the establishment of an early and accurate diagnosis. So far, numerous studies have revealed the significance of early treatment administration for MS and its association with slower disease progression and better late outcomes of the disease with regards to disability accumulation. However, according to current research results, both neuroinflammatory and neurodegenerative processes may exist prior to symptom initiation. Despite the fact that a significant proportion of individuals with radiologically isolated syndrome (RIS) progress to MS, currently, there is no available treatment approved for RIS. Therefore, our idea of "early treatment administration" might be already late in some cases. In order to detect the individuals who will progress to MS, we need accurate biomarkers. In this review, we present notable research results regarding the underlying pathology of MS, as well as several potentially useful laboratory and neuroimaging biomarkers for the identification of high-risk individuals with RIS for developing MS. This review aims to raise clinicians' awareness regarding "subclinical" MS, enrich their understanding of MS pathology, and familiarize them with several potential biomarkers that are currently under investigation and might be used in clinical practice in the future for the identification of individuals with RIS at high risk for conversion to definite MS.
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Affiliation(s)
- Sotiria Stavropoulou De Lorenzo
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Christos Bakirtzis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Natalia Konstantinidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | - Dimitrios Parissis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
| | | | - Dina Elsayed
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Eman Hamdy
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Sameh Said
- Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria 21311, Egypt; (D.E.); (E.H.); (S.S.)
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece; (S.S.D.L.); (N.K.); (E.K.); (D.P.); (N.G.)
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4
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Adamczyk B, Morawiec N, Mamak G, Boczek S, Brzęk D, Trędota N, Walocha P, Czuba ZP, Błachut M, Bartman W, Adamczyk-Sowa M. The Comparison of the Selected Parameters of Brain Injury and Interleukins in the CSF in Patients Diagnosed De Novo with RRMS Compared to the Control Group. Diagnostics (Basel) 2023; 13:3436. [PMID: 37998571 PMCID: PMC10670079 DOI: 10.3390/diagnostics13223436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disorder affecting the central nervous system (CNS). Due to the different phenotypes of the disease and non-specific symptoms of MS, there is a great need for a validated panel of biomarkers to facilitate the diagnosis, predict disease progression, and evaluate treatment outcomes. METHODS We determined the levels of the parameters of brain injury (NF-H, GPAF, S100B, and UCHL1) and the selected cytokines in the cerebrospinal fluid (CSF) in 101 patients diagnosed de novo with RRMS and 75 healthy controls. All determinations were made using the Bio-Plex method. RESULTS We found higher levels of NF-H and GFAP in the relapsing-remitting multiple sclerosis (RRMS) group compared to the controls. The concentrations of both molecules were significantly increased in patients with Gd+ lesions on brain MRI. The level of S100B did not differ significantly between the groups. UCHL1 concentrations were higher in the control group. We found some correlations between the selected cytokines, the levels of the parameters of brain injury, and the time from the first symptoms to the diagnosis of MS. CONCLUSIONS The role of the above molecules in MS is promising. However, further research is warranted to define their precise functions.
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Affiliation(s)
- Bożena Adamczyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Natalia Morawiec
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Gabriela Mamak
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Sylwia Boczek
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Dominika Brzęk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Natalia Trędota
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Patryk Walocha
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Zenon P. Czuba
- Department of Microbiology and Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. Jordana 19, 41-808 Zabrze, Poland;
| | - Michał Błachut
- Clinical Department of Psychiatry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Wojciech Bartman
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland; (N.M.); (G.M.); (S.B.); (D.B.); (N.T.); (P.W.); (W.B.); (M.A.-S.)
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Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
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Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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6
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Bower A, Makhani N. Radiologically Isolated Syndrome and the Multiple Sclerosis Prodrome in Pediatrics: Early Features of the Spectrum of Demyelination. Semin Pediatr Neurol 2023; 46:101053. [PMID: 37451751 DOI: 10.1016/j.spen.2023.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
Radiologically isolated syndrome refers to the clinical scenario in which individuals have imaging concerning for multiple sclerosis and would otherwise satisfy radiographic dissemination in space criteria, but do not have any attributable signs or symptoms. Radiologically isolated syndrome has been increasingly recognized in the pediatric population and it is understood certain individuals will transition to a formal diagnosis of multiple sclerosis over time. This review aims to outline the available data within this unique population including the diagnostic criteria, epidemiology, risk factors associated with transitioning to multiple sclerosis, and the current therapeutic landscape. Radiologically isolated syndrome will also be positioned within a broader spectrum of demyelinating disease as recent data has pointed towards a likely prodromal phase that precedes a first clinical event and diagnosis of multiple sclerosis. Characterizing the radiographic features, clinical symptoms, and biomarkers that constitute this prodromal phase of multiple sclerosis would help identify patients who may most benefit from early intervention in the future.
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Affiliation(s)
- Aaron Bower
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Naila Makhani
- Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
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Dolcetti E, Bruno A, Azzolini F, Gilio L, Pavone L, Iezzi E, Galifi G, Gambardella S, Ferese R, Buttari F, De Vito F, Colantuono P, Furlan R, Finardi A, Musella A, Mandolesi G, Centonze D, Stampanoni Bassi M. Genetic regulation of IL-8 influences disease presentation of multiple sclerosis. Mult Scler 2023; 29:512-520. [PMID: 36803228 DOI: 10.1177/13524585231155049] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Individual genetic variability may influence the course of multiple sclerosis (MS). The interleukin (IL)-8C>T rs2227306 single nucleotide polymorphism (SNP) regulates IL-8 activity in other clinical conditions; however, its role in MS has never been investigated. OBJECTIVES To explore the association between IL-8 SNP rs2227306, cerebrospinal fluid (CSF) IL-8 concentrations, clinical, and radiological characteristics in a group of newly diagnosed MS patients. METHODS In 141 relapsing-remitting (RR)-MS patients, rs2227306 polymorphism, CSF levels of IL-8, clinical, and demographical characteristics were determined. In 50 patients, structural magnetic resonance imaging (MRI) measures were also assessed. RESULTS An association between CSF IL-8 and Expanded Disability Status Scale (EDSS) at diagnosis was found in our set of patients (r = 0.207, p = 0.014). CSF IL-8 concentrations were significantly higher in patients carrying the T variant of rs2227306 (p = 0.004). In the same group, a positive correlation emerged between IL-8 and EDSS (r = 0.273, p = 0.019). Finally, a negative correlation between CSF levels of IL-8 and cortical thickness emerged in rs2227306T carriers (r = -0.498, p = 0.005). CONCLUSION We describe for the first time a role of SNP rs2227306 of IL-8 gene in regulating the expression and the activity of this inflammatory cytokine in MS.
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Affiliation(s)
| | | | | | | | | | | | | | - Stefano Gambardella
- IRCSS Neuromed, Pozzilli, Italy/Department of Biomolecular Sciences, University of Urbino "Carlo Bo," Urbino, Italy
| | | | | | | | - Paola Colantuono
- Department of Medicine and Health Sciences "Vincenzo Tiberio," Unimol, Campobasso, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Hospital, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Hospital, Milan, Italy
| | - Alessandra Musella
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Roma, Italy/Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Rome, Italy
| | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele Roma, Roma, Italy/Department of Human Sciences and Quality of Life Promotion, University of Rome San Raffaele, Rome, Italy
| | - Diego Centonze
- IRCSS Neuromed, Pozzilli, Italy/Department of Systems Medicine, Tor Vergata University, Rome, Italy
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Burman J, Zjukovskaja C, Svenningsson A, Freyhult E, Wiberg A, Kultima K. Cerebrospinal fluid cytokines after autologous haematopoietic stem cell transplantation and intrathecal rituximab treatment for multiple sclerosis. Brain Commun 2023; 5:fcad011. [PMID: 36756308 PMCID: PMC9901571 DOI: 10.1093/braincomms/fcad011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis has been established as an inflammatory disease of the central nervous system. Many aspects of the pathophysiology are still unknown and it is presently unclear how different treatments affect the immunopathology of multiple sclerosis. In this study, we explored cytokines discriminating between individuals with multiple sclerosis and healthy controls and then how these cytokines were affected by treatment intervention with autologous haematopoietic stem cell transplantation or intrathecal rituximab. CSF from individuals with multiple sclerosis and healthy controls were analysed with a proximity extension assay to simultaneously determine the level of 92 cytokines and other inflammation-related proteins. In total, CSF from 158 multiple sclerosis patients and 53 healthy controls were analysed. Sixty-four patients with relapsing-remitting multiple sclerosis and 27 with progressive multiple sclerosis took part in a cross-sectional study and underwent lumbar puncture on a single occasion. Forty-five patients with relapsing-remitting multiple sclerosis were treated with autologous haematopoietic stem cell transplantation and underwent lumbar puncture at baseline and then at follow-up visits made at 1-, 2- and 5 years. Twenty-two patients with progressive multiple sclerosis were treated with intrathecal rituximab and followed with lumbar punctures at baseline and then at follow-up visits made at 3-, 6- and 12 months. Of the 92 studied cytokines, 16 were found to be altered in multiple sclerosis and 11 were decreased after treatment with autologous haematopoietic stem cell transplantation. None of the studied cytokines was affected by treatment with intrathecal rituximab for progressive multiple sclerosis. Some proteins were highly associated with each other. Therefore, a cluster analysis was made and then the highest-ranked protein from the four highest-ranked clusters was used for the subsequent analyses. CCL3, IL-12B, CXCL10 and IL-8 discriminated between multiple sclerosis patients and controls, but only IL-12B differed between patients with relapsing-remitting and progressive multiple sclerosis. The CSF concentrations of CCL3, IL-12B and CXCL10 were decreased after autologous haematopoietic stem cell transplantation, whereas IL-8 appeared to be unaffected by this intervention. High concentrations of IL-8 were associated with worse outcome in both treatment groups. Overall, the results suggest a profound effect of autologous haematopoietic stem cell transplantation on the inflammatory milieu of the CSF in multiple sclerosis.
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Affiliation(s)
- Joachim Burman
- Correspondence to: Joachim Burman, M.D. Ph.D Department of Medical Sciences, Neurology, Uppsala University, Uppsala SE-751 85, Sweden E-mail:
| | - Christina Zjukovskaja
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala SE-751 85, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm SE-171 77, Sweden
| | - Eva Freyhult
- Department of Cell and Molecular Biology, Uppsala University, Uppsala SE-751 23, Sweden
| | - Anna Wiberg
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala SE-751 85, Sweden,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala SE-751 85, Sweden
| | - Kim Kultima
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala SE-751 85, Sweden
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9
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Stampanoni Bassi M, Buttari F, Gilio L, Iezzi E, Galifi G, Carbone F, Micillo T, Dolcetti E, Azzolini F, Bruno A, Borrelli A, Mandolesi G, Rovella V, Storto M, Finardi A, Furlan R, Centonze D, Matarese G. Osteopontin Is Associated with Multiple Sclerosis Relapses. Biomedicines 2023; 11:biomedicines11010178. [PMID: 36672686 PMCID: PMC9855779 DOI: 10.3390/biomedicines11010178] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Osteopontin, an extracellular matrix protein involved in bone remodeling, tissue repair and inflammation, has previously been associated with increased inflammation and neurodegeneration in multiple sclerosis (MS), promoting a worse disease course. Osteopontin is also likely involved in acute MS relapses. METHODS In 47 patients with relapsing-remitting MS, we explored the correlation between the time elapsed between the last clinical relapse and lumbar puncture, and the cerebrospinal fluid (CSF) levels of osteopontin and a group of inflammatory cytokines and adipokines such as resistin, plasminogen activator inhibitor-1, osteoprotegerin, interleukin (IL)-1β, IL-2, IL-6 and IL-1 receptor antagonist (IL-1ra). We also analyzed the correlations between CSF levels of osteopontin and the other CSF molecules considered. RESULTS Osteopontin CSF concentrations were higher in patients with a shorter time interval between the last clinical relapse and CSF withdrawal. In addition, CSF levels of osteopontin were positively correlated with the proinflammatory cytokines IL-2 and IL-6 and negatively correlated with the anti-inflammatory molecule IL-1ra. CONCLUSIONS Our results further suggest the role of osteopontin in acute MS relapses showing that, in proximity to relapses, osteopontin expression in CSF may be increased along with other proinflammatory mediators and correlated with decreased concentrations of anti-inflammatory molecules.
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Affiliation(s)
| | | | | | | | | | - Fortunata Carbone
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
- Laboratory of Immunology, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Teresa Micillo
- Treg Cell Lab, Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
| | | | | | | | | | - Georgia Mandolesi
- Synaptic Immunopathology Lab, IRCCS San Raffaele, 00163 Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, University of Roma San Raffaele, 00166 Rome, Italy
| | - Valentina Rovella
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | | | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Diego Centonze
- IRCCS Neuromed, 86077 Pozzilli, Italy
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Correspondence: ; Tel./Fax: +39-0865-929250
| | - Giuseppe Matarese
- Laboratory of Immunology, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
- Treg Cell Lab, Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
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10
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Younger DS. Multiple sclerosis: Motor dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:119-147. [PMID: 37620066 DOI: 10.1016/b978-0-323-98817-9.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Multiple sclerosis is a chronic neurological disease characterized by inflammation and degeneration within the central nervous system. Over the course of the disease, most MS patients successively accumulate inflammatory lesions, axonal damage, and diffuse CNS pathology, along with an increasing degree of motor disability. While the pharmacological approach to MS targets inflammation to decrease relapse rates and relieve symptoms, disease-modifying therapy and immunosuppressive medications may not prevent the accumulation of pathology in most patients leading to long-term motor disability. This has been met with recent interest in promoting plasticity-guided concepts, enhanced by neurophysiological and neuroimaging approaches to address the preservation of motor function.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Rival M, Thouvenot E, Du Trieu de Terdonck L, Laurent-Chabalier S, Demattei C, Uygunoglu U, Castelnovo G, Cohen M, Okuda DT, Kantarci OH, Pelletier D, Azevedo C, Marin P, Lehmann S, Siva A, Mura T, Lebrun-Frenay C. Neurofilament Light Chain Levels Are Predictive of Clinical Conversion in Radiologically Isolated Syndrome. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200044. [PMID: 36280258 PMCID: PMC9621336 DOI: 10.1212/nxi.0000000000200044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the predictive value of serum neurofilament light chain (sNfL) and CSF NfL (cNfL) in patients with radiologically isolated syndrome (RIS) for evidence of disease activity (EDA) and clinical conversion (CC). METHODS sNfL and cNfL were measured at RIS diagnosis by single-molecule array (Simoa). The risk of EDA and CC according to sNfL and cNfL was evaluated using the Kaplan-Meier analysis and multivariate Cox regression models including age, spinal cord (SC) or infratentorial lesions, oligoclonal bands, CSF chitinase 3-like protein 1, and CSF white blood cells. RESULTS Sixty-one patients with RIS were included. At diagnosis, sNfL and cNfL were correlated (Spearman r = 0.78, p < 0.001). During follow-up, 47 patients with RIS showed EDA and 36 patients showed CC (median time 12.6 months, 1-86). When compared with low levels, medium and high cNfL (>260 pg/mL) and sNfL (>5.0 pg/mL) levels were predictive of EDA (log rank, p < 0.01 and p = 0.02, respectively). Medium-high cNfL levels were predictive of CC (log rank, p < 0.01). In Cox regression models, cNfL and sNfL were independent factors of EDA, while SC lesions, cNfL, and sNfL were independent factors of CC. DISCUSSION cNfL >260 pg/mL and sNfL >5.0 pg/mL at diagnosis are independent predictive factors of EDA and CC in RIS. Although cNfL predicts disease activity better, sNfL is more accessible than cNfL and can be considered when a lumbar puncture is not performed. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in people with radiologic isolated syndrome (RIS), initial serum and CSF NfL levels are associated with subsequent evidence of disease activity or clinical conversion.
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Affiliation(s)
- Manon Rival
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Eric Thouvenot
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France.
| | - Lucile Du Trieu de Terdonck
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Sabine Laurent-Chabalier
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christophe Demattei
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Ugur Uygunoglu
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Giovanni Castelnovo
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Mikael Cohen
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Darin T Okuda
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Orhun H Kantarci
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Daniel Pelletier
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christina Azevedo
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Philippe Marin
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Sylvain Lehmann
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Aksel Siva
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Thibault Mura
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christine Lebrun-Frenay
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
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Rival M, Galoppin M, Thouvenot E. Biological Markers in Early Multiple Sclerosis: the Paved Way for Radiologically Isolated Syndrome. Front Immunol 2022; 13:866092. [PMID: 35572543 PMCID: PMC9094445 DOI: 10.3389/fimmu.2022.866092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022] Open
Abstract
Radiologically Isolated Syndrome (RIS) is characterized by MRI-typical brain lesions fulfilling the 2009 Okuda criteria, detected in patients without clinical conditions suggestive of MS. Half of all RIS patients convert to MS within 10 years. The individual course of the disease, however, is highly variable with 12% of RIS converting directly to progressive MS. Demographic and imaging markers have been associated with the risk of clinical MS in RIS: male sex, younger age, infra-tentorial, and spinal cord lesions on the index scan and gadolinium-enhancing lesions on index or follow-up scans. Although not considered as a distinct MS phenotype, RIS certainly shares common pathological features with early active and progressive MS. In this review, we specifically focus on biological markers that may help refine the risk stratification of clinical MS and disability for early treatment. Intrathecal B-cell activation with cerebrospinal fluid (CSF) oligoclonal bands, elevated kappa free light chains, and cytokine production is specific to MS, whereas neurofilament light chain (NfL) levels reflect disease activity associated with neuroaxonal injury. Specific microRNA profiles have been identified in RIS converters in both CSF and blood. CSF levels of chitinases and glial acidic fibrillary protein (GFAP) reflecting astrogliosis might help predict the evolution of RIS to progressive MS. Innovative genomic, proteomic, and metabolomic approaches have provided several new candidate biomarkers to be explored in RIS. Leveraging data from randomized controlled trials and large prospective RIS cohorts with extended follow-up to identify, as early as possible, biomarkers for predicting greater disease severity would be invaluable for counseling patients, managing treatment, and monitoring.
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Affiliation(s)
- Manon Rival
- Department of Neurology, Nîmes University Hospital Center, Univ. Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Manon Galoppin
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital Center, Univ. Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
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Amato MP, De Stefano N, Inglese M, Morena E, Ristori G, Salvetti M, Trojano M. Secondary Prevention in Radiologically Isolated Syndromes and Prodromal Stages of Multiple Sclerosis. Front Neurol 2022; 13:787160. [PMID: 35359637 PMCID: PMC8964010 DOI: 10.3389/fneur.2022.787160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Following the extraordinary progress in the treatment of multiple sclerosis (MS), two major unmet needs remain: understanding the etiology of the disease and, hence, designing definitive cures (this perspective is neither at hand, nor it can be taken for granted that the etiologic targets will be readily treatable); the prevention of an overt and disabling disease, which seems to be a more realistic and pragmatic perspective, as the integration of genetic data with endophenotypes, MRI, and other biomarkers ameliorates our ability to identify early neuroinflammation. Radiologically isolated syndrome (RIS; diagnosed when the unanticipated MRI finding of brain spatial dissemination of focal white matter lesions highly suggestive of MS occurs in subjects without symptoms of MS, and with normal neurological examinations) and the recently focused “prodromal MS” are conditions at risk of conversion toward overt disease. Here, we explore the possibility of secondary prevention approaches in these early stages of neuroinflammation. RIS and prodromal MS are rare conditions, which suggest the importance of Study Groups and Disease Registry to implement informative clinical trials. We summarize ongoing preventive approaches in the early stages of the demyelinating process, especially in RIS conditions. Moreover, we highlight the importance of the biomarkers and the predictors of evolution to overt disease, which may be useful to select the individuals at risk of conversion to clinically isolated syndrome (CIS) and/or clinically definite MS. Finally, we illustrate the importance of the endophenotypes to test the frontline immunomodulatory approach for preventive strategies. Future investigations, especially in relatives of patients, based on MRI techniques and biological studies (better with integrated approaches) may provide opportunities to understand the MS early causal cascade and may help to identify a “therapeutic window” to potentially reverse early disease processes.
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Affiliation(s)
- Maria Pia Amato
- Department of Neurosciences, Psycology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,San Martino Hospital-IRCCS, Genoa, Italy
| | - Emanuele Morena
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Neuroinflammation Is Associated with GFAP and sTREM2 Levels in Multiple Sclerosis. Biomolecules 2022; 12:biom12020222. [PMID: 35204724 PMCID: PMC8961656 DOI: 10.3390/biom12020222] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Astrocytes and microglia play an important role in the inflammatory process of multiple sclerosis (MS). We investigated the associations between the cerebrospinal fluid (CSF) levels of glial fibrillary acid protein (GFAP) and soluble triggering receptors expressed on myeloid cells-2 (sTREM-2), inflammatory molecules, and clinical characteristics in a group of patients with relapsing-remitting MS (RRMS). Methods: Fifty-one RRMS patients participated in the study. Clinical evaluation and CSF collection were performed at the time of diagnosis. The CSF levels of GFAP, sTREM-2, and of a large set of inflammatory and anti-inflammatory molecules were determined. MRI structural measures (cortical thickness, T2 lesion load, cerebellar volume) were examined. Results: The CSF levels of GFAP and sTREM-2 showed significant correlations with inflammatory cytokines IL-8, G-CSF, and IL-5. Both GFAP and sTREM-2 CSF levels positively correlated with age at diagnosis. GFAP was also higher in male MS patients, and was associated with an increased risk of MS progression, as evidenced by higher BREMS at the onset. Finally, a negative association was found between GFAP CSF levels and cerebellar volume in RRMS at diagnosis. Conclusions: GFAP and sTREM-2 represent suitable biomarkers of central inflammation in MS. Our results suggest that enhanced CSF expression of GFAP may characterize patients with a higher risk of progression.
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15
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Stampanoni Bassi M, Iezzi E, Centonze D. Multiple sclerosis: Inflammation, autoimmunity and plasticity. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:457-470. [PMID: 35034754 DOI: 10.1016/b978-0-12-819410-2.00024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, experimental studies have clarified that immune system influences the functioning of the central nervous system (CNS) in both physiologic and pathologic conditions. The neuro-immune crosstalk plays a crucial role in neuronal development and may be critically involved in mediating CNS response to neuronal damage. Multiple sclerosis (MS) represents a good model to investigate how the immune system regulates neuronal activity. Accordingly, a growing body of evidence has demonstrated that increased levels of pro-inflammatory mediators may significantly impact synaptic mechanisms, influencing overall neuronal excitability and synaptic plasticity expression. In this chapter, we provide an overview of preclinical data and clinical studies exploring synaptic functioning noninvasively with transcranial magnetic stimulation (TMS) in patients with MS. Moreover, we examine how inflammation-driven synaptic dysfunction could affect synaptic plasticity expression, negatively influencing the MS course. Contrasting CSF inflammation together with pharmacologic enhancement of synaptic plasticity and application of noninvasive brain stimulation, alone or in combination with rehabilitative treatments, could improve the clinical compensation and prevent the accumulating deterioration in MS.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology & Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy; Laboratory of Synaptic Immunopathology, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
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16
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Kozin M, Kiselev I, Baulina N, Kabaeva A, Pavlova G, Boyko A, Favorova O, Kulakova O. Global transcriptome profiling in peripheral blood mononuclear cells identifies dysregulation of immune processes in individuals with radiologically isolated syndrome. Mult Scler Relat Disord 2021; 58:103469. [PMID: 34954650 DOI: 10.1016/j.msard.2021.103469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/28/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
The presence of brain/spinal white matter lesions typical for multiple sclerosis (MS) in asymptomatic individuals is known as 'radiologically isolated syndrome' (RIS). Taking into account that RIS patients are at high risk of MS development, the understanding of mechanisms underlying its pathogenesis is of great importance. In order to investigate RIS-specific transcription signature we performed high-throughput RNA-sequencing in peripheral blood mononuclear cells (PBMCs) of 8 RIS patients and 8 age- and sex-matched healthy controls. We identified 57 differentially expressed genes (DEGs), which levels differed by more than 2 times when comparing RIS patients to healthy controls (FDR p value < 0.05). Gene ontology enrichment analysis in the "biological process" category revealed 16 signaling pathways significantly overrepresented by identified DEGs. The most significant changes in gene expression in PBMCs of RIS patients occur in pathways involved in regulation of the immune response, cytokine and chemokine signaling, cytokine production, and leukocyte migration. In general, analyzing the global transcriptome we demonstrated the dysregulation of immune processes in PBMCs of RIS patients, confirming the current assumption that RIS represents the preclinical stage and/or subclinical form of MS.
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Affiliation(s)
- Maxim Kozin
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; Sirius University of Science and Technology, Sochi 354340 Russia.
| | - Ivan Kiselev
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; Sirius University of Science and Technology, Sochi 354340 Russia
| | - Natalia Baulina
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; Sirius University of Science and Technology, Sochi 354340 Russia
| | - Anastasia Kabaeva
- Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Galina Pavlova
- Pirogov Russian National Research Medical University, Moscow 117997, Russia; Sirius University of Science and Technology, Sochi 354340 Russia
| | - Alexey Boyko
- Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Olga Favorova
- Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Olga Kulakova
- Pirogov Russian National Research Medical University, Moscow 117997, Russia
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17
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Donninelli G, Studer V, Brambilla L, Zecca C, Peluso D, Laroni A, Michelis D, Mantegazza R, Confalonieri P, Volpe E. Immune Soluble Factors in the Cerebrospinal Fluid of Progressive Multiple Sclerosis Patients Segregate Into Two Groups. Front Immunol 2021; 12:633167. [PMID: 33777018 PMCID: PMC7988186 DOI: 10.3389/fimmu.2021.633167] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
Primary-progressive (PP) and secondary-progressive (SP) multiple sclerosis (MS) are characterized by neurological deficits caused by a permanent neuronal damage, clinically quantified by the expanded disability status scale (EDSS). Neuronal tissue damage is also mediated by immune infiltrates producing soluble factors, such as cytokines and chemokines, which are released in the cerebrospinal fluid (CSF). The mechanisms regulating the production of a soluble factor are not completely defined. Using multiplex bead-based assays, we simultaneously measured 27 immune soluble factors in the CSF collected from 38 patients, 26 with PP-MS and 12 with SP-MS. Then, we performed a correlation matrix of all soluble factors expressed in the CSF. The CSF from patients with PP-MS and SP-MS had similar levels of cytokines and chemokines; however, the stratification of patients according to active or inactive magnetic resonance imaging (MRI) unveils some differences. Correlative studies between soluble factors in the CSF of patients with PP-MS and SP-MS revealed two clusters of immune mediators with pro-inflammatory functions, namely IFN-γ, MCP-1, MIP-1α, MIP-1β, IL-8, IP-10, and TNF-α (group 1), and anti-inflammatory functions, namely IL-9, IL-15, VEGF, and IL-1ra (group 2). However, most of the significant correlations between cytokines of group 1 and of group 2 were lost in patients with more severe disability (EDSS ≥ 4) compared to patients with mild to moderate disability (EDSS < 4). These results suggest a common regulation of cytokines and chemokines belonging to the same group and indicate that, in patients with more severe disability, the production of those factors is less coordinated, possibly due to advanced neurodegenerative mechanisms that interfere with the immune response.
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Affiliation(s)
- Gloria Donninelli
- Molecular Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Valeria Studer
- Neuroimmunology and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Neurology Department, Martini Hospital, Turin, Italy
| | - Laura Brambilla
- Neuroimmunology and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Zecca
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Daniele Peluso
- Bioinformatics e Biostatistics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Opthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Michelis
- Department of Neuroscience, Rehabilitation, Opthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paolo Confalonieri
- Neuroimmunology and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisabetta Volpe
- Molecular Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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18
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Early multiple sclerosis: diagnostic challenges in clinically and radiologically isolated syndrome patients. Curr Opin Neurol 2021; 34:277-285. [PMID: 33661162 DOI: 10.1097/wco.0000000000000921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW With the introduction of new diagnostic criteria, the sensibility for multiple sclerosis (MS) diagnosis increased and the number of cases with the clinically isolated syndrome (CIS) decreased. Nevertheless, a misdiagnosis might always be around the corner, and the exclusion of a 'better explanation' is mandatory.There is a pressing need to provide an update on the main prognostic factors that increase the risk of conversion from CIS or from radiologically isolated syndrome (RIS) to MS, and on the potential 'red flags' to consider during the diagnostic workup. RECENT FINDINGS We discuss diagnostic challenges when facing patients presenting with a first demyelinating attack or with a RIS, with a focus on recently revised diagnostic criteria, on other neuroinflammatory conditions to be considered in the differential diagnosis and on factors distinguishing patients at risk of developing MS.A correct definition of a 'typical' demyelinating attack, as well as a correct interpretation of MRI findings, remains crucial in the diagnostic process. The cerebrospinal fluid examination is warmly recommended to confirm the dissemination in time of the demyelinating process and to increase the diagnostic accuracy. SUMMARY An early and accurate diagnosis of MS requires careful consideration of all clinical, paraclinical and radiological data, as well the reliable exclusion of other mimicking pathological conditions. This is advocated to promptly initiate an appropriate disease-modifying therapy, which can impact positively on the long-term outcome of the disease.
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19
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Ghafouri-Fard S, Honarmand K, Taheri M. A comprehensive review on the role of chemokines in the pathogenesis of multiple sclerosis. Metab Brain Dis 2021; 36:375-406. [PMID: 33404937 DOI: 10.1007/s11011-020-00648-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Multiple sclerosis (MS) as a chronic inflammatory disorder of the central nervous system (CNS) is thought to be caused by the abnormal induction of immune responses. Chemokines as molecules that can engage leukocytes into the location of inflammation, actively participate in the pathogenesis of MS. Several members of this family of chemo attractants have been shown to be dysregulated in the peripheral blood, cerebrospinal fluid or CNS lesions of MS patients. Studies in animal models of MS particularly experimental autoimmune encephalomyelitis have indicated the critical roles of chemokines in the pathophysiology of MS. In the current review, we summarize the data regarding the role of CCL2, CCL3, CCL4, CCL11, CCL20, CXCL1, CXCL2, CXCL8, CXCL10, CXCL12 and CXCL13 in the pathogenesis of MS.
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Affiliation(s)
- Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kasra Honarmand
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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20
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Momtazmanesh S, Shobeiri P, Saghazadeh A, Teunissen CE, Burman J, Szalardy L, Klivenyi P, Bartos A, Fernandes A, Rezaei N. Neuronal and glial CSF biomarkers in multiple sclerosis: a systematic review and meta-analysis. Rev Neurosci 2021; 32:573-595. [PMID: 33594840 DOI: 10.1515/revneuro-2020-0145] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/15/2021] [Indexed: 12/29/2022]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease associated with inflammatory demyelination and astroglial activation, with neuronal and axonal damage as the leading factors of disability. We aimed to perform a meta-analysis to determine changes in CSF levels of neuronal and glial biomarkers, including neurofilament light chain (NFL), total tau (t-tau), chitinase-3-like protein 1 (CHI3L1), glial fibrillary acidic protein (GFAP), and S100B in various groups of MS (MS versus controls, clinically isolated syndrome (CIS) versus controls, CIS versus MS, relapsing-remitting MS (RRMS) versus progressive MS (PMS), and MS in relapse versus remission. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we included 64 articles in the meta-analysis, including 4071 subjects. For investigation of sources of heterogeneity, subgroup analysis, meta-regression, and sensitivity analysis were conducted. Meta-analyses were performed for comparisons including at least three individual datasets. NFL, GFAP, t-tau, CHI3L1, and S100B were higher in MS and NFL, t-tau, and CHI3L1 were also elevated in CIS patients than controls. CHI3L1 was the only marker with higher levels in MS than CIS. GFAP levels were higher in PMS versus RRMS, and NFL, t-tau, and CHI3L1 did not differ between different subtypes. Only levels of NFL were higher in patients in relapse than remission. Meta-regression showed influence of sex and disease severity on NFL and t-tau levels, respectively and disease duration on both. Added to the role of these biomarkers in determining prognosis and treatment response, to conclude, they may serve in diagnosis of MS and distinguishing different subtypes.
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Affiliation(s)
- Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran14194, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran14194, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Location VUmc, PK 2 BR 141, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Joachim Burman
- Department of Neuroscience, Uppsala University Hospital, 75185Uppsala, Sweden
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, 6725Szeged, Hungary
| | - Peter Klivenyi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, 6725Szeged, Hungary
| | - Ales Bartos
- Department of Neurology, Third Faculty of Medicine, Charles University, Ruska 87, 100 00Prague 10, Czech Republic
| | - Adelaide Fernandes
- Department of Pharmacological Sciences and Medicines, Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003Lisbon, Portugal
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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21
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Radiologically isolated syndrome: from biological bases to practical management. Neurol Sci 2021; 42:1335-1344. [PMID: 33496891 DOI: 10.1007/s10072-021-05069-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. CONCLUSION At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.
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22
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Kabaeva AR, Boyko AN, Kulakova OG, Favorova OO. [Radiologically isolated syndrome: prognosis and predictors of conversion to multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-12. [PMID: 32844624 DOI: 10.17116/jnevro20201200727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased sensitivity and availability of magnetic resonance imaging (MRI) in neurological routine practice led to the fact that more and more experts began to encounter changes typical for multiple sclerosis (MS) according to MRI in the absence of anamnestic and clinical indications of damage to the central nervous system (CNS). This nosological form has been defined as a radiologically isolated syndrome (RIS). More and more RIS cases convert to MS (up to 30% in the first 5 years after RIS diagnosis). At the moment, there are no biological markers that allow combining RIS and MS into one pathological process and early treatment with disease-modifying drugs (DMT). Prospective studies are actively being conducted to identify demographic, clinical, neuroimaging and biochemical conversion predictors. The identification of the molecular biological RIS features, combining these changes with MS, is an urgent scientific task and will allow timely initiation of therapy of the pathological process already at the subclinical stage.
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Affiliation(s)
- A R Kabaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Cerebrovascular Pathology and Stroke, Moscow, Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
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23
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Hosseiny M, Newsome SD, Yousem DM. Radiologically Isolated Syndrome: A Review for Neuroradiologists. AJNR Am J Neuroradiol 2020; 41:1542-1549. [PMID: 32763896 DOI: 10.3174/ajnr.a6649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022]
Abstract
Radiologically isolated syndrome refers to an entity in which white matter lesions fulfilling the criteria for multiple sclerosis occur in individuals without a history of a clinical demyelinating attack or alternative etiology. Since its introduction in 2009, the diagnostic criteria of radiologically isolated syndrome and its clinical relevance have been widely debated by neurologists and radiologists. The aim of the present study was to review the following: 1) historical evolution of radiologically isolated syndrome criteria, 2) clinical and imaging findings in adults and children with radiologically isolated syndrome, 3) imaging features of patients with radiologically isolated syndrome at high risk for conversion to MS, and 4) challenges and controversies for work-up, management, and therapeutic interventions of patients with radiologically isolated syndrome.
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Affiliation(s)
- M Hosseiny
- From the Department of Radiological Sciences (M.H.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - S D Newsome
- Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D M Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences (D.M.Y.), Johns Hopkins Medical Institution, Baltimore, Maryland.
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24
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Jons D, Zetterberg H, Malmeström C, Bergström T, Axelsson M, Blennow K, Thulin M, Sundström P, Andersen O. Intrathecal immunoreactivity in people with or without previous infectious mononucleosis. Acta Neurol Scand 2020; 142:161-168. [PMID: 32415852 DOI: 10.1111/ane.13280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The risk of developing multiple sclerosis (MS) increases (OR: 3.1) after infectious mononucleosis (IM). However, the nature of this link is obscure. We tested the hypothesis that IM might incur long-term sequelae, including low-key inflammatory activity, with characteristics of an MS endophenotype (or presymptomatic trait) and that assays of MS-relevant cyto-/chemokines in the cerebrospinal fluid (CSF) post-IM may show a trend in this direction. MATERIALS AND METHODS We selected seven CSF cytokines (IL-1b, IL-6, YKL-40, TNF-alpha) or chemokines (IL-8, CCL2, IP-10), representing pro-inflammatory factors previously associated with MS. We assayed the CSF levels of these seven cyto-/chemokines in healthy individuals with a median follow-up time of 10 years after serologically confirmed IM (post-IM group, n = 22), and in healthy controls without a history of IM (n = 19). A group of MS patients (n = 23) were included as reference. RESULTS The CSF levels of IP-10, YKL-40, and CCL-2 were higher in the post-IM group than in our IM unexposed controls (P = .021, .049, .028). Seven of seven cyto-/chemokine assays showed a trend in the predicted direction (P of binomial ratio = .008). However, this trend was non-significant in a multivariate test (P = .22). A power analysis indicated that similar studies including a larger cohort would be numerically realistic. CONCLUSIONS These results do not reject the hypothesis that the established epidemiological association between IM and MS results from a stepwise inflammatory propagation from IM sequelae to an MS endophenotype (or presymptomatic trait) in a proportion of IM patients, pending confirmation with adequate power.
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Affiliation(s)
- Daniel Jons
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- UK Dementia Research Institute at UCL London UK
- Department of Neurodegenerative Diseases UCL Institute of Neurology London UK
| | - Clas Malmeström
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Tomas Bergström
- Department of Clinical Microbiology Sahlgrenska University HospitalVästra Götaland Region Gothenburg Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Mölndal Sweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - Måns Thulin
- Department of Statistics Uppsala University Uppsala Sweden
- School of Mathematics and Maxwell Institute for Mathematical Sciences University of Edinburgh Edinburgh UK
| | - Peter Sundström
- Department of Clinical Science, Neurosciences Umeå University Umeå Sweden
| | - Oluf Andersen
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
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25
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Stampanoni Bassi M, Iezzi E, Drulovic J, Pekmezovic T, Gilio L, Furlan R, Finardi A, Marfia GA, Sica F, Centonze D, Buttari F. IL-6 in the Cerebrospinal Fluid Signals Disease Activity in Multiple Sclerosis. Front Cell Neurosci 2020; 14:120. [PMID: 32655367 PMCID: PMC7324533 DOI: 10.3389/fncel.2020.00120] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Specific proinflammatory and anti-inflammatory molecules could represent useful cerebrospinal fluid (CSF) biomarkers to predict the clinical course of multiple sclerosis (MS). The proinflammatory molecule interleukin (IL)-6 has been investigated in the pathophysiology of MS and has been associated in previous smaller studies to increased disability and disease activity. Here, we wanted to further address IL-6 as a possible CSF biomarker of MS by investigating its detectability in a large cohort of 534 MS patients and in 103 individuals with other non-inflammatory neurological diseases. In these newly diagnosed patients, we also explored correlations between IL-6 detectability, MS phenotypes, and disease characteristics. We found that IL-6 was more frequently detectable in the CSF of MS patients compared with their control counterparts as significant differences emerged between patients with Clinically isolated syndrome (CIS), Relapsing–remitting (RR), and secondary progressive and primary progressive MS compared to non-inflammatory controls. IL-6 was equally present in the CSF of all MS phenotypes. In RR MS patients, IL-6 detectability was found to signal clinically and/or radiologically defined disease activity, among all other clinical characteristics. Our results add further evidence that CSF proinflammatory cytokines could be useful for the identification of those MS patients who are prone to increased disease activity. In particular, IL-6 could represent an interesting prognostic biomarker of MS, as also demonstrated in other diseases where CSF IL-6 was found to identify patients with worse disease severity.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Luana Gilio
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Girolama Alessandra Marfia
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Sica
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
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26
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Grzegorski T, Losy J. What do we currently know about the clinically isolated syndrome suggestive of multiple sclerosis? An update. Rev Neurosci 2020; 31:335-349. [DOI: 10.1515/revneuro-2019-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 12/31/2022]
Abstract
AbstractMultiple sclerosis (MS) is a chronic, demyelinating, not fully understood disease of the central nervous system. The first demyelinating clinical episode is called clinically isolated syndrome (CIS) suggestive of MS. Although the most common manifestations of CIS are long tracts dysfunction and unilateral optic neuritis, it can also include isolated brainstem syndromes, cerebellar involvement, and polysymptomatic clinical image. Recently, the frequency of CIS diagnosis has decreased due to the more sensitive and less specific 2017 McDonald criteria compared with the revisions from 2010. Not all patients with CIS develop MS. The risk of conversion can be estimated based on many predictive factors including epidemiological, ethnical, clinical, biochemical, radiological, immunogenetic, and other markers. The management of CIS is nowadays widely discussed among clinicians and neuroscientists. To date, interferons, glatiramer acetate, teriflunomide, cladribine, and some other agents have been evaluated in randomized, placebo-controlled, double-blind studies relying on large groups of patients with the first demyelinating event. All of these drugs were shown to have beneficial effects in patients with CIS and might be used routinely in the future. The goal of this article is to explore the most relevant topics regarding CIS as well as to provide the most recent information in the field. The review presents CIS definition, classification, clinical image, predictive factors, and management. What is more, this is one of very few reviews summarizing the topic in the light of the 2017 McDonald criteria.
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Affiliation(s)
- Tomasz Grzegorski
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
| | - Jacek Losy
- Department of Clinical Neuroimmunology, Chair of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355Poznan, Poland
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27
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Abstract
PURPOSE OF REVIEW This review provides the reader with updated information needed to make an accurate diagnosis of radiologically isolated syndrome (RIS), discusses controversies and considerations related to therapeutic intervention in RIS, and summarizes ongoing clinical intervention trials. RECENT FINDINGS Individuals with RIS lack clinical neurological symptoms but are at risk for the subsequent development of a first clinical neurological event consistent with a diagnosis of multiple sclerosis. There are two ongoing clinical intervention trials to determine whether disease-modifying treatments for multiple sclerosis can delay or prevent a first clinical event in individuals with RIS. If clinical trials demonstrate a beneficial effect of disease-modifying therapy, such interventions should be considered in individuals with RIS.
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28
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Bisulca J, De Lury A, Coyle PK, Syritsyna O, Peyster R, Bangiyev L, Duong TQ. MRI features associated with high likelihood of conversion of radiologically isolated syndrome to multiple sclerosis. Mult Scler Relat Disord 2019; 36:101381. [PMID: 31518773 DOI: 10.1016/j.msard.2019.101381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Abstract
Radiologically isolated syndrome (RIS) is the asymptomatic precursor to clinically isolated syndrome, relapsing-remitting multiple sclerosis (MS) or primary progressive MS. RIS is frequently diagnosed when an individual gets an MRI for an unrelated medical issue, such as headache or trauma. Treating RIS patients is controversial, but physicians may be inclined to offer prophylactic treatment for high-risk RIS patients. Identifying imaging and clinical features associated with high likelihood of early clinical conversion may prove helpful to identify a high-risk subset for potential MS therapy. The goal of this paper is to review current literatures to identify imaging and clinical features that predict early (within 5 years) conversion from RIS to MS.
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Affiliation(s)
- Joseph Bisulca
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Amy De Lury
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Patricia K Coyle
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Olga Syritsyna
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Robert Peyster
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Lev Bangiyev
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Tim Q Duong
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA.
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29
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Stampanoni Bassi M, Iezzi E, Mori F, Simonelli I, Gilio L, Buttari F, Sica F, De Paolis N, Mandolesi G, Musella A, De Vito F, Dolcetti E, Bruno A, Furlan R, Finardi A, Marfia GA, Centonze D, Rizzo FR. Interleukin-6 Disrupts Synaptic Plasticity and Impairs Tissue Damage Compensation in Multiple Sclerosis. Neurorehabil Neural Repair 2019; 33:825-835. [DOI: 10.1177/1545968319868713] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Synaptic plasticity helps in reducing the clinical expression of brain damage and represents a useful mechanism to compensate the negative impact of new brain lesions in multiple sclerosis (MS). Inflammation, altering synaptic plasticity, could negatively influence the disease course in relapsing-remitting MS (RR-MS). Objective: In the present study, we explored whether interleukin (IL)-6, a major proinflammatory cytokine involved in MS pathogenesis, alters synaptic plasticity and affects the ability to compensate for ongoing brain damage. Methods: The effect of IL-6 incubation on long-term potentiation (LTP) induction was explored in vitro, in mice hippocampal slices. We also explored the correlation between the cerebrospinal fluid (CSF) levels of this cytokine and the LTP-like effect induced by the paired associative stimulation (PAS) in a group of RR-MS patients. Finally, we examined the correlation between the CSF levels of IL-6 at the time of diagnosis and the prospective disease activity in a cohort of 150 RR-MS patients. Results: In vitro LTP induction was abolished by IL-6. Consistently, in patients with MS, a negative correlation emerged between IL-6 CSF concentrations and the effect of PAS. In MS patients, longer disease duration before diagnosis was associated with higher IL-6 CSF concentrations. In addition, elevated CSF levels of IL-6 were associated with greater clinical expression of new inflammatory brain lesions, unlike in patients with low or absent IL-6 concentrations, who had a better disease course. Conclusions: IL-6 interfering with synaptic plasticity mechanisms may impair the ability to compensate the clinical manifestation of new brain lesions in RR-MS patients.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Francesco Mori
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | - Ilaria Simonelli
- Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy
| | - Luana Gilio
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Francesco Sica
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Nicla De Paolis
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Georgia Mandolesi
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, Rome, Italy
- San Raffaele University, Via di Val Cannuta 247, Rome, Italy
| | - Alessandra Musella
- Laboratory of Synaptic Immunopathology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, Rome, Italy
- San Raffaele University, Via di Val Cannuta 247, Rome, Italy
| | - Francesca De Vito
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Ettore Dolcetti
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | - Antonio Bruno
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | | | | | - Girolama A. Marfia
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Tor Vergata University, Department of Systems Medicine, Via Montpellier 1, Rome, Italy
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Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that leads to inflammation, demyelination and ultimately axonal degeneration. In most cases, it is preceded by its precursor, clinically isolated syndrome (CIS) with conversion rates to clinically definite MS (CDMS) of roughly 20-75%. Neurologists are therefore faced with the challenge of initiating a disease-modifying therapy (DMT) as early as possible to favorably influence the course of the disease. During the past 20 years, a multitude of drugs have been incorporated into our therapeutic armamentarium for MS and CIS. Choosing the right drug for an individual patient is complex and should be based not only on the drug's overall efficacy to prevent disease progression but also its specific adverse reaction profile, the severity of individual disease courses and, finally, patient compliance in order to adequately weigh associated risks and benefits. Here, we review the available data on the efficacy, safety and tolerability of DMTs tested for CIS and discuss their value regarding a delay of progression to CDMS.
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Affiliation(s)
- Moritz Förster
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Mares
- Department of Neurology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany
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31
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Wei Y, Chang H, Feng H, Li X, Zhang X, Yin L. Low Serum Interleukin-10 Is an Independent Predictive Factor for the Risk of Second Event in Clinically Isolated Syndromes. Front Neurol 2019; 10:604. [PMID: 31244763 PMCID: PMC6579832 DOI: 10.3389/fneur.2019.00604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To evaluated the prognostic ability of several serum cytokines in clinically isolated syndrome (CIS) patients regarding second events and conversion to multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). Methods: We enrolled 69 CIS patients whose serum samples were collected during the acute phase of the first onset before immunotherapy. Fifteen other non-inflammatory neurological disorder (OND) patients were also included. The serum levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-13, IL-17A, IL-21, IL-23, interferon-γ (IFN-γ), and transforming growth factor beta 1 (TGF-β1) were measured using the human cytokine multiplex assay or ELISA. Patients were seen every 3-6 months. Unscheduled visits occur in case of exacerbations. Clinical measures of disease progression were recorded. Results: Twenty CIS cases had second events during follow-up at a mean time of 15.3 ± 9.9 months. Serum IL-10 levels were significantly lower in CIS patients who relapsed compared to patients who did not. Low serum IL-10 levels were associated with higher risk and shorter times to second events. In clinical correlations, a significantly higher CSF white blood cells count, number of T2 lesions, and gadolinium-enhancing (Gd+) lesions in baseline MRI were found in the low serum IL-10 level group. Of the 20 relapsed cases, seven converted to MS, and eight converted to NMOSD. No significant differences were found in any cytokine levels between these patients at first onset. Conclusions: These findings support using serum IL-10 as a biomarker associated with the risk of relapse and the time to second events in patients with CIS. However, serum cytokine levels can not differentiate between the conversion from CIS to MS or NMOSD.
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Affiliation(s)
- Yuzhen Wei
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haoxiao Chang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xindi Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Linlin Yin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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32
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Hartung HP, Graf J, Aktas O, Mares J, Barnett MH. Diagnosis of multiple sclerosis: revisions of the McDonald criteria 2017 – continuity and change. Curr Opin Neurol 2019; 32:327-337. [DOI: 10.1097/wco.0000000000000699] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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33
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Stampanoni Bassi M, Iezzi E, Landi D, Monteleone F, Gilio L, Simonelli I, Musella A, Mandolesi G, De Vito F, Furlan R, Finardi A, Marfia GA, Centonze D, Buttari F. Delayed treatment of MS is associated with high CSF levels of IL-6 and IL-8 and worse future disease course. J Neurol 2018; 265:2540-2547. [PMID: 30167879 DOI: 10.1007/s00415-018-8994-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical deterioration of relapsing-remitting MS (RR-MS) patients reflects not only the number and severity of overt inflammatory and demyelinating episodes, but also subtle central damage caused by persistent exposure to inflammatory molecules. OBJECTIVE To explore the correlation between levels of CSF inflammatory molecules at the time of diagnosis and both demographic and clinical characteristics of a large sample of RR-MS patients, as well as the predictive value of cytokine levels on their prospective disease course. METHODS In 205 patients diagnosed with RR-MS, we measured at the time of diagnosis the CSF levels of inflammatory molecules. Clinical and MRI evaluation was collected at the time of CSF withdrawal and during a median follow-up of 3 years. RESULTS The time interval between the first anamnestic episode of focal neurological dysfunction and RR-MS diagnosis was the main factor associated with high CSF levels of IL-6 and IL-8. Furthermore, elevated CSF levels of these cytokines correlated with enhanced risk of clinical and radiological disease reactivation, switch to second-line treatments, and with disability progression in the follow-up. CONCLUSIONS Delayed diagnosis and treatment initiation are associated with higher CSF levels of IL-6 and IL-8 in RR-MS, leading to worsening disease course and poor response to treatments.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Doriana Landi
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Fabrizia Monteleone
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Luana Gilio
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Alessandra Musella
- Laboratory of Neuroimmunology and Synaptic Plasticity, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00163, Rome, Italy
| | - Georgia Mandolesi
- Laboratory of Neuroimmunology and Synaptic Plasticity, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00163, Rome, Italy
| | - Francesca De Vito
- Laboratory of Neuroimmunology and Synaptic Plasticity, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00163, Rome, Italy
| | - Roberto Furlan
- Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSpe), San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Neuroimmunology Unit, Division of Neuroscience, Institute of Experimental Neurology (INSpe), San Raffaele Scientific Institute, Milan, Italy
| | - Girolama A Marfia
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.
- Multiple Sclerosis Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy.
| | - Fabio Buttari
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
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Lebrun C, Kantarci OH, Siva A, Pelletier D, Okuda DT. Anomalies Characteristic of Central Nervous System Demyelination: Radiologically Isolated Syndrome. Neurol Clin 2018; 36:59-68. [PMID: 29157404 DOI: 10.1016/j.ncl.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiologically isolated syndrome (RIS) was defined in 2009 for asymptomatic patients who presented incidentally identified white matter anomalies within the central nervous system suggestive of multiple sclerosis (MS). Approximately one-third of RIS subjects will have a seminal clinical demyelinating event within 5 years of the identification of their abnormal MRI. Clinical evolution mirrors relapsing remitting or progressive forms of MS. Pejorative factors for clinical conversion are male gender, age younger than 35 years, and spinal cord lesions.
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Affiliation(s)
- Christine Lebrun
- Service de Neurologie, Centre de Ressources et de Compétences Sclérose en Plaques, Université Nice Sophia Antipolis, Hôpital Pasteur 2, 30 voie romaine, Nice Cedex 06002, France.
| | - Orhun H Kantarci
- Department of Neurology, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55902, USA
| | - Aksel Siva
- Department of Neurology, University of Istanbul, Cerrahpasa School of Medicine, Beyazıt, Fatih/Istanbul 34452, Turkey
| | - Daniel Pelletier
- Department of Neuroradiology, University Southern California, 1520 San Pablo Street, Los Angeles, CA 90032, USA
| | - Darin T Okuda
- Department of Neurology, University of Texas Southwestern Medical Center, 5959 Harry Hines Boulevard, Dallas, TX 75390, USA
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35
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Kitzler HH, Wahl H, Eisele JC, Kuhn M, Schmitz-Peiffer H, Kern S, Rutt BK, Deoni SCL, Ziemssen T, Linn J. Multi-component relaxation in clinically isolated syndrome: Lesion myelination may predict multiple sclerosis conversion. NEUROIMAGE-CLINICAL 2018; 20:61-70. [PMID: 30094157 PMCID: PMC6070690 DOI: 10.1016/j.nicl.2018.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/01/2018] [Accepted: 05/27/2018] [Indexed: 12/12/2022]
Abstract
We performed a longitudinal case-control study on patients with clinically isolated syndrome (CIS) with the aid of quantitative whole-brain myelin imaging. The aim was (1) to parse early myelin decay and to break down its distribution pattern, and (2) to identify an imaging biomarker of the conversion into clinically definite Multiple Sclerosis (MS) based on in vivo measurable changes of myelination. Imaging and clinical data were collected immediately after the onset of first neurological symptoms and follow-up explorations were performed after 3, 6, and, 12 months. The multi-component Driven Equilibrium Single Pulse Observation of T1/T2 (mcDESPOT) was applied to obtain the volume fraction of myelin water (MWF) in different white matter (WM) regions at every time-point. This measure was subjected to further voxel-based analysis with the aid of a comparison of the normal distribution of myelination measures with an age and sex matched healthy control group. Both global and focal relative myelination content measures were retrieved. We found that (1) CIS patients at the first clinical episode suggestive of MS can be discriminated from healthy control WM conditions (p < 0.001) and therewith reproduced our earlier findings in late CIS, (2) that deficient myelination in the CIS group increased in T2 lesion depending on the presence of gadolinium enhancement (p < 0.05), and (3) that independently the CIS T2 lesion relative myelin content provided a risk estimate of the conversion to clinically definite MS (Odds Ratio 2.52). We initially hypothesized that normal appearing WM myelin loss may determine the severity of early disease and the subsequent risk of clinically definite MS development. However, in contrast we found that WM lesion myelin loss was pivotal for MS conversion. Regional myelination measures may thus play an important role in future clinical risk stratification. The multicomponent relaxation method mcDESPOT allowed 3D resolved data acquisition appropriate for group comparison and voxel-wise analysis. Myelin imaging in early clinically isolated syndrome revealed initial imaging widespread myelin loss even in normal appearing brain tissue. In clinically isolated syndrome the myelin measures varied depending on the presence of Gadolinium enhancement. Short-term risk of clinically isolated syndrome to convert to multiple sclerosis was determined by myelin measures within white matter lesions.
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Key Words
- Clinically isolated syndrome
- DAWM, diffusely abnormal white matter
- DVF, deficient volume fraction of myelin water
- EDSS, extended disability status scale
- FLASH, fast low-angle shot
- MCRI, multicomponent relaxation imaging
- MRI
- MSFC, multiple sclerosis functional composite
- MWF, myelin water fraction
- Multicomponent relaxation
- Multiple sclerosis
- Myelin imaging
- NAWM, normal appearing white matter
- mcDESPOT
- mcDESPOT, multi-component Driven Equilibrium Single Pulse Observation of T1/T2
- trueFISP, true fast imaging with steady state precession
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Affiliation(s)
- Hagen H Kitzler
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany.
| | - Hannes Wahl
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany
| | - Judith C Eisele
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Matthias Kuhn
- Institute of Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | | | - Simone Kern
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Brian K Rutt
- Richard M. Lucas Center for Imaging, School of Medicine, Department of Radiology, Stanford University, Stanford, CA, USA
| | - Sean C L Deoni
- Memorial Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Tjalf Ziemssen
- Dept. of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Jennifer Linn
- Dept. of Neuroradiology, Technische Universität Dresden, Dresden, Germany
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36
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Thouvenot E. Multiple sclerosis biomarkers: Helping the diagnosis? Rev Neurol (Paris) 2018; 174:364-371. [PMID: 29784249 DOI: 10.1016/j.neurol.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/04/2018] [Indexed: 11/29/2022]
Abstract
Multiple sclerosis (MS) is a complex heterogeneous disease. Diagnostic criteria are based on symptoms, biomarkers, MRI data and exclusion of differential diagnoses. Over the past few years, the usefulness of biomarkers has progressively decreased with the development of new MRI criteria, yet dozens of new biomarkers, especially in cerebrospinal fluid, for MS diagnosis and prognosis have been described. Large-scale studies validating some of these new biomarkers have also provided confirmation of a restricted set of biomarkers (presented here in this review) as having potential value for different stages of the disease, including as early as clinically isolated syndrome and radiologically isolated syndrome. However, differentiating progressive forms of MS from relapsing-remitting MS remains a genuine challenge, and could help to predict future conversion to secondary-progressive MS. In addition, new approaches combining multiple biomarkers might allow us to unravel the complexity of the disease and determine disease stages more precisely. Moreover, recent technological developments allowing analysis of biomarkers in plasma have also provided less invasive analysis of MS, and should serve to predict MS evolution and therapeutic responses during follow-up.
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Affiliation(s)
- E Thouvenot
- Department of neurology, centre hospitalier universitaire Carémeau, 9, place du Pr. Robert Debré, 30029 Nîmes cedex 9, France; Équipe neuroprotéomique et signalisation des maladies neurologiques et psychiatriques, UMR5203, institut de génomique fonctionnelle, université de Montpellier, 141, rue de la Cardonille, 34094 Montpellier c edex 5, France.
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37
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Pranzatelli MR. Advances in Biomarker-Guided Therapy for Pediatric- and Adult-Onset Neuroinflammatory Disorders: Targeting Chemokines/Cytokines. Front Immunol 2018; 9:557. [PMID: 29670611 PMCID: PMC5893838 DOI: 10.3389/fimmu.2018.00557] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/05/2018] [Indexed: 12/26/2022] Open
Abstract
The concept and recognized components of “neuroinflammation” are expanding at the intersection of neurobiology and immunobiology. Chemokines (CKs), no longer merely necessary for immune cell trafficking and positioning, have multiple physiologic, developmental, and modulatory functionalities in the central nervous system (CNS) through neuron–glia interactions and other mechanisms affecting neurotransmission. They issue the “help me” cry of neurons and astrocytes in response to CNS injury, engaging invading lymphoid cells (T cells and B cells) and myeloid cells (dendritic cells, monocytes, and neutrophils) (adaptive immunity), as well as microglia and macrophages (innate immunity), in a cascade of events, some beneficial (reparative), others destructive (excitotoxic). Human cerebrospinal fluid (CSF) studies have been instrumental in revealing soluble immunobiomarkers involved in immune dysregulation, their dichotomous effects, and the cells—often subtype specific—that produce them. CKs/cytokines continue to be attractive targets for the pharmaceutical industry with varying therapeutic success. This review summarizes the developing armamentarium, complexities of not compromising surveillance/physiologic functions, and insights on applicable strategies for neuroinflammatory disorders. The main approach has been using a designer monoclonal antibody to bind directly to the chemo/cytokine. Another approach is soluble receptors to bind the chemo/cytokine molecule (receptor ligand). Recombinant fusion proteins combine a key component of the receptor with IgG1. An additional approach is small molecule antagonists (protein therapeutics, binding proteins, and protein antagonists). CK neutralizing molecules (“neutraligands”) that are not receptor antagonists, high-affinity neuroligands (“decoy molecules”), as well as neutralizing “nanobodies” (single-domain camelid antibody fragment) are being developed. Simultaneous, more precise targeting of more than one cytokine is possible using bispecific agents (fusion antibodies). It is also possible to inhibit part of a signaling cascade to spare protective cytokine effects. “Fusokines” (fusion of two cytokines or a cytokine and CK) allow greater synergistic bioactivity than individual cytokines. Another promising approach is experimental targeting of the NLRP3 inflammasome, amply expressed in the CNS and a key contributor to neuroinflammation. Serendipitous discovery is not to be discounted. Filling in knowledge gaps between pediatric- and adult-onset neuroinflammation by systematic collection of CSF data on CKs/cytokines in temporal and clinical contexts and incorporating immunobiomarkers in clinical trials is a challenge hereby set forth for clinicians and researchers.
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Affiliation(s)
- Michael R Pranzatelli
- National Pediatric Neuroinflammation Organization, Inc., Orlando, FL, United States.,College of Medicine, University of Central Florida, Orlando, FL, United States
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38
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Thouvenot E, Hinsinger G, Demattei C, Uygunoglu U, Castelnovo G, Pittion-Vouyovitch S, Okuda D, Kantarci O, Pelletier D, Lehmann S, Marin P, Siva A, Lebrun C. Cerebrospinal fluid chitinase-3-like protein 1 level is not an independent predictive factor for the risk of clinical conversion in radiologically isolated syndrome. Mult Scler 2018; 25:669-677. [DOI: 10.1177/1352458518767043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Younger age, male sex and presence of spinal cord lesion(s) increase the risk of conversion from radiologically isolated syndrome (RIS) to relapsing-remitting multiple sclerosis (RRMS). Elevated cerebrospinal fluid (CSF) chitinase-3-like protein 1 (CHI3L1) levels predict conversion from clinically isolated syndrome (CIS) to RRMS. Objective: To evaluate the prognostic value of CSF CHI3L1 in RIS patients for conversion to RRMS. Methods: We compared CSF CHI3L1 concentrations in RIS, CIS, RRMS and symptomatic controls (SCs). We analysed the influence of epidemiological, radiological and CSF parameters on the risk of clinical event. Results: A total of 211 patients (71 RIS, 48 CIS, 50 RRMS and 42 SC) were included. CSF CHI3L1 levels were lower in RIS than in RRMS and higher in RIS with positive CSF versus negative CSF and SC. The presence of at least one spinal cord lesion was the only independent predictor of faster conversion to RRMS. Association of high CSF CHI3L1 levels, positive CSF (presence of oligoclonal bands and/or an elevated IgG index) or four Barkhof criteria with any spinal cord lesion showed a tendency for reduced mean conversion time. Conclusion: CSF CHI3L1 correlates with positive CSF but is not an independent predictor of the risk of conversion from RIS to RRMS.
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Affiliation(s)
- Eric Thouvenot
- Service de Neurologie, Hôpital Caremeau, CHU de Nîmes, Nîmes, France/ Institut de Génomique Fonctionnelle, UMR 5203, 1191 INSERM, Université de Montpellier, Montpellier, France
| | - Geoffrey Hinsinger
- Institut de Génomique Fonctionnelle, UMR 5203, 1191 INSERM, Université de Montpellier, Montpellier, France
| | | | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa School of Medicine, University of Istanbul, Istanbul, Turkey
| | | | | | - Darin Okuda
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Sylvain Lehmann
- RMB, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France
| | - Philippe Marin
- Institut de Génomique Fonctionnelle, UMR 5203, 1191 INSERM, Université de Montpellier, Montpellier, France
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, University of Istanbul, Istanbul, Turkey
| | - Christine Lebrun
- Service de Neurologie, Hôpital Pasteur 2, CHU de Nice, Nice, France
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39
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Brenner P, Granqvist M, Königsson J, Al Nimer F, Piehl F, Jokinen J. Depression and fatigue in multiple sclerosis: Relation to exposure to violence and cerebrospinal fluid immunomarkers. Psychoneuroendocrinology 2018; 89:53-58. [PMID: 29324301 DOI: 10.1016/j.psyneuen.2018.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory condition characterized by chronic dysregulation of immune responses leading to repeated episodes of inflammation in the central nervous system. Depression and fatigue are common among MS patients, even in early disease phases, and the disease course can be negatively affected by stressful events. IL-6 and IL-8 have been associated with depression and stressful life events in non-MS patients. The aim of this study was to examine the relationships between depression, fatigue, and exposure to violence, with IL-6 and IL-8 levels in the cerebrospinal fluid (CSF) of MS patients. Levels of IL-6 and -8 were analyzed in the CSF of 47 patients with relapsing-remitting MS. Correlations between IL-6 and IL-8 levels and self-rated depression and fatigue symptoms, as well as clinician-rated history of being exposed to interpersonal violence, were analyzed with correction for age, sex and MS disability status. IL-6 correlated significantly (p < 0.05) with depressive symptoms (adjusted Spearman's ρ = 0.39), fatigue (ρ = 0.39), and exposure to violence in adult life (ρ = 0.35). Depression correlated with both fatigue and being exposed to violence. Associations were not present among patients exposed to disease modifying drugs. In exploratory analyses, the relationship between exposure to violence and IL-6 was non-significant when controlled for depression. Further research should focus on replication of these results, as well as exploring the impact of stressful life events on immune regulation and the clinical characteristics and prognosis of MS patients.
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Affiliation(s)
- Philip Brenner
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Mathias Granqvist
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Johan Königsson
- Department of Clinical Sciences, Umeå University, SE-901 87, Umeå, Sweden
| | - Faiez Al Nimer
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Fredrik Piehl
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jussi Jokinen
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Sciences, Umeå University, SE-901 87, Umeå, Sweden
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40
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Stampanoni Bassi M, Garofalo S, Marfia GA, Gilio L, Simonelli I, Finardi A, Furlan R, Sancesario GM, Di Giandomenico J, Storto M, Mori F, Centonze D, Iezzi E. Amyloid-β Homeostasis Bridges Inflammation, Synaptic Plasticity Deficits and Cognitive Dysfunction in Multiple Sclerosis. Front Mol Neurosci 2017; 10:390. [PMID: 29209169 PMCID: PMC5702294 DOI: 10.3389/fnmol.2017.00390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022] Open
Abstract
Cognitive deficits are frequently observed in multiple sclerosis (MS), mainly involving processing speed and episodic memory. Both demyelination and gray matter atrophy can contribute to cognitive deficits in MS. In recent years, neuroinflammation is emerging as a new factor influencing clinical course in MS. Inflammatory cytokines induce synaptic dysfunction in MS. Synaptic plasticity occurring within hippocampal structures is considered as one of the basic physiological mechanisms of learning and memory. In experimental models of MS, hippocampal plasticity is profoundly altered by proinflammatory cytokines. Although mechanisms of inflammation-induced hippocampal pathology in MS are not completely understood, alteration of Amyloid-β (Aβ) metabolism is emerging as a key factor linking together inflammation, synaptic plasticity and neurodegeneration in different neurological diseases. We explored the correlation between concentrations of Aβ1–42 and the levels of some proinflammatory and anti-inflammatory cytokines (interleukin-1β (IL-1β), IL1-ra, IL-8, IL-10, IL-12, tumor necrosis factor α (TNFα), interferon γ (IFNγ)) in the cerebrospinal fluid (CSF) of 103 remitting MS patients. CSF levels of Aβ1–42 were negatively correlated with the proinflammatory cytokine IL-8 and positively correlated with the anti-inflammatory molecules IL-10 and interleukin-1 receptor antagonist (IL-1ra). Other correlations, although noticeable, were either borderline or not significant. Our data show that an imbalance between proinflammatory and anti-inflammatory cytokines may lead to altered Aβ homeostasis, representing a key factor linking together inflammation, synaptic plasticity and cognitive dysfunction in MS. This could be relevant to identify novel therapeutic approaches to hinder the progression of cognitive dysfunction in MS.
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Affiliation(s)
- Mario Stampanoni Bassi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sara Garofalo
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Girolama A Marfia
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luana Gilio
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Simonelli
- Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Service of Medical Statistics & Information Technology, Fondazione Fatebenefratelli per la Ricerca e la Formazione Sanitaria e Sociale, Rome, Italy
| | - Annamaria Finardi
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Furlan
- Neuroimmunology Unit, Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Giulia M Sancesario
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Jonny Di Giandomenico
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Marianna Storto
- Clinical Pathology Unit, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Francesco Mori
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diego Centonze
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.,Multiple Sclerosis Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ennio Iezzi
- Unit of Neurology & Unit of Neurorehabilitation, IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
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41
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Yamout B, Al Khawajah M. Radiologically isolated syndrome and multiple sclerosis. Mult Scler Relat Disord 2017; 17:234-237. [PMID: 29055465 DOI: 10.1016/j.msard.2017.08.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Incidental white matter lesions (WML) are increasingly seen on brain magnetic resonance imaging (MRI) in clinical practice. Demyelination consistent with MS is seen in 0.1-0.7% of the population as evident by autopsy and MRI studies. The term radiologically isolated syndrome (RIS) was coined to define a subgroup of patients with demyelinating lesions highly suggestive of multiple sclerosis (MS). The Okuda criteria for diagnosing RIS help in stratifying the risk of conversion to MS but RIS is still not considered a distinct MS phenotype. METHODS The authors reviewed the current literature on diagnostic criteria, natural history and treatment indications in RIS, to assess the challenges faced in diagnosing and treating such patients in clinical practice. RESULTS Typically, one-third of patients convert to clinically definite MS within 5 years, with some progressing directly into primary progressive MS (PPMS). The main risk factors for conversion are: age < 37 years, male gender and presence of spinal cord lesions. Patients with RIS have evidence of early axonal loss, brain atrophy, cognitive deficits, increased anxiety and depression, and subclinical inflammatory disease. CONCLUSION Patients with RIS at high risk of clinical conversion might be considered for treatment, although this is still a controversial issue. Prospective follow-up of RIS patients by an MS specialist is recommended.
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Affiliation(s)
- B Yamout
- Nehme & Therese Tohme MS Center at the American University of Beirut Medical Center, Lebanon.
| | - M Al Khawajah
- Neurosciences Department of King Faisal Specialist Hospital and Research Center (KFSHRC-R), Al Faisal University, Riyadh, Saudi Arabia.
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42
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Rossi S, Studer V, Motta C, Polidoro S, Perugini J, Macchiarulo G, Giovannetti AM, Pareja-Gutierrez L, Calò A, Colonna I, Furlan R, Martino G, Centonze D. Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis. Neurology 2017; 89:1338-1347. [DOI: 10.1212/wnl.0000000000004411] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/13/2017] [Indexed: 11/15/2022] Open
Abstract
Objective:To explore the inflammatory processes in the pathogenesis of psychiatric symptoms and the prognostic value of psychiatric comorbidities in multiple sclerosis (MS).Methods:Four hundred five patients with relapsing-remitting (RR) MS underwent psychiatric evaluation by means of Beck Depression Inventory II (BDI-II) and State/Trait Anxiety Inventory (STAI-Y). The inflammatory activity level was assessed by MRI. In a subset of 111 treatment-naive patients, CSF levels of proinflammatory cytokines were determined. Correlation and regression analyses were performed to determine associations between variables.Results:Relapsing patients demonstrated greater values of STAI-state and BDI-II compared with remitting patients but comparable trait-anxiety scores. There were no significant differences in psychometric parameters between relapsing and asymptomatic MRI-active patients, highlighting the effect of subclinical inflammation on mood disturbances. A significant reduction of STAI-state and BDI-II scores was recorded, along with the subsiding of neuroinflammation. Interleukin-2 CSF levels were found to correlate with STAI-state, while tumor necrosis factor-α and interleukin-1β correlated with BDI-II. Because emotional disorders were associated with subclinical inflammation, variations of the psychometric profile were able to detect subclinical reactivation earlier. In line with this, high STAI-state values considerably predicted the possibility of disease reactivation.Conclusions:Mood alterations are induced by intrathecal inflammation, even though not clinically apparent, and are able to predict inflammatory reactivations in RRMS. Inflammation is therefore a biological event, not less important than the traditional psychosocial factors, involved in mood disorders.
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Cerebrospinal fluid and serum levels of interleukin-8 in patients with multiple sclerosis and its correlation with Q-albumin. Mult Scler Relat Disord 2017; 14:12-15. [DOI: 10.1016/j.msard.2017.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/12/2022]
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44
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Fereidan-Esfahani M, Mahmudi F, Jahansouz M, Weber MS, Rodriguez M. Biomarkers in radiologically isolated syndrome: The missing piece in the puzzle of treatment indication? J Neurol Sci 2017; 375:129. [PMID: 28320114 DOI: 10.1016/j.jns.2017.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Mahboobeh Fereidan-Esfahani
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Mahmudi
- Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Martin S Weber
- Institute of Neuropathology, University Medical Center, Göttingen, Germany; Department of Neurology, University Medical Center, Göttingen, Germany.
| | - Moses Rodriguez
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Sisay S, Lopez-Lozano L, Mickunas M, Quiroga-Fernández A, Palace J, Warnes G, Alvarez-Lafuente R, Dua P, Meier UC. Untreated relapsing remitting multiple sclerosis patients show antibody production against latent Epstein Barr Virus (EBV) antigens mainly in the periphery and innate immune IL-8 responses preferentially in the CNS. J Neuroimmunol 2017; 306:40-45. [PMID: 28385186 DOI: 10.1016/j.jneuroim.2017.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/17/2017] [Accepted: 02/27/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory and neurodegenerative disorder of the central nervous system (CNS). Reliable biomarkers are urgently needed for its diagnosis and management, and as clues to its pathogenesis, in which EBV is implicated. OBJECTIVE To measure IgG antibodies against EBV nuclear antigen-1 (EBNA-1) and innate inflammation status in paired serum and cerebrospinal fluid (CSF) samples from untreated relapsing-remitting MS (RRMS) patients. MATERIALS AND METHODS Anti-EBNA-1 IgG titers and IL-8, IL-1β, IL-6, IL-10, TNF-α and IL-12p70 cytokine levels were measured in 20 untreated RRMS-patients and 17 healthy controls. RESULTS We found higher serum anti-EBNA-1 IgG and IL-8 levels in RRMS-patients than in healthy controls. Interestingly, levels of IL-8 - relative to total protein - were much higher in the CSF, whereas the anti-EBNA-1 antibodies were significantly higher in the sera. More detailed analysis showed that anti-EBNA-1 antibodies relative to total IgG were also higher in the serum in the majority of RRMS patients compared to CSF. Levels of anti-EBNA-1 IgG and IL-8 showed a strong correlation between serum and CSF. CONCLUSION These findings in newly diagnosed RRMS-patients imply anti-EBNA-1 antibody production mainly in the periphery and innate immune responses preferentially in the CNS. Both their potential as disease biomarkers and their implications for the pathogenesis of MS warrant further investigation.
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Affiliation(s)
- Sofia Sisay
- Department of Neuroscience and Trauma, Neuroinflammation and Psychoneuroimmunology Group, Blizard Institute, Queen Mary University London, UK.
| | - Lorena Lopez-Lozano
- Department of Neuroscience and Trauma, Neuroinflammation and Psychoneuroimmunology Group, Blizard Institute, Queen Mary University London, UK; MS Unit, Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Marius Mickunas
- Department of Neuroscience and Trauma, Neuroinflammation and Psychoneuroimmunology Group, Blizard Institute, Queen Mary University London, UK
| | | | | | - Gary Warnes
- Flow cytometry facility, Blizard Institute, Queen Mary University London, UK.
| | | | - Priyamvada Dua
- Department of Neuroscience and Trauma, Neuroinflammation and Psychoneuroimmunology Group, Blizard Institute, Queen Mary University London, UK.
| | - Ute-Christiane Meier
- Department of Neuroscience and Trauma, Neuroinflammation and Psychoneuroimmunology Group, Blizard Institute, Queen Mary University London, UK.
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46
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Niino M, Miyazaki Y. Radiologically isolated syndrome and clinically isolated syndrome. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Masaaki Niino
- Department of Clinical Research; Hokkaido Medical Center; Sapporo Japan
| | - Yusei Miyazaki
- Department of Clinical Research; Hokkaido Medical Center; Sapporo Japan
- Department of Neurology; Hokkaido Medical Center; Sapporo Japan
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Abstract
Optic neuritis, myelitis and brainstem syndrome accompanied by a symptomatic MRI T2 or FLAIR hyperintensity and T1 hypointensity are highly suggestive of multiple sclerosis (MS) in young adults. They are called "clinically isolated syndrome" (CIS) and correspond to the typical first multiple sclerosis (MS) episode, especially when associated with other asymptomatic demyelinating lesions, without clinical, radiological and immunological sign of differential diagnosis. After a CIS, the delay of apparition of a relapse, which corresponds to the conversion to clinically definite MS (CDMS), varies from several months to more than 10 years (10-15% of cases, generally called benign RRMS). This delay is generally associated with the number and location of demyelinating lesions of the brain and spinal cord and the results of CSF analysis. Several studies comparing different MRI criteria for dissemination in space and dissemination in time of demyelinating lesions, two hallmarks of MS, provided enough substantial data to update diagnostic criteria for MS after a CIS. In the last revision of the McDonald's criteria in 2010, diagnostic criteria were simplified and now the diagnosis can be made by a single initial scan that proves the presence of active asymptomatic lesions (with gadolinium enhancement) and of unenhanced lesions. However, time to conversion remains highly unpredictable for a given patient and CIS can remain isolated, especially for idiopathic unilateral optic neuritis or myelitis. Univariate analyses of clinical, radiological, biological or electrophysiological characteristics of CIS patients in small series identified numerous risk factors of rapid conversion to MS. However, large series of CIS patients analyzing several characteristics of CIS patients and the influence of disease modifying therapies brought important information about the risk of CDMS or RRMS over up to 20 years of follow-up. They confirmed the importance of the initial MRI pattern of demyelinating lesions and of CSF oligoclonal bands. Available treatments of MS (immunomodulators or immunosuppressants) have also shown unequivocal efficacy to slow the conversion to RRMS after a CIS, but they could be unnecessary for patients with benign RRMS. Beyond diagnostic criteria, knowledge of established and potential risk factors of conversion to MS and of disability progression is essential for CIS patients' follow-up and initiation of disease modifying therapies.
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Affiliation(s)
- Éric Thouvenot
- Hôpital Carémeau, service de neurologie, 30029 Nîmes cedex 9, France; Université de Montpellier, institut de génomique fonctionnelle, équipe « neuroprotéomique et signalisation des maladies neurologiques et psychiatriques », UMR 5203, 34094 Montpellier cedex, France.
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