1
|
MacKenzie EG, Snow NJ, Chaves AR, Reza SZ, Ploughman M. Weak grip strength among persons with multiple sclerosis having minimal disability is not related to agility or integrity of the corticospinal tract. Mult Scler Relat Disord 2024; 88:105741. [PMID: 38936325 DOI: 10.1016/j.msard.2024.105741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Mobility impairment is common in multiple sclerosis (MS); however, agility has received less attention. Agility requires strength and neuromuscular coordination to elicit controlled propulsive rapid whole-body movement. Grip strength is a common method to assess whole body force production, but also reflects neuromuscular integrity and global brain health. Impaired agility may be linked to loss of neuromuscular integrity (reflected by grip strength or corticospinal excitability). OBJECTIVES We aimed to determine whether grip strength would be associated with agility and transcranial magnetic stimulation (TMS)-based indices of corticospinal excitability and inhibition in persons with MS having low disability. We hypothesized that low grip strength would predict impaired agility and reflect low corticospinal excitability. METHODS We recruited 34 persons with relapsing MS (27 females; median [range] age 45.5 [21.0-65.0] years) and mild disability (median [range] Expanded Disability Status Scale 2.0 [0-3.0]), as well as a convenience sample of age- and sex-matched apparently healthy controls. Agility was tested by measuring hop length during bipedal hopping on an instrumented walkway. Grip strength was measured using a calibrated dynamometer. Corticospinal excitability and inhibition were examined using TMS-based motor evoked potential (MEP) and corticospinal silent period (CSP) recruitment curves, respectively. RESULTS MS participants had significantly lower grip strength than controls independent of sex. Females with and without MS had weaker grip strength than males. There were no statistically significant sex or group differences in agility. After controlling for sex, weaker grip strength was associated with shorter hop length in controls only (r = 0.645, p < .05). Grip strength did not significantly predict agility in persons with MS, nor was grip strength predicted by corticospinal excitability or inhibition. CONCLUSIONS In persons with MS having low disability, grip strength (normalized to body mass) was reduced despite having intact agility and walking performance. Grip strength was not associated with corticospinal excitability or inhibition, suggesting peripheral neuromuscular function, low physical activity or fitness, or other psychosocial factors may be related to weakness. Low grip strength is a putative indicator of early neuromuscular aging in persons with MS having mild disability and normal mobility.
Collapse
Affiliation(s)
- Evan G MacKenzie
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Nicholas J Snow
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Arthur R Chaves
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, ON, Canada; Neuromodulation Research Clinic, The Royal's Institute of Mental Health Research, ON, Canada; Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, QC, Canada
| | - Syed Z Reza
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada
| | - Michelle Ploughman
- Faculty of Medicine, Recovery & Performance Laboratory, Memorial University of Newfoundland and Labrador, Room 400, L.A. Miller Center, 100 Forest Road, St. John's, St. John's, NL A1A 1E5, Canada.
| |
Collapse
|
2
|
Zertal A, Alami Marrouni K, Arbour N, Jutras-Aswad D, Pomey MP, Rouleau I, Prat A, Larochelle C, Beaulieu P, Chamelian L, Sylvestre MP, Morin D, Ouellette JS, Fréjeau N, Duquette P. Efficacy of cannabinoids compared to the current standard treatments on symptom relief in persons with multiple sclerosis (CANSEP trial): study protocol for a randomized clinical trial. Front Neurol 2024; 15:1440678. [PMID: 39114536 PMCID: PMC11303178 DOI: 10.3389/fneur.2024.1440678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system. More than 90,000 Canadians are affected; a cure is yet to be found. Available treatments to manage the disease course are only partially effective. For many years, persons with MS (PwMS) have used cannabis to relax, to reduce pain and spasticity, or to improve sleep and daily functioning, despite the lack of scientific evidence on the efficacy of specific cannabinoids [i.e., tetrahydrocannabinol (THC) and cannabidiol (CBD)] on these MS symptoms. The purpose of this clinical trial is to assess the effectiveness of different doses of these cannabinoids, alone or combined, on spasticity relief, compared to placebo. Moreover, we aim to determine which treatment is best effective to address other key MS conditions. Methods A double-blinded, randomized, factorial, placebo-controlled trial will be performed. We intend to include up to 250 PwMS aged over 21 recruited from the Centre hospitalier de l'Université de Montréal MS Clinic. PwMS will be randomly assigned on a 1:1:1:1 ratio to one of the trial arms: THC alone, CBD alone, THC/CBD combination, or placebo, using stratified blocked randomization, with random blocks within each stratum. The primary outcome is a self-assessment of spasticity using the mean Numeric Rating Scale score over 7 days. The main outcome will be the difference in this score at 4 weeks compared to baseline. Secondary outcomes include assessments of spasticity as measured by a clinician, pain, fatigue, sleep, bowel, bladder, and sexual dysfunction, restless legs syndrome, mental health, quality of life, mobility, cognitive functioning, and adverse events. Treatment responders are eligible for a 12-week extension phase, using the same treatment allocation and assessments. Discussion Previous clinical studies examined the efficacy of cannabis-based medicines in PwMS, mostly using products with 1:1 THC/CBD ratio. The major barrier to effectively use cannabis in real-world clinical settings is the lack of evidence on benefits of specific cannabinoids and information on possible related risks. The CANSEP study will contribute to overcome these limitations and identify the risks and benefits of cannabis-based treatments in PwMS. Clinical trial registration ClinicalTrials.Gov, NCT05092191.
Collapse
Affiliation(s)
- Amel Zertal
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Kanza Alami Marrouni
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Nathalie Arbour
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychiatrie et d’addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Gestion, d’évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
- Centre d’Excellence sur le Partenariat avec les Patients et le Public, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Rouleau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Psychologie, Faculté des Sciences Humaines, Université du Québec à Montréal, Montreal, QC, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Catherine Larochelle
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre Beaulieu
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
- Département d'anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Laury Chamelian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montreal, QC, Canada
| | - Danielle Morin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Jean-Sylvain Ouellette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- MS Canada, Toronto, ON, Canada
| | - Nathalie Fréjeau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| |
Collapse
|
3
|
Altieri M, Roldán-Tapia MD, Santangelo G. Editorial: Sex differences in cognition and psychological outcomes in chronic diseases. Front Psychiatry 2024; 15:1414613. [PMID: 39077627 PMCID: PMC11284100 DOI: 10.3389/fpsyt.2024.1414613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/02/2024] [Indexed: 07/31/2024] Open
Affiliation(s)
- Manuela Altieri
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| |
Collapse
|
4
|
van den Berg R, Blok K, Tebayna N, van Dijk M, van Rosmalen J, de Beukelaar J. Reasons Patients With Primary Progressive Multiple Sclerosis Contact Their Specialist Nurses. Int J MS Care 2024; 26:30-35. [PMID: 38213677 PMCID: PMC10779713 DOI: 10.7224/1537-2073.2022-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Questions asked by patients with primary progressive multiple sclerosis (PPMS) during patient-initiated MS nurse consultations may contain salient information that can help health care providers understand their needs, which, in turn, can help tailor counseling and treatment. METHODS Records of all patients with PPMS visiting the MS center of a large teaching hospital in the Netherlands between January 2007 and January 2021 were studied retrospectively. Number and type (scheduled or patient initiated) of MS nurse consultations, reasons for consultations (in prespecified categories), and frequency of subsequent referrals were registered. Association between factors (living with partner, Expanded Disability Status Scale score, comorbidities, age, sex) and number of patient-initiated consultations was studied using negative binomial regression analysis. RESULTS In total, 98 patients with PPMS were included, with 720 MS nurse consultations during follow-up (median duration, 8.1 years), of which 274 (38%) were patient initiated. Patients had a broad spectrum of reasons to contact MS nurses. The most common categories were treatment (36%) and micturition and defecation (31%). Patients living without a partner (incidence rate ratio, 2.340; 95% CI, 1.057-5.178) and male patients (incidence rate ratio, 1.890; 95% CI, 0.925-3.861) consulted MS nurses more frequently. The MS nurses made 146 referrals (20% of all contacts); 59 were after patient-initiated consultation (22%). The most frequent referrals were to neurologists, urologists, and rehabilitation specialists. CONCLUSIONS Multiple sclerosis nurses have a pivotal role in PPMS care, especially for patients living without a partner and male patients. Recurring questions about (new) treatment options illustrate the pressing need for highly effective treatment. Micturition and defecation problems are also a considerable concern and warrant close monitoring.
Collapse
Affiliation(s)
- Rosaline van den Berg
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Katelijn Blok
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
- Multiple Sclerosis Center ErasMS of the Department of Neurology (KB)
| | - Nura Tebayna
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Monique van Dijk
- Nursing Science Section of the Department of Internal Medicine (MvD)
| | | | | |
Collapse
|
5
|
Skarlis C, Papadopoulos V, Raftopoulou S, Mavragani CP, Evangelopoulos ME. B-cell activating factor gene variants in multiple sclerosis: Possible associations with disease susceptibility among females. Clin Immunol 2023; 257:109847. [PMID: 37995946 DOI: 10.1016/j.clim.2023.109847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Although B cells and B cell activating factor (BAFF) have been previously implicated in MS pathogenesis, data regarding the genetic influence of BAFF polymorphisms on MS susceptibility are limited. Here we aim to explore whether BAFF polymorphisms could contribute to MS susceptibility. 156 RRMS patients fulfilling the revised McDonald criteria for MS diagnosis and 220 HCs were enrolled. Clinical, laboratory, and imaging characteristics were recorded. BAFF rs9514827, rs1041569, and rs9514828 polymorphisms were assessed by RFLP-PCR in DNA samples extracted from whole peripheral blood. The BAFF rs1041569 TT genotype along with the CTT and TTC haplotypes were associated with significantly increased risk for MS development in female MS patients compared to healthy female counterparts. These findings were not confirmed in males. The rs1041569 BAFF variant together with the CTT and TTC BAFF haplotypes derived from the BAFF rs9514827, rs1041569, and rs9514828 polymorphisms may represent novel genetic contributors to the development of MS in females.
Collapse
Affiliation(s)
- Charalampos Skarlis
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece
| | - Vassilis Papadopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sylvia Raftopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens (NKUA), M. Asias 75, 11527, Athens, Greece; Joint Academic Rheumatology Program, NKUA, Greece.
| | - Maria-Eleftheria Evangelopoulos
- First Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Kheirdeh M, Koushkie Jahromi M, Hemmatinafar M, Nemati J. Additive beneficial effects of aerobic training and royal jelly on hippocampal inflammation and function in experimental autoimmune encephalomyelitis rats. Mult Scler Relat Disord 2023; 70:104527. [PMID: 36696832 DOI: 10.1016/j.msard.2023.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the beneficial role of training and the use of some antioxidants in physiological and psychological disorders in autoimmune diseases has been reported, the simultaneous effect of aerobic training (AT) and royal jelly (RJ) with different doses is not well understood. The present study aimed to investigate the impact of AT and RJ on inflammatory factors in the hippocampus, as well as depression and anxiety in the experimental autoimmune encephalomyelitis (EAE). METHODS Sprague-Dawley rats with EAE were assigned to seven groups: (1) EAE without any other intervention (EAE); (2) sham, receiving normal saline (Sh); (3) 50 mg/kg RJ (RJ50); (4) 100 mg/kg RJ (RJ100); (5) AT; (6) AT + RJ50; and (7) AT + RJ100. In addition, a healthy control group was assessed. RESULTS EAE significantly increased interleukin 17 (IL-17), transforming growth factor-β (TGF-β) gene expression and immobilization time as well as anxiety and depression indices, and significantly decreased interleukin 10 (IL-10), compared to the control group. AT decreased significantly IL-17, TGF-β gene expression and immobilization time as well as anxiety and depression indices, while it significantly increased IL-10, compared to the EAE group. RJ50 and RJ100 decreased significantly IL-17, IL-23 gene expression, anxiety and depression indices, and significantly increased IL-10 compared to the EAE group. AT + RJ50 and AT + RJ100 significantly decreased IL-17, IL-23, and TGF-β and as well as anxiety and depression indices while significantly increasing IL-10 compared to the EAE group. The effects of AT + RJ100 on significant decreasing IL-17, IL-23, anxiety and depression and increasing TGF-β, IL-10 were more favorable than RJ50. CONCLUSION AT and RJ improved inflammatory and regulatory factors of autoimmunity and reduced anxiety and depression. The RJ combined with AT induced additive effects while using RJ100 was more favorable than RJ50.
Collapse
Affiliation(s)
- Maryam Kheirdeh
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Iran
| | | | - Mohammad Hemmatinafar
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Iran
| | - Javad Nemati
- Department of Sport Sciences, School of Education and Psychology, Shiraz University, Iran
| |
Collapse
|
7
|
Tremblay A, Charest K, Brando E, Roger E, Duquette P, Rouleau I. Cognitive reserve as a moderating factor between EDSS and cognition in multiple sclerosis. Mult Scler Relat Disord 2023; 70:104482. [PMID: 36603291 DOI: 10.1016/j.msard.2022.104482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES It is now well recognized that brain damage and/or atrophy apparent on MRI is only moderately correlated to cognitive functioning. The cognitive reserve (CR) hypothesis has been proposed to explain this functional heterogeneity, but it has only been addressed recently in the MS literature and has not yet been thoroughly investigated. The objective of this study is to examine the protective role of CR in cognition using a standardized CR tool in a population with a wide age range. METHODS A neuropsychological evaluation was performed on 84 pwMS aged between 27 and 78 years old and the CR Index questionnaire (CRIq) was used to estimate CR. The EDSS scale was used to assess the degree of neurologic impairment and estimate the disease burden. RESULTS A moderating effect of CR was observed in the relationship between EDSS score and specific cognitive domains: processing efficiency, visuospatial learning and memory, as well as a tendency for verbal memory. In pwMS with a high level of CR, there was no negative relationship between these cognitive domains and EDSS. CONCLUSION The results support the protective role of CR in a sample of pwMS with a wide age range. This role seems to be limited to specific cognitive tasks that pose a greater challenge and therefore require greater adaptability.
Collapse
Affiliation(s)
- Alexandra Tremblay
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Kim Charest
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Estefan Brando
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada
| | - Elaine Roger
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, QC, Montreal H3C 3P8, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, QC H2 X 3H8, Montréal, Canada.
| |
Collapse
|
8
|
Branigan GL, Torrandell-Haro G, Vitali F, Brinton RD, Rodgers K. Age and sex differences on anti-hyperglycemic medication exposure and risk of newly diagnosed multiple sclerosis in propensity score matched type 2 diabetics. Heliyon 2022; 8:e11196. [PMID: 36325137 PMCID: PMC9618986 DOI: 10.1016/j.heliyon.2022.e11196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background The association between exposure to anti-hyperglycemic medications (A-HgM) for Type 2 Diabetes Mellitus (T2D) treatment and Multiple Sclerosis (MS) in T2D patients is unclear. Methods This retrospective cohort analysis used the Mariner claims database. Patient records were surveyed for a diagnosis of MS starting 12 months after diagnosis of T2D. Patients were required to be actively enrolled in the Mariner claims records for six months prior and at least three years after the diagnosis of T2D without a history of previous neurodegenerative disease. Survival analysis was used to determine the association between A-HgM exposure and diagnosis of MS. A propensity score approach was used to minimize measured and unmeasured selection bias. The analyses were conducted between January 1st and April 28th, 2021. Findings In T2D patients younger than 45, A-HgM exposure was associated with a reduced risk of developing MS (RR: 0.22, 95%CI: 0.17-0.29, p-value <0.001). In contrast, A-HgM exposure in patients older than 45 was associated with an increased risk of MS with women exhibiting greater risk (RR: 1.53, 95%CI: 1.39-1.69, p < 0.001) than men (RR: 1.17, 95%CI: 1.01-1.37, p = 0 · 04). Patients who developed MS had a higher incidence of baseline comorbidities. Mean follow-up was 6.2 years with a standard deviation of 1.8 years. Interpretation In this study, A-HgM exposure in patients with T2D was associated with reduced risk of MS in patients younger than 45 whereas in patients older than 45, exposure to A-HgM was associated with an increased risk of newly diagnosed MS, particularly in women.
Collapse
Affiliation(s)
- Gregory L. Branigan
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA
- Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA
- MD-PhD Training Program; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Georgina Torrandell-Haro
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA
- Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Francesca Vitali
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA
- Department of Neurology; University of Arizona College of Medicine, Tucson, Arizona, USA
- Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Roberta Diaz Brinton
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA
- Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Neurology; University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Kathleen Rodgers
- Center for Innovation in Brain Science; University of Arizona, Tucson, Arizona, USA
- Department of Pharmacology; University of Arizona College of Medicine, Tucson, Arizona, USA
| |
Collapse
|
9
|
Liu Z, Niu X, Wang J. Naringenin as a natural immunomodulator against T cell-mediated autoimmune diseases: literature review and network-based pharmacology study. Crit Rev Food Sci Nutr 2022; 63:11026-11043. [PMID: 35776085 DOI: 10.1080/10408398.2022.2092054] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
T cells, especially CD4+ T helper (Th) cells, play a vital role in the pathogenesis of specific autoimmune diseases. Naringenin, a citrus flavonoid, exhibits anti-inflammatory, anti-oxidant, and antitumor properties, which have been verified in animal autoimmune disease models. However, naringenin's possible effects and molecular mechanisms in T cell-mediated autoimmune diseases are unclear. This review summarizes the findings of previous studies and predicts the target of naringenin in T cell-mediated autoimmune disorders such as multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis through network pharmacology analysis. We performed DAVID enrichment analysis, protein-protein interaction analysis, and molecular docking to predict the positive effect of naringenin on T cell-mediated autoimmune disorders. Sixteen common genes were screened, among which the core genes were PTGS2, ESR1, CAT, CASP3, MAPK1, and AKT1. The possible molecular mechanism relates to HIF-1, estrogen, TNF, and NF-κB signaling pathways. Our findings have significance for future naringenin treatment of T cell-mediated autoimmune diseases.
Collapse
Affiliation(s)
- Zejin Liu
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, Kaifeng, China
| | - Xinli Niu
- School of Life Sciences, Henan University, Kaifeng, China
| | - Junpeng Wang
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, Kaifeng, China
| |
Collapse
|
10
|
Raggi A, Monasta L, Beghi E, Caso V, Castelpietra G, Mondello S, Giussani G, Logroscino G, Magnani FG, Piccininni M, Pupillo E, Ricci S, Ronfani L, Santalucia P, Sattin D, Schiavolin S, Toppo C, Traini E, Steinmetz J, Nichols E, Ma R, Vos T, Feigin V, Leonardi M. Incidence, prevalence and disability associated with neurological disorders in Italy between 1990 and 2019: an analysis based on the Global Burden of Disease Study 2019. J Neurol 2022; 269:2080-2098. [PMID: 34498172 PMCID: PMC9938710 DOI: 10.1007/s00415-021-10774-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Neurological conditions are highly prevalent and disabling, in particular in the elderly. The Italian population has witnessed sharp ageing and we can thus expect a rising trend in the incidence, prevalence and disability of these conditions. METHODS We relied on the Global Burden of Disease 2019 study to extract Italian data on incidence, prevalence and years lived with a disability (YLDs) referred to a broad set of neurological disorders including, brain and nervous system cancers, stroke, encephalitis, meningitis, tetanus, traumatic brain injury, and spinal cord injury. We assessed changes between 1990 and 2019 in counts and age-standardized rates. RESULTS The most prevalent conditions were tension-type headache, migraine, and dementias, whereas the most disabling were migraine, dementias and traumatic brain injury. YLDs associated with neurological conditions increased by 22.5%, but decreased by 2.3% in age-standardized rates. The overall increase in prevalence and YLDs counts was stronger for non-communicable diseases with onset in old age compared to young to adult-age onset ones. The same trends were in the opposite direction when age-standardized rates were taken into account. CONCLUSIONS The increase in YLDs associated with neurological conditions is mostly due to population ageing and growth: nevertheless, lived disability and, as a consequence, impact on health systems has increased. Actions are needed to improve outcome and mitigate disability associated with neurological conditions, spanning among diagnosis, treatment, care pathways and workplace interventions.
Collapse
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Lorenzo Monasta
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy
| | - Ettore Beghi
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Valeria Caso
- Stroke Unit and Division of Internal and Cardiovascular Medicine, Università di Perugia, Perugia, Italy
| | - Giulio Castelpietra
- Region Friuli Venezia Giulia, Central Health Directorate, Outpatient and Inpatient Care Service, Trieste, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giorgia Giussani
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience, and Sense Organs, Università di Bari Aldo Moro, Bari, Italy
| | - Francesca Giulia Magnani
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Marco Piccininni
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabetta Pupillo
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Stefano Ricci
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Cittá di Castello Hospital, Perugia, Italy
| | - Luca Ronfani
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy
| | - Paola Santalucia
- Neurology and Stroke Unit, Ospedale San Giuseppe-Multimedica, Milan, Italy
| | - Davide Sattin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| | - Eugenio Traini
- S.C.R. Epidemiologia Clinica e Ricerca Sui Servizi Sanitari, IRCCS Materno Infantile “Burlo Garofolo”, Trieste, Italy,Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jaimie Steinmetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Emma Nichols
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Rui Ma
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, Australia
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy
| |
Collapse
|
11
|
Pau M, Porta M, Coghe G, Frau J, Lorefice L, Cocco E. Does Multiple Sclerosis Differently Impact Physical Activity in Women and Man? A Quantitative Study Based on Wearable Accelerometers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8848. [PMID: 33260721 PMCID: PMC7729610 DOI: 10.3390/ijerph17238848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023]
Abstract
In people with multiple sclerosis (pwMS), fatigue, weakness and spasticity may reduce mobility and promote sedentary behavior. However, little is known about the existence of possible differences in the way MS modifies the propensity to perform physical activity (PA) in men and women. The present study aimed to partly close this gap by means of quantitative analysis carried out using wearable sensors. Forty-five pwMS (23 F, 22 M, mean age 50.3) and 41 unaffected age- and sex-matched individuals wore a tri-axial accelerometer 24 h/day for 7 consecutive days. Raw data were processed to calculate average number of daily steps, vector magnitude (VM) counts, and percentage of time spent in sedentary behavior and in PA of different intensities (i.e., light and moderate-to-vigorous, MVPA). Women with MS spent more time in sedentary behavior and exhibited a reduced amount of light intensity activity with respect to men, while MVPA was similar across sexes. However, in comparison with unaffected individuals, the overall PA patterns appear significantly modified mostly in women who, in presence of the disease, present increased sedentary behavior, reduced MVPA, number of daily steps and VM counts. The findings of the present study highlight the urgency of including sex as variable in all studies on PA in pwMS.
Collapse
Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy;
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy;
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Jessica Frau
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, 09123 Cagliari, Italy; (G.C.); (J.F.); (L.L.); (E.C.)
| |
Collapse
|
12
|
Tremblay A, Charest K, Brando E, Roger E, Duquette P, Rouleau I. The effects of aging and disease duration on cognition in multiple sclerosis. Brain Cogn 2020; 146:105650. [PMID: 33212390 DOI: 10.1016/j.bandc.2020.105650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Multiple sclerosis (MS) is a disease of the central nervous system that can interfere with cognitive functions. The purpose of this study is to document the impact of MS, aging and disease duration on cognitive functioning as both life expectancy and incidence of the disease among persons with MS (PwMS) aged 50 years and over (late-onset MS) are increasing in the last two decades. METHODS Exhaustive neuropsychological evaluation was performed in 84 PwMS (30 young, 30 elderly adult-onset, 25 elderly late-onset) and 50 control participants (25 young, 24 elderly). ANCOVAs and hierarchical linear regressions were used to meet the objectives. RESULTS Interaction effects were found between age and presence of MS on higher executive function and information processing speed/working memory. After controlling for confounding variables (fatigue, quality of life, depression, MS course, comorbidity), results demonstrated an important role of age on all cognitive functions but only a trend of disease duration on information processing speed/working memory. CONCLUSION Decline in higher executive functions and information processing speed/working memory in aging is accentuated by the presence of MS, but the impact of age and MS on memory are independent. Age appears to be the variable having the most important role on cognition.
Collapse
Affiliation(s)
- Alexandra Tremblay
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, Montreal H3C 3P8, Canada
| | - Kim Charest
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, Montreal H3C 3P8, Canada
| | - Estefania Brando
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, Montreal H3C 3P8, Canada
| | - Elaine Roger
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, QC H2X 3H8, Canada
| | - Pierre Duquette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, QC H2X 3H8, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, CP 8888, succ. Centre-ville, Montreal H3C 3P8, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Montréal, QC H2X 3H8, Canada.
| |
Collapse
|
13
|
Schriefer D, Ness NH, Haase R, Ziemssen T. Gender disparities in health resource utilization in patients with relapsing-remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients. Ther Adv Neurol Disord 2020; 13:1756286420960274. [PMID: 33178335 PMCID: PMC7592171 DOI: 10.1177/1756286420960274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background: For the case of multiple sclerosis, research on gender differences from a
health economics perspective has not received much attention. However,
cost-of-illness analyses can provide valuable information about the diverse
impact of the disease and thus help decision-makers to allocate scarce
resources. The aim of this study was to describe healthcare resource use and
associated societal costs from a gender perspective. In particular, we aimed
to identify how resource utilization potentially differs in certain cost
components between men and women. Methods: Clinical and economic data were extracted from two prospective, multicentre,
non-interventional, observational studies in Germany. Information on health
resource use was obtained from all patients on a quarterly basis using a
validated questionnaire. Cost analyses were conducted from the societal perspective including all
direct (healthcare-related) and indirect (work-related) costs, regardless of
who bears them. Gender-related differences were analysed by a multivariable
generalized linear model with a negative binomial distribution and log link
function due to the right-skewed distribution pattern of cost data. In
addition, costs for men and women were descriptively analysed within
subgroups of two-year disease activity. Results: In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of
41.85 years and a median Expanded Disability Status Scale of 2
(interquartile range 1–3.5) (p > 0.30 for gender-related
differences). Women and men did not statistically differ in total quarterly
costs (€2329 ± €2570 versus €2361 ± €2612). For both, costs
were higher with advancing disease severity and indirect costs were the main
societal cost driver. Regarding healthcare-related resources, women incurred
higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16,
confidence interval (CI) 1.04–1.31], complementary medicine (IRR 2.41, CI
1.14–5.06), medical consumables (IRR 2.53, CI 1.69–3.79) and informal care
(IRR 2.79, CI 1.56–5.01). Among indirect costs, we found higher costs for
men for presenteeism (IRR 0.62; CI 0.53–0.72) and higher costs for women for
disability pension (IRR 1.62; CI 1.23–2.13). Conclusions: Multiple sclerosis poses a significant economic burden on patients, families
and society. While the total economic burden did not differ between male and
female patients, we found gender differences in specific cost items that are
similar to those in the wider non-MS population.
Collapse
Affiliation(s)
- Dirk Schriefer
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Nils-Henning Ness
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Rocco Haase
- MS Center Dresden, Center of Clinical Neuroscience, Neurological University Clinic Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany
| |
Collapse
|
14
|
Crespo-Castrillo A, Garcia-Segura LM, Arevalo MA. The synthetic steroid tibolone exerts sex-specific regulation of astrocyte phagocytosis under basal conditions and after an inflammatory challenge. J Neuroinflammation 2020; 17:37. [PMID: 31992325 PMCID: PMC6986022 DOI: 10.1186/s12974-020-1719-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tibolone is a synthetic steroid used in clinical practice for the treatment of climacteric symptoms and osteoporosis. Active metabolites of tibolone, generated in target tissues, have an affinity for estrogen and androgen receptors. Astrocytes are direct targets for estrogenic compounds and previous studies have shown that tibolone protects brain cortical neurons in association with a reduction in reactive astrogliosis in a mouse model of traumatic brain injury. Since phagocytosis is a crucial component of the neuroprotective function exerted by astrocytes, in the present study, we have assessed whether tibolone regulates phagocytosis in primary astrocytes incubated with brain-derived cellular debris. METHODS Male and female astrocyte cell cultures were obtained from newborn (P0-P2) female and male Wistar rats. Astrocytic phagocytosis was first characterized using carboxylate beads, Escherichia coli particles, or brain-derived cellular debris. Then, the effect of tibolone on the phagocytosis of Cy3-conjugated cellular debris was quantified by measuring the intensity of Cy3 dye-emitted fluorescence in a given GFAP immunoreactive area. Before the phagocytosis assays, astrocytes were incubated with tibolone in the presence or absence of estrogen or androgen receptor antagonists or an inhibitor of the enzyme that synthesizes estradiol. The effect of tibolone on phagocytosis was analyzed under basal conditions and after inflammatory stimulation with lipopolysaccharide. RESULTS Tibolone stimulated phagocytosis of brain-derived cellular debris by male and female astrocytes, with the effect being more pronounced in females. The effect of tibolone in female astrocytes was blocked by a selective estrogen receptor β antagonist and by an androgen receptor antagonist. None of these antagonists affected tibolone-induced phagocytosis in male astrocytes. In addition, the inhibition of estradiol synthesis in the cultures enhanced the stimulatory effect of tibolone on phagocytosis in male astrocytes but blocked the effect of the steroid in female cells under basal conditions. However, after inflammatory stimulation, the inhibition of estradiol synthesis highly potentiated the stimulation of phagocytosis by tibolone, particularly in female astrocytes. CONCLUSIONS Tibolone exerts sex-specific regulation of phagocytosis in astrocytes of both sexes, both under basal conditions and after inflammatory stimulation.
Collapse
Affiliation(s)
| | - Luis-Miguel Garcia-Segura
- Instituto Cajal, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludables (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria-Angeles Arevalo
- Instituto Cajal, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain. .,Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludables (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
15
|
Odabaş FÖ, Gümüş H, Akkurt HE, Uca AU, Yilmaz H. The Assessment of Sexual Dysfunction in Male Patients with Multiple Sclerosis. ACTA ACUST UNITED AC 2019; 55:349-353. [PMID: 30622392 DOI: 10.5152/npa.2017.19335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/20/2016] [Indexed: 01/22/2023]
Abstract
Introduction To investigate the effects of multiple sclerosis (MS) on male sexuality. Methods While 61 men with MS were included into the study group, 60 healthy men constituted the control group in the study. In MS patients, such parameters as functional status and depression levels were assessed with the Expanded Disability Status Scala (EDSS) and the Beck Depression Scale (BDS), other parameters such as pain levels, sexual function and quality of life (QoL) were evaluated with the Visual Analog Scala (VAS), the International Index of Erectile Function (IIEF) and the short form-36 (SF-36), respectively. Results Patients with MS were classified as 45 with EDSS <5.5 and 19 with EDSS >5.5. Mean VAS and BDI scores patients with MS were found statistically significantly higher, compared with those of the controls (p<0.05). Mean IIEF and all sub-group scores of SF-36 of patients with MS were found to be statistically significantly lower, compared with those of the control group (p<0.05). Mean EDSS in patients with MS was 2.75±2.42. While there was a positive correlation between IIEF scores of patients with MS, and mean mental and physical components of SF-36, a negative correlation was found between IIEF scores in MS patients, and age, disease duration, number of attacks, number of marital years and scores of EDSS, VAS and BDI (p<0.00). When BDI ≥17 was accepted as the threshold for depression, the depression was detected in 62.5% of patients with MS and 11.7% of the controls (p<0.001). Conclusion Sexual functions are affected negatively in male patients with MS and seem to be associated with increased disability, pain and accompanying depression. Therefore, male patients with MS should also be evaluated with regard to sexual function, as well as disability during their follow-ups.
Collapse
Affiliation(s)
- Faruk Ömer Odabaş
- Department of Neurology, SBÜ Konya Training and Research Hospital, Konya, Turkey
| | - Haluk Gümüş
- Department of Neurology, Karatay University School of Medicine, Medicana Hospital, Konya, Turkey
| | - Halil Ekrem Akkurt
- Department of Physical Medicine and Rehabilitation, SBÜ Konya Training and Research Hospital, Konya, Turkey
| | - Ali Ulvi Uca
- Department of Neurology, NEÜ Meram Medical Faculty, Konya, Turkey
| | - Halim Yilmaz
- Department of Physical Medicine and Rehabilitation, SBÜ Konya Training and Research Hospital, Konya, Turkey
| |
Collapse
|
16
|
Chistyakov DV, Azbukina NV, Astakhova AA, Goriainov SV, Chistyakov VV, Sergeeva MG. Sex-Mediated Differences in LPS Induced Alterations of TNFα, IL-10 Expression, and Prostaglandin Synthesis in Primary Astrocytes. Int J Mol Sci 2018; 19:ijms19092793. [PMID: 30227622 PMCID: PMC6164227 DOI: 10.3390/ijms19092793] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 01/14/2023] Open
Abstract
Although many neurological and psychiatric disorders reveal clear sex-dependent variations, the molecular mechanism of this process is not clear enough. Astrocytes are involved in the response of neural tissue to injury and inflammation, produce steroid hormones, and sense steroid presence. To explore the hypothesis that astrocytes may participate in sex-mediated differences of inflammatory responses, we have examined whether male and female primary rat astrocytes show different responses to lipopolysaccharide (LPS) as a toll-like receptor 4 (TLR4) agonist. Levels of mRNA and proteins of tumor necrosis factor alpha (TNFα), interleukin-10 (IL-10), and cyclooxygenase (COX)-2 were assessed using qPCR, immunoblotting, and ELISA. UPLC-MS/MS was used to detect prostaglandins (PGs). LPS stimulation resulted in different levels of cytokine production; more TNFα and less IL-10 were produced in female cells compared with male astrocytes. Although the levels of the COX-2 expression were not altered, LPS significantly induced the synthesis of PGs with notable sex-related differences. PGE2 and PGD2 were less and 6-keto-PGF1α was more upregulated in female astrocytes, and TXB2 had similar levels in cells obtained from males and females. Trilostane, an inhibitor of 3β-Hydroxysteroid dehydrogenase (3β-HSD), inhibited the LPS-induced TNFα production and the release of PGE2, PGD2, and 6-keto-PGF1α in female astrocytes. Thus, male and female astrocytes differentially respond to inflammatory challenges on the level of production of cytokines and steroid hormones. Sex-mediated differences in pro- and anti-inflammatory responses should be taken into consideration for the effective treatment of disorders with neuroinflammation.
Collapse
Affiliation(s)
- Dmitry V Chistyakov
- Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow 119992, Russia.
- Laboratory of electrophysiology, Pirogov Russian National Research Medical University, Moscow 117997, Russia.
| | - Nadezda V Azbukina
- Faculty of Bioengineering and Bioinformatics, Moscow Lomonosov State University, Moscow 119234, Russia.
| | - Alina A Astakhova
- Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow 119992, Russia.
| | - Sergei V Goriainov
- SREC PFUR, Peoples' Friendship University of Russia (RUDN University), Moscow 117198, Russia.
| | - Viktor V Chistyakov
- SREC PFUR, Peoples' Friendship University of Russia (RUDN University), Moscow 117198, Russia.
| | - Marina G Sergeeva
- Belozersky Institute of Physico-Chemical Biology, Moscow State University, Moscow 119992, Russia.
| |
Collapse
|
17
|
Kumar S, Rohatgi A, Chaudhari H, Thakor P. Evolving Landscape of Multiple Sclerosis in India: Challenges in the Management. Ann Indian Acad Neurol 2018; 21:107-115. [PMID: 30122834 PMCID: PMC6073961 DOI: 10.4103/aian.aian_33_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disease which often leads to disability. The complex etiology and progressive nature pose challenges in the management of patients with MS, particularly in developing countries like India. Lack of data on prevalence further complicates estimation of the magnitude of MS in India. There are various other challenges associated with management of patients with MS due to which the therapy is utilized by only a small segment of population in India. This article encapsulates the gaps and challenges in the management of patients with MS and presents suggestions and recommendations of the members of advisory boards held to discuss these challenges. The advisory board members suggested that an early diagnosis of MS and an early initiation of treatment are essential to achieve better results for tackling MS-related challenges. In addition, awareness and education about MS among people, regular training to physicians, emphasis on the use of revised 2010 McDonald criteria, and utilization of advanced diagnostic modalities in magnetic resonance imaging would help to achieve desirable as well as effective therapeutic outcomes. Further, access to an easy-to-use therapy delivery system could also be beneficial in attaining an adequate treatment adherence and related health benefits.
Collapse
Affiliation(s)
- Sudhir Kumar
- Department of Neurology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Harshal Chaudhari
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
| | - Priti Thakor
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
| |
Collapse
|
18
|
Abstract
Concern about what is best practice when caring for women with neurologic disease is a common clinical scenario. Therefore, knowledge about women's health issues and their intersection with neurologic disorders is imperative. This review will discuss the appropriate gender-based considerations in epilepsy, multiple sclerosis, migraine, autoimmune disease, sleep disorders, stroke, and paraneoplastic disorders.
Collapse
|
19
|
Melendez-Torres GJ, Auguste P, Armoiry X, Maheswaran H, Court R, Madan J, Kan A, Lin S, Counsell C, Patterson J, Rodrigues J, Ciccarelli O, Fraser H, Clarke A. Clinical effectiveness and cost-effectiveness of beta-interferon and glatiramer acetate for treating multiple sclerosis: systematic review and economic evaluation. Health Technol Assess 2018; 21:1-352. [PMID: 28914229 DOI: 10.3310/hta21520] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND At the time of publication of the most recent National Institute for Health and Care Excellence (NICE) guidance [technology appraisal (TA) 32] in 2002 on beta-interferon (IFN-β) and glatiramer acetate (GA) for multiple sclerosis, there was insufficient evidence of their clinical effectiveness and cost-effectiveness. OBJECTIVES To undertake (1) systematic reviews of the clinical effectiveness and cost-effectiveness of IFN-β and GA in relapsing-remitting multiple sclerosis (RRMS), secondary progressive multiple sclerosis (SPMS) and clinically isolated syndrome (CIS) compared with best supportive care (BSC) and each other, investigating annualised relapse rate (ARR) and time to disability progression confirmed at 3 months and 6 months and (2) cost-effectiveness assessments of disease-modifying therapies (DMTs) for CIS and RRMS compared with BSC and each other. REVIEW METHODS Searches were undertaken in January and February 2016 in databases including The Cochrane Library, MEDLINE and the Science Citation Index. We limited some database searches to specific start dates based on previous, relevant systematic reviews. Two reviewers screened titles and abstracts with recourse to a third when needed. The Cochrane tool and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Philips checklists were used for appraisal. Narrative synthesis and, when possible, random-effects meta-analysis and network meta-analysis (NMA) were performed. Cost-effectiveness analysis used published literature, findings from the Department of Health's risk-sharing scheme (RSS) and expert opinion. A de novo economic model was built for CIS. The base case used updated RSS data, a NHS and Personal Social Services perspective, a 50-year time horizon, 2014/15 prices and a discount rate of 3.5%. Outcomes are reported as incremental cost-effectiveness ratios (ICERs). We undertook probabilistic sensitivity analysis. RESULTS In total, 6420 publications were identified, of which 63 relating to 35 randomised controlled trials (RCTs) were included. In total, 86% had a high risk of bias. There was very little difference between drugs in reducing moderate or severe relapse rates in RRMS. All were beneficial compared with BSC, giving a pooled rate ratio of 0.65 [95% confidence interval (CI) 0.56 to 0.76] for ARR and a hazard ratio of 0.70 (95% CI, 0.55 to 0.87) for time to disability progression confirmed at 3 months. NMA suggested that 20 mg of GA given subcutaneously had the highest probability of being the best at reducing ARR. Three separate cost-effectiveness searches identified > 2500 publications, with 26 included studies informing the narrative synthesis and model inputs. In the base case using a modified RSS the mean incremental cost was £31,900 for pooled DMTs compared with BSC and the mean incremental quality-adjusted life-years (QALYs) were 0.943, giving an ICER of £33,800 per QALY gained for people with RRMS. In probabilistic sensitivity analysis the ICER was £34,000 per QALY gained. In sensitivity analysis, using the assessment group inputs gave an ICER of £12,800 per QALY gained for pooled DMTs compared with BSC. Pegylated IFN-β-1 (125 µg) was the most cost-effective option of the individual DMTs compared with BSC (ICER £7000 per QALY gained); GA (20 mg) was the most cost-effective treatment for CIS (ICER £16,500 per QALY gained). LIMITATIONS Although we built a de novo model for CIS that incorporated evidence from our systematic review of clinical effectiveness, our findings relied on a population diagnosed with CIS before implementation of the revised 2010 McDonald criteria. CONCLUSIONS DMTs were clinically effective for RRMS and CIS but cost-effective only for CIS. Both RCT evidence and RSS data are at high risk of bias. Research priorities include comparative studies with longer follow-up and systematic review and meta-synthesis of qualitative studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42016043278. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- G J Melendez-Torres
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Xavier Armoiry
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hendramoorthy Maheswaran
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alan Kan
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephanie Lin
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Carl Counsell
- Divison of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Jeremy Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Institute of Neurology, University College London, London, UK
| | - Hannah Fraser
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
20
|
Rouleau I, Dagenais E, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Prospective memory impairment in multiple sclerosis: a review. Clin Neuropsychol 2017; 32:922-936. [PMID: 28774220 DOI: 10.1080/13854046.2017.1361473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is a progressive disease of the central nervous system affecting information processing speed, episodic memory, attention, and executive functions. MS patients also often report prospective memory (PM) failures that directly impact their functional autonomy, including professional and social life. The purpose of this paper was to review the literature concerning the assessment and remediation of PM deficits in MS. METHOD The literature pertaining to PM impairment in MS was carefully reviewed using PubMed, PsyINFO, and Google Scholar, as well as cross-references from the articles published on this topic. Since PM rehabilitation in MS patients is still in its infancy, this review mainly focuses on studies that have directly assessed PM through various measures including questionnaires, standardized clinical tests, and experimental procedures. CONCLUSION This literature review confirms the presence of PM deficits in MS patients, even in the early stages of the disease. A further need for controlled studies on PM assessment and PM interventions in patients with MS is stressed.
Collapse
Affiliation(s)
- Isabelle Rouleau
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada.,b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
| | - Emmanuelle Dagenais
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Alexandra Tremblay
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Mélanie Demers
- a Department of Psychology , Université du Québec à Montréal , Montreal , Canada
| | - Élaine Roger
- b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
| | - Céline Jobin
- c Neurology Service , Hôpital du Sacré-Coeur de Montréal , Montreal , Canada
| | - Pierre Duquette
- b Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) , Montreal , Canada
| |
Collapse
|
21
|
Sanchis-Segura C, Cruz-Gómez AJ, Belenguer A, Fittipaldi Márquez MS, Ávila C, Forn C. Increased regional gray matter atrophy and enhanced functional connectivity in male multiple sclerosis patients. Neurosci Lett 2016; 630:154-157. [PMID: 27436479 DOI: 10.1016/j.neulet.2016.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/24/2016] [Accepted: 07/16/2016] [Indexed: 10/21/2022]
Abstract
Evidence suggests that sex/gender is an important factor for understanding multiple sclerosis (MS) and that some of its neuropathological consequences might manifest earlier in males. In the present study, we assessed gray matter (GM) volume and functional connectivity (FC) in a sample of female and male MS patients (MSp) and female and male healthy controls (HCs). As compared to female MSp, male MSp showed decreased GM volume in the bilateral frontal areas and increased FC between different brain regions. Because both sets of changes correlated significantly and no differences in cognitive performance were observed, we suggest that the FC increase observed in male MSp acts as a compensatory mechanism for their more extensive GM loss and that it promotes a functional convergence between male- and female-MSp.
Collapse
Affiliation(s)
- C Sanchis-Segura
- Universitat Jaume I. Departament de Psicología Bàsica, Clínica i Psicobiología, Castelló de la Plana, Spain
| | - A J Cruz-Gómez
- Universitat Jaume I. Departament de Psicología Bàsica, Clínica i Psicobiología, Castelló de la Plana, Spain
| | - A Belenguer
- Servicio de Neurología, Hospital General de Castellón, Castelló de la Plana, Spain
| | - M S Fittipaldi Márquez
- Universitat Jaume I. Departament de Psicología Bàsica, Clínica i Psicobiología, Castelló de la Plana, Spain
| | - C Ávila
- Universitat Jaume I. Departament de Psicología Bàsica, Clínica i Psicobiología, Castelló de la Plana, Spain
| | - C Forn
- Universitat Jaume I. Departament de Psicología Bàsica, Clínica i Psicobiología, Castelló de la Plana, Spain.
| |
Collapse
|
22
|
Chung WS, Lin CL, Tsai TC, Hsu WH, Kao CH. Multiple sclerosis increases the risk of venous thromboembolism: a nationwide cohort analysis. Eur J Clin Invest 2015; 45:1228-33. [PMID: 26186501 DOI: 10.1111/eci.12502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/07/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of multiple sclerosis (MS) on the risk of venous thromboembolism (VTE) development. METHODS We identified patients diagnosed with MS in Taiwan between 1998 and 2010 using the National Health Insurance Research Database and the Catastrophic Illness Patient Database (RCIPD). Each MS patient was frequency matched to 4 controls according to age, sex and the year of MS registration to the RCIPD. Patients with a history of VTE and incomplete information of age and sex were excluded. All patients were followed up from the index year until VTE diagnosis, loss to follow-up or the end of 2010. We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of VTE in the MS and comparison cohorts using Cox proportional hazards regression models. RESULTS We followed up 1238 MS patients and 4952 comparison patients for approximately 6437 and 27 595 person-years, respectively. After adjusting for age, sex and comorbidities, the MS patients exhibited a 6·87-fold increased risk of VTE compared with the control patients. Women with MS were associated with an 11·1-fold increased risk of VTE development compared with the non-MS women (95% CI: 2·70-45·5). The MS patients aged < 50 years exhibited a 14·8-fold increased risk of developing VTE compared with age-matched patients in the comparison cohort (95% CI: 2·99-73·4). The risk of VTE development increased with the duration of hospitalization stay. CONCLUSION MS patients are associated with significantly greater risk of developing VTE compared with non-MS patients.
Collapse
Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan.,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Chang Tsai
- Department of Neurology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
23
|
Update on treatments in multiple sclerosis. Presse Med 2015; 44:e137-51. [DOI: 10.1016/j.lpm.2015.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
|
24
|
Anens E, Emtner M, Zetterberg L, Hellström K. Physical activity in subjects with multiple sclerosis with focus on gender differences: a survey. BMC Neurol 2014; 14:47. [PMID: 24612446 PMCID: PMC3975577 DOI: 10.1186/1471-2377-14-47] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 03/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background There is increasing research that examines gender-issues in multiple sclerosis (MS), but little focus has been placed on gender-issues regarding physical activity. The aim of the present study was to describe levels of physical activity, self-efficacy for physical activity, fall-related self-efficacy, social support for physical activity, fatigue levels and the impact of MS on daily life, in addition to investigating gender differences. Methods The sample for this cross-sectional cohort study consisted of 287 (84 men; 29.3%) adults with MS recruited from the Swedish Multiple Sclerosis Registry. A questionnaire was sent to the subjects consisting of the self-administrated measurements: Physical Activity Disability Survey – Revised, Exercise Self-Efficacy Scale, Falls- Efficacy Scale (Swedish version), Social Influences on Physical Activity, Fatigue Severity Scale and Multiple Sclerosis Impact Scale. Response rate was 58.2%. Results Men were less physically active, had lower self-efficacy for physical activity and lower fall-related self-efficacy than women. This was explained by men being more physically affected by the disease. Men also received less social support for physical activity from family members. The level of fatigue and psychological consequences of the disease were similar between the genders in the total sample, but subgroups of women with moderate MS and relapsing remitting MS experienced more fatigue than men. Conclusions Men were less physically active, probably a result of being more physically affected by the disease. Men being more physically affected explained most of the gender differences found in this study. However, the number of men in the subgroup analyses was small and more research is needed. A gender perspective should be considered in strategies for promoting physical activity in subjects with MS, e.g. men may need more support to be physically active.
Collapse
Affiliation(s)
| | | | | | - Karin Hellström
- Department of Neuroscience, Section for Physiotherapy, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW This article reviews the current understanding of the interactions between multiple sclerosis (MS) and pregnancy, and implications for reproductive counseling. This is a key topic in MS because the typical patient is a young woman of childbearing age. RECENT FINDINGS It has been known for some time that MS disease activity markedly reduces during the last trimester of pregnancy, then markedly increases in the 3 months postpartum before returning to the prepregnancy baseline. High relapse rate or disability before pregnancy, as well as relapse during pregnancy, have been associated with increased risk for postpartum attacks. Recent data continue to support the conclusion that long-term disease progression is not worsened (and may actually be lessened) with pregnancy in patients with relapsing MS; the data are not so clear for those with progressive MS. Among the MS disease-modifying therapies, the only one that requires contraception use by men is the new oral agent teriflunomide, because the drug is present in semen. It is reassuring that, to date, no human teratogenic effects have been documented for any of the MS disease-modifying therapies. SUMMARY Pregnancy has a profound effect on MS disease activity. Identification of the responsible mechanisms for this effect should lead to new disease insights and therapeutic strategies.
Collapse
|
26
|
Abstract
Multiple sclerosis (MS) is universally found to be more prevalent in women than men. This has led to extensive studies of differences in the immune system or nervous system between women and men, which might be caused by the effects of gonadal hormones, genetic differences, and different environmental exposures and modern lifestyle in men and women. We review the effects of sex and gender from a genetic, immunological and clinical point of view. We discuss the effects of sex on the clinical expression of MS and responses to therapy, as well as issues concerning pregnancy.
Collapse
Affiliation(s)
- Hanne F Harbo
- Department of Neurology, Oslo University Hospital, Ullevål and University of Oslo, 0407 Oslo, Norway
| | | | | |
Collapse
|
27
|
Ojeda E, Díaz-Cortes D, Rosales D, Duarte-Rey C, Anaya JM, Rojas-Villarraga A. Prevalence and clinical features of multiple sclerosis in Latin America. Clin Neurol Neurosurg 2013; 115:381-7. [DOI: 10.1016/j.clineuro.2012.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 11/20/2012] [Accepted: 11/27/2012] [Indexed: 01/15/2023]
|
28
|
|
29
|
Pediatric multiple sclerosis-a challenging demyelinating disease: case report and brief review of the literature. Case Rep Pediatr 2012; 2012:684064. [PMID: 22844627 PMCID: PMC3400330 DOI: 10.1155/2012/684064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/21/2012] [Indexed: 11/18/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory, demyelinating, neurodegenerative disorder of the central nervous system (CNS) of unknown etiology. The peak onset is between age 20 and 40 years and usually affects more women than men. Although much knowledge has been achieved on the diagnosis and treatment of adult patients with MS, it remains a matter of debate and controversy in childhood. We present a case of MS in 9-year-old girl, review the current state of the knowledge on pediatric MS, and discuss the available tools for the diagnosis and treatment.
Collapse
|
30
|
Martinez NE, Sato F, Omura S, Minagar A, Alexander JS, Tsunoda I. Immunopathological patterns from EAE and Theiler's virus infection: Is multiple sclerosis a homogenous 1-stage or heterogenous 2-stage disease? ACTA ACUST UNITED AC 2012; 20:71-84. [PMID: 22633747 DOI: 10.1016/j.pathophys.2012.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiple sclerosis (MS) is a disease which can presents in different clinical courses. The most common form of MS is the relapsing-remitting (RR) course, which in many cases evolves into secondary progressive (SP) disease. Autoimmune models such as experimental autoimmune encephalomyelitis (EAE) have been developed to represent the various clinical forms of MS. These models along with clinico-pathological evidence obtained from MS patients have allowed us to propose '1-stage' and '2-stage' disease theories to explain the transition in the clinical course of MS from RR to SP. Relapses in MS are associated with pro-inflammatory T helper (Th) 1/Th17 immune responses, while remissions are associated with anti-inflammatory Th2/regulatory T (Treg) immune responses. Based on the '1-stage disease' theory, the transition from RR to SP disease occurs when the inflammatory immune response overwhelms the anti-inflammatory immune response. The '2-stage disease' theory proposes that the transition from RR to SP-MS occurs when the Th2 response or some other responses overwhelm the inflammatory response resulting in the sustained production of anti-myelin antibodies, which cause continuing demyelination, neurodegeneration, and axonal loss. The Theiler's virus model is also a 2-stage disease, where axonal degeneration precedes demyelination during the first stage, followed by inflammatory demyelination during the second stage.
Collapse
Affiliation(s)
- Nicholas E Martinez
- Department of Microbiology and Immunology, Center for Molecular and Tumor Virology, LSU Health, School of Medicine, Shreveport, LA 71130, USA
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system characterized by episodic and progressive neurologic dysfunction resulting from inflammatory and autoimmune reactions. The underlying pathogenesis of MS remains largely unclear. However, it is currently accepted as a T cell-mediated autoimmune disease. Among other clinical manifestations, sexual dysfunction (SD) is a painful but still underreported and underdiagnosed symptom of the disorder. SD in MS patients may result from a complex set of conditions and may be associated with multiple anatomic, physiologic, biologic, medical and psychological factors. SD arises primarily from lesions affecting the neural pathways involved in physiologic function. In addition, psychological factors, the side effects of medications and physical symptoms such as fatigue, muscular weakness, menstrual changes, pain and concerns about bladder and bowel incontinence may also be involved. Since MS primarily affects young people, SD secondary to MS may have a great impact on quality of life. Thus, maintaining a healthy sexual life with MS is an important priority. The treatment of SD requires multidisciplinary teamwork and cooperation among specialists, individual patients, partners and the society.
Collapse
|
32
|
Santos-Galindo M, Acaz-Fonseca E, Bellini MJ, Garcia-Segura LM. Sex differences in the inflammatory response of primary astrocytes to lipopolysaccharide. Biol Sex Differ 2011; 2:7. [PMID: 21745355 PMCID: PMC3143074 DOI: 10.1186/2042-6410-2-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/11/2011] [Indexed: 01/09/2023] Open
Abstract
Background Numerous neurological and psychiatric disorders show sex differences in incidence, age of onset, symptomatology or outcome. Astrocytes, one of the glial cell types of the brain, show sex differences in number, differentiation and function. Since astrocytes are involved in the response of neural tissue to injury and inflammation, these cells may participate in the generation of sex differences in the response of the brain to pathological insults. To explore this hypothesis, we have examined whether male and female astrocytes show a different response to an inflammatory challenge and whether perinatal testosterone influences this response. Methods Cortical astrocyte cultures were prepared from postnatal day 1 (one day after birth) male or female CD1 mice pups. In addition, cortical astrocyte cultures were also prepared from female pups that were injected at birth with 100 μg of testosterone propionate or vehicle. Cultures were treated for 5 hours with medium containing lipopolysaccharide (LPS) or with control medium. The mRNA levels of IL6, interferon-inducible protein 10 (IP10), TNFα, IL1β, Toll-like receptor 4 (TLR4), steroidogenic acute regulatory protein and translocator protein were assessed by quantitative real-time polymerase chain reaction. Statistical significance was assessed by unpaired t-test or by one-way analysis of variance followed by the Tukey post hoc test. Results The mRNA levels of IL6, TNFα and IL1β after LPS treatment were significantly higher in astrocytes derived from male or androgenized females compared to astrocytes derived from control or vehicle-injected females. In contrast, IP10 mRNA levels after LPS treatment were higher in astrocytes derived from control or vehicle-injected females than in those obtained from males or androgenized females. The different response of male and female astrocytes to LPS was due neither to differences in the basal expression of the inflammatory molecules nor to differences in the expression of the LPS receptor TLR4. In contrast, the different inflammatory response was associated with increased mRNA levels of translocator protein, a key steroidogenic regulator, in female astrocytes that were treated with LPS. Conclusions Male and female cortical astrocytes respond differentially to an inflammatory challenge and this may be predetermined by perinatal testosterone exposure.
Collapse
|
33
|
Varicella zoster virus and relapsing remitting multiple sclerosis. Mult Scler Int 2011; 2011:214763. [PMID: 22096629 PMCID: PMC3195831 DOI: 10.1155/2011/214763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/04/2011] [Accepted: 02/02/2011] [Indexed: 01/24/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disorder; however, little is known about the triggering factors of the abnormal immune response. Different viruses from the herpes family have been mentioned as potential participants. Here, we review the evidences that support the association of varicella zoster virus (VZV) with MS. Epidemiological studies from geographical areas, where incidence of MS has increased in recent decades, pointed out a high frequency of varicella and zoster in the clinical antecedents of MS patients, and also laboratory investigations have found large quantities of DNA from VZV in leucocytes and cerebrospinal fluid of MS patients restricted to the ephemeral period of MS relapse, followed by disappearance of the virus during remission. The above observations and the peculiar features of VZV, mainly characterized by its neurotropism and long periods of latency followed by viral reactivation, support the idea on the participation of VZV in the etiology of MS. However, as with reports from studies with other viruses, particularly Epstein Barr virus, conflicting results on confirmatory studies about the presence of viral gene products in brain tissue indicate the need for further research on the potential participation of VZV in the etiology of MS.
Collapse
|