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Mishra S, Bapuraj J, Srinivasan A. Multiple Sclerosis Part 2: Advanced Imaging and Emerging Techniques. Magn Reson Imaging Clin N Am 2024; 32:221-231. [PMID: 38555138 DOI: 10.1016/j.mric.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Multiple advanced imaging methods for multiple sclerosis (MS) have been in investigation to identify new imaging biomarkers for early disease detection, predicting disease prognosis, and clinical trial endpoints. Multiple techniques probing different aspects of tissue microstructure (ie, advanced diffusion imaging, magnetization transfer, myelin water imaging, magnetic resonance spectroscopy, glymphatic imaging, and perfusion) support the notion that MS is a global disease with microstructural changes evident in normal-appearing white and gray matter. These global changes are likely better predictors of disability compared with lesion load alone. Emerging techniques in glymphatic and molecular imaging may improve understanding of pathophysiology and emerging treatments.
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Affiliation(s)
- Shruti Mishra
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2A209, Ann Arbor, MI 48109-5030, USA.
| | - Jayapalli Bapuraj
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2A209, Ann Arbor, MI 48109-5030, USA
| | - Ashok Srinivasan
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, UH B2A209, Ann Arbor, MI 48109-5030, USA
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Chylińska M, Komendziński J, Wyszomirski A, Karaszewski B. Brain Atrophy as an Outcome of Disease-Modifying Therapy for Remitting-Relapsing Multiple Sclerosis. Mult Scler Int 2023; 2023:4130557. [PMID: 37693228 PMCID: PMC10484652 DOI: 10.1155/2023/4130557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Currently, clinical trials of DMTs strive to determine their effect on neuroinflammation and neurodegeneration. We aimed to determine the impact of currently used DMTs on brain atrophy and disability in RRMS. The main goal of this review is to evaluate the neuroprotective potential of MS therapy and assess its impact on disability. Methods We performed a systematic analysis of clinical trials that used brain atrophy as an outcome or performed post hoc analysis of volumetric MRI parameters to assess the neuroprotective potential of applied therapies. Trials between 2008 and 2019 that included published results of brain parenchymal fraction (BPF) change and brain volume loss (BVL) in the period from baseline to week 96 or longer were considered. Results Twelve from 146 clinical trials met the inclusion criteria and were incorporated into the analysis. DMTs that presented a large reduction in BVL also exhibited robust effects on clinical disability worsening, e.g., alemtuzumab with a 42% risk reduction in 6-month confirmed disability accumulation (p = 0.0084), ocrelizumab with a 40% risk reduction in 6-month confirmed disability progression (p = 0.003), and other DMTs (cladribine and teriflunomide) with moderate influence on brain atrophy were also associated with a marked impact on disability worsening. Dimethyl fumarate (DEFINE) and fingolimod (FREEDOMS I) initially exhibited significant effect on BVL; however, this effect was not confirmed in further clinical trials: CONFIRM and FREEDOMS II, respectively. Peg-IFN-β1a shows a modest effect on BVL and disability worsening. Conclusion Our results show that BVL in one of the components of clinical disability worsening, together with other variables (lesion volume and annualized relapse rate). Standardization of atrophy measurement technique as well as harmonization of disability worsening and progression criteria in further clinical trials are of utmost importance as they enable a reliable comparison of neuroprotective potential of DMTs.
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Affiliation(s)
| | - Jakub Komendziński
- Department of Adult Neurology, Gdańsk Medical University, Gdańsk, Poland
| | - Adam Wyszomirski
- Department of Adult Neurology, Gdańsk Medical University, Gdańsk, Poland
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Barc ED, Yucel F, Kutlu C. Three Dimensional Brain Parameters of Multiple Sclerosis (MS) Patients. Mult Scler Relat Disord 2023; 70:104475. [PMID: 36584653 DOI: 10.1016/j.msard.2022.104475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 12/05/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND & OBJECTIVES MS is not only a demyelinating disease of central nervous system, but it also affects cortical and deep gray matter (GM). Furthermore, it causes axonal damage in the brain and spinal cord through inflammation and axonal degeneration. It is mostly seen between the ages of 20 and 40 and prevalence of the disease is higher among females than males. In the present study, we measured different parameters in the brains of patients with multiple sclerosis (MS) and healthy controls in both genders to determine the amount of brain atrophy quantitatively in MS patients. METHODS We used T2-weighted MRI scans of 40 MS patients (25 females + 15 males) with clinically definite relapsing-remitting multiple sclerosis that was determined according to Poser criteria in multiple parts of the brain, and we compared these data with those of sex-matched healthy controls in the same numbers. RESULTS Wideness of the lateral and third ventricles and the volumes of cerebral sulci in MS patients were significantly increased compared to both male and female controls. Brain width, corpus callosum area and the total brain/cerebellum + brain stem volumes of MS patients were decreased considerably. INTERPRETATION & CONCLUSIONS The present measurements indicated that MS caused parenchymal destruction in the cortex, axonal degeneration and myelin loss in the white matter of the brain. Consequently, the current observations correlate well with worsening disability in MS patients.
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Affiliation(s)
- Esma Deniz Barc
- Department of Audiometry, Vocational School of Health Services, Yuksek Ihtisas University, Ankara 06291, Turkey.
| | - Ferruh Yucel
- Department of Anatomy, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir 26480, Turkey
| | - Ceyhan Kutlu
- Department of Neurology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir 26480, Turkey
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Kossowski B, Kong Y, Klimiec-Moskal E, Emir U, Palace J, Juryńczyk M. Relapsing antibody-negative patients with features of neuromyelitis optica spectrum disorders: Differences in N-acetylaspartate level in the cervical spinal cord indicate distinct underlying processes. Mult Scler 2022; 28:2221-2230. [PMID: 35971567 DOI: 10.1177/13524585221115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to lack of biomarkers, antibody-negative patients with features of neuromyelitis optica spectrum disorders (NMOSD) are among the most challenging to diagnose and treat. Using unsupervised clustering, we recently identified 'MS-like', 'spinal MS-like', 'classic NMOSD-like' and 'NMOSD-like with brain involvement' subgroups in this cohort. OBJECTIVE We used magnetic resonance spectroscopy (MRS) to examine differences in the level of key metabolites in the spinal cord between the four identified subgroups. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features classified by the unsupervised algorithm to one of the subgroups underwent a prospective cervical spinal cord MRS. Spectra from 16 patients fulfilled quality criteria and were included in the analysis. RESULTS Total N-acetylaspartate (tNAA), but not total choline (tCho) or myo-inositol (Ins), was significantly different between the four subgroups (p = 0.03). In particular, tNAA was 47.8% lower in the 'MS-like' subgroup as compared with the 'classic NMOSD-like' subgroup (p = 0.02). While we found a negative overall correlation between tNAA and disability score (r = -0.514, p = 0.04) in the whole cohort, the disability score did not differ significantly between the subgroups to explain subgroup differences in tNAA level. CONCLUSIONS Significant differences in the cervical spinal cord tNAA measurements confirm that the previously identified clinico-radiologic subgroups contain patients with distinct underlying disease processes.
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Affiliation(s)
- Bartosz Kossowski
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Headley Way, OX3 9DU Oxford, UK.,Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteura 3 Street, 02-098 Warsaw, Poland.,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland; Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Al-Iedani O, Lea R, Ribbons K, Ramadan S, Lechner-Scott J. Neurometabolic changes in multiple sclerosis: Fingolimod versus beta interferon or glatiramer acetate therapy. J Neuroimaging 2022; 32:1109-1120. [PMID: 35922880 DOI: 10.1111/jon.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Fingolimod has been shown to be more effective in reducing relapse rate and disability than injectable therapies in clinical trials. An increase in N-acetylaspartate (NAA) as measured by MR spectroscopy is correlated with maintaining axonal metabolic functions. This study compared the neurometabolic and volumetric changes in relapsing-remitting multiple sclerosis (RRMS) patients on fingolimod or injectable therapies with healthy controls (HCs). METHODS Ninety-eight RRMS (52 on fingolimod, 46 on injectable therapies (27 on glatiramer acetate and 19 on interferon) were age and sex-matched to 51 HCs. RRMS patients underwent cognitive, fatigue, and mental health assessments, as well as an Expanded disability status scale (EDSS). MRI/S was acquired from the hippocampus, posterior cingulate gyrus (PCG), and prefrontal cortex (PFC). Volumetric and neurometabolic measures were compared across cohorts using a univariate general linear model and correlated with clinical severity and neuropsychological scores. RESULTS Clinical parameters, MR-volumetric, and neurometabolic profiles showed no differences between treatment groups (p > .05). Compared to HCs, both RRMS cohorts showed volume changes in white matter (-13%), gray matter (-16%), and cerebral spinal fluid (CSF) (+17-23%), as well as reduced NAA (-17%, p = .001, hippocampus), (-7%, p = .001, PCG), and (-9%, p = .001, PFC). MRI/S metrics in three regions were moderately correlated with cognition and fatigue functions. CONCLUSION While both treatment arms showed overall similar volumetric and neurometabolic profiles, longitudinal studies are warranted to clarify neurometabolic changes and associations with treatment efficacy.
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Affiliation(s)
- Oun Al-Iedani
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Rodney Lea
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen Ribbons
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Saadallah Ramadan
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Ansari MA, Nadeem A, Attia SM, Bakheet SA, Shahid M, Rehman MU, Alanazi MM, Alhamed AS, Ibrahim KE, Albekairi NA, Ahmad SF. CCR1 antagonist J-113863 corrects the imbalance of pro- and anti-inflammatory cytokines in a SJL/J mouse model of relapsing-remitting multiple sclerosis. Immunobiology 2022; 227:152245. [PMID: 35868215 DOI: 10.1016/j.imbio.2022.152245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Multiple sclerosis (MS), an immune-mediated and neurodegenerative disorder of the central nervous system (CNS), is characterized by infiltrating myelin-reactive T lymphocytes and demyelinating lesions. Experimental autoimmune encephalomyelitis (EAE) is a well-established animal model used to study MS. To explore the impact of chemokine receptor CCR1 blockade in EAE and the underlying mechanisms, we used CCR1 antagonist J-113863 in PLP139-151-induced EAE in SJL/J mice. Following EAE induction, mice were treated with J-113863 (10 mg/kg) daily from day 14 until day 25. We investigated the effect of J-113863 on expression levels of GM-CSF, IL-6, IL-10, IL-27 in CD4+ spleen cells, using flow cytometry. We also analyzed the effect of J-113863 on GM-CSF, IL-6, IL-10, IL-27 mRNA and protein expression levels using RT-PCR and Western blot analysis in brain tissues. J-113863 treatment decreased the populations of CD4+GM-CSF+ and CD4+IL-6+ cells and increased CD4+IL-27+ and CD4+IL-10+ cells in the spleen. J-113863 had a suppressive effect on the mRNA and protein expression levels of GM-CSF, and IL-6 in the brain tissue. On the other hand, J-113863 treatment increased the mRNA and protein expression of IL-10 and IL-27 in the brain tissue. Our results highlighted J-113863's potential role in suppressing pro-inflammatory expression and up-regulating anti-inflammatory mediators, which could represent a beneficial alternative approach to MS treatment.
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Affiliation(s)
- Mushtaq A Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ahmed Nadeem
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sabry M Attia
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Saleh A Bakheet
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mudassar Shahid
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Muneeb U Rehman
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammed M Alanazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah S Alhamed
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Khalid E Ibrahim
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Norah A Albekairi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sheikh F Ahmad
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
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Bonanno L, Ciurleo R, Marino S, Ruvolo C, Morabito R, Bramanti A, Corallo F. Effect of MAO-B Inhibitors on Neurometabolic Profile of Patients Affected by Parkinson Disease: A Proton Magnetic Resonance Spectroscopy Study. J Clin Med 2022; 11:1931. [PMID: 35407539 DOI: 10.3390/jcm11071931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 12/10/2022] Open
Abstract
Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder whose treatment is symptomatic. No suitable methods for assessing the effects of dopaminergic drugs on disease progression in clinical trials have yet been provided. The aim of this longitudinal study is to evaluate the influence of rasagiline and selegiline on neurometabolic profile in de novo PD patients by using Proton Magnetic Resonance Spectroscopy (1H-MRS). We enrolled de novo PD patients who were divided into two groups of 20 patients each, according to the dopaminergic treatment prescribed at the baseline visit (rasagiline or selegiline). At the baseline visit and after 12 months, all patients underwent neurological evaluation as well as 1H-MRS. Forty healthy controls (HC) underwent 1H-MRS at baseline and after 12 months. PD patients, compared to HC, showed significantly lower concentrations of NAA in the motor cortex, while the Cho levels showed a decreasing trend. After 12 months of therapy, the 1H-MRS study revealed that rasagiline and selegiline in a similar way were able to restore the NAA levels to values similar to those of HC. In addition, this neurometabolic change showed a correlation with UPDRS-III scores. This is the first longitudinal study that provides preliminary evidence that 1H-MRS may be a suitable method to evaluate objectively the influence of MAO-B inhibitors on the neurometabolic profile of PD patients. These results could open a new scenario on the hypothesis of a drug-induced slowing effect of PD progression.
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Mohamed AAB, Algahalan HA, Thabit MN. Correlation between functional MRI techniques and early disability in ambulatory patients with relapsing–remitting MS. Egypt J Neurol Psychiatry Neurosurg 2022. [DOI: 10.1186/s41983-022-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a common neurological disorder which can lead to an occasional damage to the central nervous system. Conventional magnetic resonance imaging (cMRI) is an important modality in the diagnosis of MS; however, correlation between cMRI findings and clinical impairment is weak. Non-conventional MRI techniques including apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (MRS) investigate the metabolic changes over the course of MS and overcome the limits of cMRI.
A total of 80 patients with MS and 20 age and sex-matched healthy control subjects were enrolled in this cross-sectional study. Ambulatory patients with relapsing–remitting MS (RRMS) were recruited. Expanded Disability Status Scale (EDSS) was used to assess the disability and the patients were categorized into three groups “no disability”, “minimal disability” and “moderate disability”. All patients underwent cMRI techniques. ADC was measured in MS plaques and in normal appearing white matter (NAWM) adjacent and around the plaque. All metabolites concentrations were expressed as ratios including N-acetyl-aspartate/creatine (NAA/Cr), choline/N-acetyl-aspartate (Cho/NAA) and choline/creatine (Cho/Cr). ADC and metabolite concentrations were measured in the normal white matter of 20 healthy control subjects.
Results
The study was carried on 80 MS patients [36 males (45%) and 44 females (55%)] and 20 healthy control [8 males (40%) and 12 females (60%)]. The ADC values and MRS parameters in NAWM of patients with MS were significantly different from those of the control group. The number of the plaques on T2 images and black holes were significantly higher at “Minimal disability” group. Most of the enhanced plaques were at the “Moderate disability” group with P value < 0.001. The mean of ADC in the group 1, 2 and 3 of disability was 1.12 ± 0.19, 1.50 ± 0.35, 1.51 ± 0.36, respectively, with P value < 0. 001. In the group 1, 2 and 3 of disability, the mean of NAA/Cr ratio at the plaque was 1.34 ± 0.44, 1.59 ± 0.51 and 1.11 ± 0.15, respectively, with P value equal 0.001.
Conclusion
The non-conventional quantitative MRI techniques are useful tools for detection of early disability in MS patients.
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Heckova E, Dal-Bianco A, Strasser B, Hangel GJ, Lipka A, Motyka S, Hingerl L, Rommer PS, Berger T, Hnilicová P, Kantorová E, Leutmezer F, Kurča E, Gruber S, Trattnig S, Bogner W. Extensive Brain Pathologic Alterations Detected with 7.0-T MR Spectroscopic Imaging Associated with Disability in Multiple Sclerosis. Radiology 2022; 303:141-150. [PMID: 34981978 DOI: 10.1148/radiol.210614] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background MR spectroscopic imaging (MRSI) allows in vivo assessment of brain metabolism and is of special interest in multiple sclerosis (MS), where morphologic MRI cannot depict major parts of disease activity. Purpose To evaluate the ability of 7.0-T MRSI to depict and visualize pathologic alterations in the normal-appearing white matter (NAWM) and cortical gray matter (CGM) in participants with MS and to investigate their relation to disability. Materials and Methods Free-induction decay MRSI was performed at 7.0 T. Participants with MS and age- and sex-matched healthy controls were recruited prospectively between January 2016 and December 2017. Metabolic ratios were obtained in white matter lesions, NAWM, and CGM regions. Subgroup analysis for MS-related disability based on Expanded Disability Status Scale (EDSS) scores was performed using analysis of covariance. Partial correlations were applied to explore associations between metabolic ratios and disability. Results Sixty-five participants with MS (mean age ± standard deviation, 34 years ± 9; 34 women) and 20 age- and sex-matched healthy controls (mean age, 32 years ± 7; 11 women) were evaluated. Higher signal intensity of myo-inositol (mI) with and without reduced signal intensity of N-acetylaspartate (NAA) was visible on metabolic images in the NAWM of participants with MS. A higher ratio of mI to total creatine (tCr) was observed in the NAWM of the centrum semiovale of all MS subgroups, including participants without disability (marginal mean ± standard error, healthy controls: 0.78 ± 0.04; EDSS 0-1: 0.86 ± 0.03 [P = .02]; EDSS 1.5-3: 0.95 ± 0.04 [P < .001]; EDSS ≥3.5: 0.94 ± 0.04 [P = .001]). A lower ratio of NAA to tCr was found in MS subgroups with disabilities, both in their NAWM (marginal mean ± standard error, healthy controls: 1.46 ± 0.04; EDSS 1.5-3: 1.33 ± 0.03 [P = .03]; EDSS ≥3.5: 1.30 ± 0.04 [P = .01]) and CGM (marginal mean ± standard error, healthy controls: 1.42 ± 0.05; EDSS ≥3.5: 1.23 ± 0.05 [P = .006]). mI/NAA correlated with EDSS (NAWM of centrum semiovale: r = 0.47, P < .001; parietal NAWM: r = 0.43, P = .002; frontal NAWM: r = 0.34, P = .01; frontal CGM: r = 0.37, P = .004). Conclusion MR spectroscopic imaging at 7.0 T allowed in vivo visualization of multiple sclerosis pathologic findings not visible at T1- or T2-weighted MRI. Metabolic abnormalities in the normal-appearing white matter and cortical gray matter were associated with disability. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Barker in this issue.
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Affiliation(s)
- Eva Heckova
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Assunta Dal-Bianco
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Bernhard Strasser
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Gilbert J Hangel
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Alexandra Lipka
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Stanislav Motyka
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Lukas Hingerl
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Paulus S Rommer
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Thomas Berger
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Petra Hnilicová
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Ema Kantorová
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Fritz Leutmezer
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Egon Kurča
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Stephan Gruber
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Siegfried Trattnig
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
| | - Wolfgang Bogner
- From the High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria (E.H., B.S., G.J.H., A.L., S.M., L.H., S.G., S.T., W.B.); Departments of Neurology (A.D.B., P.S.R., T.B., F.L.) and Neurosurgery (G.J.H.), Medical University of Vienna, Vienna, Austria; Biomedical Center Martin (P.H.) and Clinic of Neurology (E. Kantorová, E. Kurča), Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; and Karl Landsteiner Institute for Clinical Molecular MRI in Musculoskeletal System, Vienna, Austria (S.T.)
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10
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York EN, Martin SJ, Meijboom R, Thrippleton MJ, Bastin ME, Carter E, Overell J, Connick P, Chandran S, Waldman AD, Hunt DPJ. MRI-derived g-ratio and lesion severity in newly diagnosed multiple sclerosis. Brain Commun 2021; 3:fcab249. [PMID: 34877533 PMCID: PMC8643503 DOI: 10.1093/braincomms/fcab249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/19/2023] Open
Abstract
Myelin loss is associated with axonal damage in established multiple sclerosis. This relationship is challenging to study in vivo in early disease. Here, we ask whether myelin loss is associated with axonal damage at diagnosis by combining non-invasive neuroimaging and blood biomarkers. We performed quantitative microstructural MRI and single-molecule ELISA plasma neurofilament measurement in 73 patients with newly diagnosed, immunotherapy naïve relapsing-remitting multiple sclerosis. Myelin integrity was evaluated using aggregate g-ratios, derived from magnetization transfer saturation and neurite orientation dispersion and density imaging diffusion data. We found significantly higher g-ratios within cerebral white matter lesions (suggesting myelin loss) compared with normal-appearing white matter (0.61 versus 0.57, difference 0.036, 95% CI: 0.029-0.043, P < 0.001). Lesion volume (Spearman's rho rs= 0.38, P < 0.001) and g-ratio (rs= 0.24, P < 0.05) correlated independently with plasma neurofilament. In patients with substantial lesion load (n = 38), those with higher g-ratio (defined as greater than median) were more likely to have abnormally elevated plasma neurofilament than those with normal g-ratio (defined as less than median) [11/23 (48%) versus 2/15 (13%), P < 0.05]. These data suggest that, even at multiple sclerosis diagnosis, reduced myelin integrity is associated with axonal damage. MRI-derived g-ratio may provide useful additional information regarding lesion severity and help to identify individuals with a high degree of axonal damage at disease onset.
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Affiliation(s)
- Elizabeth N York
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Sarah-Jane Martin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Department of Neurosciences, University of Glasgow, Glasgow G51 4LB, UK
| | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | | | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Edwin Carter
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - James Overell
- Department of Neurosciences, University of Glasgow, Glasgow G51 4LB, UK
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Adam D Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - David P J Hunt
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, UK
- Anne Rowling Clinic, University of Edinburgh, Edinburgh EH16 4SB, UK
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11
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El Fayomy NM, Mohamed HH, Kamal MM, Alsayyad AH, Alsayyad EH, Shamloul RM. Signs of neuroinflammation outweigh neurodegeneration as predictors for early conversion to MS. Egypt J Neurol Psychiatry Neurosurg 2021. [DOI: 10.1186/s41983-021-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The pathophysiological mechanisms underlying multiple sclerosis include both inflammatory and degenerative processes. We aimed to study and compare markers of neuroinflammation and neurodegeneration in patients with first presentation of demyelinating disorder and to prospectively identify which of the studied markers serve as predictors for early conversion to multiple sclerosis. Thus, 42 patients with first clinical manifestations suggestive of demyelinating disease were included in a prospective study. Subjects underwent thorough history taking and clinical evaluation. Laboratory studies involved analysis of cerebrospinal fluid (CSF) and serum chitinase 3-like 1 levels. Brain imaging included MRI and ultrasonographic assessment.
Results
T1 black holes, elevated oligoclonal bands (OCB), high baseline T2 lesion load, and enhanced MRI lesions were significantly higher in patients with 1st attack multiple sclerosis. Significantly higher CSF-OCB and serum chitinase 3-like 1 protein was detected in patients with multiple sclerosis (MS) compared to clinically isolated syndrome, and higher levels in MS convertors than non-convertors. Cognitive dysfunction evaluated by MoCA test and brain atrophy assessed using transcranial sonography did not show significant difference among the studied groups. Logistic regression analysis showed that heavy T2 lesion load served as the only predictor of conversion to MS.
Conclusion
Early conversion to MS after first attack of demyelination is related to detection of signs of neuroinflammation rather than neurodegeneration.
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12
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Wang H, Wen H, Li J, Chen Q, Li S, Wang Y, Wang Z. Characterization of Brain Microstructural Abnormalities in High Myopia Patients: A Preliminary Diffusion Kurtosis Imaging Study. Korean J Radiol 2021; 22:1142-1151. [PMID: 33987989 PMCID: PMC8236370 DOI: 10.3348/kjr.2020.0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/28/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate microstructural damage in high myopia (HM) patients using 3T diffusion kurtosis imaging (DKI). Materials and Methods This prospective study included 30 HM patients and 33 age- and sex-matched healthy controls (HCs) with DKI. Kurtosis parameters including kurtosis fractional anisotropy (FA), mean kurtosis (MK), axial kurtosis (AK), and radial kurtosis (RK) as well as diffusion metrics including FA, mean diffusivity, axial diffusivity (AD), and radial diffusivity derived from DKI were obtained. Group differences in these metrics were compared using tract-based spatial statistics. Partial correlation analysis was used to evaluate correlations between microstructural changes and disease duration. Results Compared to HCs, HM patients showed significantly reduced AK, RK, MK, and FA and significantly increased AD, predominately in the bilateral corticospinal tract, right inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and left thalamus (all p < 0.05, threshold-free cluster enhancement corrected). In addition, DKI-derived kurtosis parameters (AK, RK, and MK) had negative correlations (r = −0.448 to −0.376, all p < 0.05) and diffusion parameter (AD) had positive correlations (r = 0.372 to 0.409, all p < 0.05) with disease duration. Conclusion HM patients showed microstructural alterations in the brain regions responsible for motor conduction and vision-related functions. DKI is useful for detecting white matter abnormalities in HM patients, which might be helpful for exploring and monitoring the pathogenesis of the disease.
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Affiliation(s)
- Huihui Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), School of Psychology, Southwest University, Chongqing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shanshan Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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13
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Freedman MS, Coyle PK, Comi G, L Scarberry S, Damian D, Hyvert Y, Dangond F, Galazka A, Jack D, Lebson LA, Leist TP. Early MRI outcomes in participants with a first clinical demyelinating event at risk of multiple sclerosis in the ORACLE-MS study. Mult Scler J Exp Transl Clin 2021; 7:2055217321990852. [PMID: 33717501 PMCID: PMC7925953 DOI: 10.1177/2055217321990852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background In the Phase 3, 96-week ORACLE-MS study, cladribine tablets 10 mg (3.5 or 5.25 mg/kg cumulative dosage over two years) significantly reduced lesions associated with multiple sclerosis versus placebo in participants following a first clinical demyelinating event (FCDE). Objective To determine the timing of effects of cladribine tablets on lesion activity assessed by magnetic resonance imaging (MRI). Methods This post hoc analysis assessed the effect of cladribine tablets versus placebo in ORACLE-MS on secondary MRI endpoints including T1 gadolinium-enhancing (Gd+), new or enlarging T2 lesions, and combined unique active lesions assessed on MRI scans performed at screening and every 3 months thereafter. Results Compared to placebo, cladribine tablets 3.5 mg/kg treatment appeared to lead to a trend of reductions in the mean number of T1 Gd+ lesions by Week 13 (first post-baseline scan: 0.37 vs. 1.00), new or enlarging T2 (0.20 vs. 1.01) and combined unique active (0.29 vs. 1.91) lesions by Week 24. Low lesion counts were maintained with cladribine tablets throughout 96 weeks. Similar results were observed with the 5.25 mg/kg dosage. Conclusion In participants with an FCDE, cladribine tablets appeared to reduce lesion numbers within 13 weeks (time of first evaluation).
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Affiliation(s)
- Mark S Freedman
- Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Patricia K Coyle
- Department of Neurology, Stony Brook University, Stony Brook, NY, USA
| | - Giancarlo Comi
- Institute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Doris Damian
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | - Fernando Dangond
- EMD Serono Research & Development Institute, Inc, Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | | | - Lori A Lebson
- EMD Serono, Inc, Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Jefferson University Hospital, Philadelphia, PA, USA
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Duncan GJ, Simkins TJ, Emery B. Neuron-Oligodendrocyte Interactions in the Structure and Integrity of Axons. Front Cell Dev Biol 2021; 9:653101. [PMID: 33763430 PMCID: PMC7982542 DOI: 10.3389/fcell.2021.653101] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
The myelination of axons by oligodendrocytes is a highly complex cell-to-cell interaction. Oligodendrocytes and axons have a reciprocal signaling relationship in which oligodendrocytes receive cues from axons that direct their myelination, and oligodendrocytes subsequently shape axonal structure and conduction. Oligodendrocytes are necessary for the maturation of excitatory domains on the axon including nodes of Ranvier, help buffer potassium, and support neuronal energy metabolism. Disruption of the oligodendrocyte-axon unit in traumatic injuries, Alzheimer's disease and demyelinating diseases such as multiple sclerosis results in axonal dysfunction and can culminate in neurodegeneration. In this review, we discuss the mechanisms by which demyelination and loss of oligodendrocytes compromise axons. We highlight the intra-axonal cascades initiated by demyelination that can result in irreversible axonal damage. Both the restoration of oligodendrocyte myelination or neuroprotective therapies targeting these intra-axonal cascades are likely to have therapeutic potential in disorders in which oligodendrocyte support of axons is disrupted.
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Affiliation(s)
- Greg J Duncan
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Tyrell J Simkins
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,Vollum Institute, Oregon Health & Science University, Portland, OR, United States.,Department of Neurology, VA Portland Health Care System, Portland, OR, United States
| | - Ben Emery
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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15
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Weber CE, Nagel K, Ebert A, Roßmanith C, Paschke N, Adlung A, Platten M, Schad LR, Gass A, Eisele P. Diffusely appearing white matter in multiple sclerosis: Insights from sodium ( 23Na) MRI. Mult Scler Relat Disord 2021; 49:102752. [PMID: 33486402 DOI: 10.1016/j.msard.2021.102752] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In multiple sclerosis (MS), magnetic resonance imaging (MRI) frequently shows ill-defined areas with intermediate signal intensity between the normal appearing white matter (NAWM) and focal T2-hyperintense lesions, termed "diffusely appearing white matter" (DAWM). Even though several advanced MRI techniques have shown the potential to detect and quantify subtle commonly not visible microscopic tissue changes, to date only a few advanced MRI studies investigated DAWM changes in a quantitative manner. The aim of this study was to detect and quantify tissue abnormalities in the DAWM in comparison to focal lesions and the NAWM in MS patients by sodium (23Na) MRI. METHODS 23Na and conventional MRI were performed in 25 MS patients with DAWM (DAWM+) and in 25 sex- and age matched MS patients without DAWM (DAWM-), as well as in ten healthy controls (HC). Mean total sodium concentrations (TSC) were quantified in the DAWM, NAWM, normal appearing grey matter (NAGM) and in focal MS lesions. RESULTS In MS DAWM+and DAWM-, TSC values were increased in the NAGM (DAWM+: 44.61 ± 4.09 mM; DAWM-: 45.37 ± 3.8 mM) and in the NAWM (DAWM+: 39.85 ± 3.89 mM; DAWM-: 39.82 ± 4.25 mM) compared to normal grey and white matter in HC (GM 40.87 ± 3.25 mM, WM 35.9 ± 1.81 mM; p < 0.05 for all comparisons). Interestingly, the DAWM showed similar sodium concentrations (39.32 ± 4.59 mM) to the NAWM (39.85 ± 3.89 mM), whereas TSC values in T1 hypointense (46.53 ± 7.87 mM) and T1 isointense (41.99 ± 6.10 mM) lesions were significantly higher than in the DAWM (p < 0.001 and 0.017 respectively). CONCLUSION 23Na MRI is confirmed as a sensitive marker of even subtle tissue abnormalities. DAWM sodium levels are increased and comparable to the abnormalities in NAWM, suggesting pathological changes less severe than in focal lesions comparable to what is expected in the NAWM.
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17
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Cree BAC, Bowen JD, Hartung HP, Vermersch P, Hughes B, Damian D, Hyvert Y, Dangond F, Galazka A, Grosso M, Jones DL, Leist TP. Subgroup analysis of clinical and MRI outcomes in participants with a first clinical demyelinating event at risk of multiple sclerosis in the ORACLE-MS study. Mult Scler Relat Disord 2020; 49:102695. [PMID: 33578191 DOI: 10.1016/j.msard.2020.102695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 12/12/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND In the Phase 3, 96-week ORACLE-MS study, cladribine 10 mg tablets (3.5 mg/kg or 5.25 mg/kg cumulative dose over 2 years) significantly reduced the rate of conversion to clinically definite multiple sclerosis (CDMS) per the Poser criteria (henceforth referred to as CDMS), multiple sclerosis (MS) per the 2005 McDonald criteria, and the number of new or persisting T1 gadolinium-enhancing (Gd+), new or enlarging T2, and combined unique active (CUA) lesions versus placebo in participants with a first clinical demyelinating event (FCDE). Patient demographic and disease characteristics may be predictors of disease progression. The current study analyzed the effect of cladribine tablets in subgroups of participants in the ORACLE-MS study by baseline demographics and disease characteristics. METHODS This analysis retrospectively examined data collected from 616 participants enrolled in the ORACLE-MS study (placebo, n=206; cladribine tablets 3.5 mg/kg, n=206; cladribine tablets 5.25 mg/kg, n=204). Five subgroups were predetermined by baseline demographics, including sex, age (<30 or ≥30 years), classification of FCDE, and lesion characteristics, including absence or presence of T1 Gd+ lesions and number of T2 lesions (<9 or ≥9). Selected endpoints of the ORACLE-MS study were re-analyzed for these subgroups. The primary and main secondary endpoints were time to conversion to CDMS and MS (2005 McDonald criteria), respectively. Secondary magnetic resonance imaging (MRI) endpoints included cumulative T1 Gd+ and new or enlarging T2 lesions. Cox proportional hazards models were used to evaluate time to conversion to CDMS and MS (2005 McDonald criteria). This analysis focused primarily on the results for the cladribine tablets 3.5 mg/kg group because this dosage is approved for relapsing forms of MS. RESULTS In the overall intent-to-treat (ITT) population, cladribine tablets 3.5 mg/kg significantly reduced the risk of conversion to CDMS (hazard ratio [HR]=0.326; P<0.0001) and MS (2005 McDonald criteria; HR=0.485; P<0.0001) versus placebo. Similar effects of cladribine tablets on risk of conversion were observed in post hoc analyses of subgroups defined by various baseline characteristics. In both the ITT population and across subgroups, cladribine tablets 3.5 mg/kg reduced the numbers of cumulative T1 Gd+ (range of rate ratios: 0.106-0.399), new or enlarging T2 (range of rate ratios: 0.178-0.485), and CUA (range of rate ratios: 0.154-0.384) lesions versus placebo (all nominal P<0.03). Multivariate Cox proportional hazards models revealed that age (HR=0.577, nominal P<0.0001), FCDE classification (HR=0.738, nominal P=0.0043), presence of T1 Gd+ lesions (HR=0.554, nominal P<0.0001), and number of T2 lesions (HR=0.417, nominal P<0.0001) at baseline were factors associated with risk of conversion to MS (2005 McDonald criteria), whereas no baseline factors examined were associated with risk of conversion to CDMS. CONCLUSION In this post hoc analysis of the ORACLE-MS study, cladribine tablets reduced the risk of conversion to multiple sclerosis and lesion burden in participants with an FCDE in the overall ITT population and multiple subgroups defined by baseline demographics and lesion characteristics.
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Affiliation(s)
- Bruce A C Cree
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - James D Bowen
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Hans-Peter Hartung
- Department of Neurology, University Hospital of Düsseldorf, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Patrick Vermersch
- University of Lille, INSERM U1172, Lille Neurosciences and Cognition, CHU Lille, FHU Imminent, F-59000 Lille, France
| | - Bruce Hughes
- MercyOne Ruan Multiple Sclerosis Center, Des Moines, IA, USA
| | - Doris Damian
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | - Fernando Dangond
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | | | - Megan Grosso
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Daniel L Jones
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Jefferson University, Philadelphia, PA, USA
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Solanky BS, John NA, DeAngelis F, Stutters J, Prados F, Schneider T, Parker RA, Weir CJ, Monteverdi A, Plantone D, Doshi A, MacManus D, Marshall I, Barkhof F, Gandini Wheeler-Kingshott CAM, Chataway J. NAA is a Marker of Disability in Secondary-Progressive MS: A Proton MR Spectroscopic Imaging Study. AJNR Am J Neuroradiol 2020; 41:2209-2218. [PMID: 33154071 DOI: 10.3174/ajnr.a6809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The secondary progressive phase of multiple sclerosis is characterised by disability progression due to processes that lead to neurodegeneration. Surrogate markers such as those derived from MRI are beneficial in understanding the pathophysiology that drives disease progression and its relationship to clinical disability. We undertook a 1H-MRS imaging study in a large secondary progressive MS (SPMS) cohort, to examine whether metabolic markers of brain injury are associated with measures of disability, both physical and cognitive. MATERIALS AND METHODS A cross-sectional analysis of individuals with secondary-progressive MS was performed in 119 participants. They underwent 1H-MR spectroscopy to obtain estimated concentrations and ratios to total Cr for total NAA, mIns, Glx, and total Cho in normal-appearing WM and GM. Clinical outcome measures chosen were the following: Paced Auditory Serial Addition Test, Symbol Digit Modalities Test, Nine-Hole Peg Test, Timed 25-foot Walk Test, and the Expanded Disability Status Scale. The relationship between these neurometabolites and clinical disability measures was initially examined using Spearman rank correlations. Significant associations were then further analyzed in multiple regression models adjusting for age, sex, disease duration, T2 lesion load, normalized brain volume, and occurrence of relapses in 2 years preceding study entry. RESULTS Significant associations, which were then confirmed by multiple linear regression, were found in normal-appearing WM for total NAA (tNAA)/total Cr (tCr) and the Nine-Hole Peg Test (ρ = 0.23; 95% CI, 0.06-0.40); tNAA and tNAA/tCr and the Paced Auditory Serial Addition Test (ρ = 0.21; 95% CI, 0.03-0.38) (ρ = 0.19; 95% CI, 0.01-0.36); mIns/tCr and the Paced Auditory Serial Addition Test, (ρ = -0.23; 95% CI, -0.39 to -0.05); and in GM for tCho and the Paced Auditory Serial Addition Test (ρ = -0.24; 95% CI, -0.40 to -0.06). No other GM or normal-appearing WM relationships were found with any metabolite, with associations found during initial correlation testing losing significance after multiple linear regression analysis. CONCLUSIONS This study suggests that metabolic markers of neuroaxonal integrity and astrogliosis in normal-appearing WM and membrane turnover in GM may act as markers of disability in secondary-progressive MS.
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Affiliation(s)
- B S Solanky
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - N A John
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - F DeAngelis
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - J Stutters
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - F Prados
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Centre for Medical Image Computing (F.P., F.B.), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Universitat Oberta de Catalunya (F.P.), Barcelona, Spain
| | | | - R A Parker
- Edinburgh Clinical Trials Unit (R.A.P., C.J.W.), Usher Institute
| | - C J Weir
- Edinburgh Clinical Trials Unit (R.A.P., C.J.W.), Usher Institute
| | - A Monteverdi
- Department of Brain and Behavioural Sciences (A.M., C.A.M.G.W.-K.), University of Pavia, Pavia, Italy
| | - D Plantone
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - A Doshi
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - D MacManus
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
| | - I Marshall
- Centre for Clinical Brain Sciences (I.M.), University of Edinburgh, Edinburgh, UK
| | - F Barkhof
- Centre for Medical Image Computing (F.P., F.B.), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- National Institute for Health Research (F.B.), University College London Hospitals Biomedical Research Centre, London, UK
- Department of Radiology and Nuclear Medicine (F.B., J.C.), MS Center Amsterdam, Amsterdam, the Netherlands
| | - C A M Gandini Wheeler-Kingshott
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Brain MRI 3T Research Center (C.A.M.G.W.-K.), Scientific Institute for Research, Hospitalization and Healthcare Mondino National Neurological Institute Foundation, Pavia, Italy
- Department of Brain and Behavioural Sciences (A.M., C.A.M.G.W.-K.), University of Pavia, Pavia, Italy
| | - J Chataway
- From the Department of Neuroinflammation (B.S.S., N.A.J., F.D., J.S., F.P., D.P., A.D., D.M., C.A.M.G.W.-K., J.C.), Faculty of Brain Sciences, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology
- Department of Radiology and Nuclear Medicine (F.B., J.C.), MS Center Amsterdam, Amsterdam, the Netherlands
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Schmidt E, Schinke C, Rullmann M, Luthardt J, Becker GA, Haars S, Stoppe M, Lobsien D, Hoffmann KT, Sabri O, Hesse S, Then Bergh F. Changes of central noradrenaline transporter availability in immunotherapy-naïve multiple sclerosis patients. Sci Rep 2020; 10:14651. [PMID: 32887904 DOI: 10.1038/s41598-020-70732-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/17/2020] [Indexed: 02/07/2023] Open
Abstract
The neurotransmitter noradrenaline (NA) mediates arousal, attention and mood, and exerts anti-inflammatory and neuroprotective effects. Alterations of monoamine signalling were reported in multiple sclerosis (MS) and psychiatric illness and may account for the high prevalence of comorbid depression and fatigue in MS patients. We assessed central noradrenaline transporter (NAT) availability using positron emission tomography (PET) and the NAT selective radiotracer S,S-[11C]O-methylreboxetine in immunotherapy-naïve patients with relapsing–remitting MS (RRMS; n = 11) compared to healthy controls (HC; n = 12), and its association to lesion load, time since manifestation, the expanded disability status scale (EDSS), the fatigue scale Würzburger Erschöpfungsinventar bei MS (WEIMuS) and Beck Depression Inventory (BDI). We found NAT availability to be increased in the thalamus, amygdala, putamen and pons/midbrain of MS patients. No relation to clinical or psychometric variables was found. These first data indicate higher NAT availability in subcortical brain regions of immunotherapy-naïve RRMS patients. If these changes of noradrenergic neurotransmission predispose to psychiatric symptoms or associate with disease activity needs to be investigated in longitudinal studies or a larger sample which allows subgroup analyses.
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20
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Iacobaeus E, Arrambide G, Amato MP, Derfuss T, Vukusic S, Hemmer B, Tintore M, Brundin L. Aggressive multiple sclerosis (1): Towards a definition of the phenotype. Mult Scler 2020; 26:1352458520925369. [PMID: 32530385 PMCID: PMC7412876 DOI: 10.1177/1352458520925369] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023]
Abstract
While the major phenotypes of multiple sclerosis (MS) and relapsing-remitting, primary and secondary progressive MS have been well characterized, a subgroup of patients with an active, aggressive disease course and rapid disability accumulation remains difficult to define and there is no consensus about their management and treatment. The current lack of an accepted definition and treatment guidelines for aggressive MS triggered a 2018 focused workshop of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) on aggressive MS. The aim of the workshop was to discuss approaches on how to describe and define the disease phenotype and its treatments. Unfortunately, it was not possible to come to consensus on a definition because of unavailable data correlating severe disease with imaging and molecular biomarkers. However, the workshop highlighted the need for future research needed to define this disease subtype while also focusing on its treatment and management. Here, we review previous attempts to define aggressive MS and present characteristics that might, with additional research, eventually help characterize it. A companion paper summarizes data regarding treatment and management.
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Affiliation(s)
- Ellen Iacobaeus
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d’Esclerosi Múltiple de Catalunya, (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Pia Amato
- Department NeuroFarBa, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandra Vukusic
- Service de neurologie, Sclérose en plaques, Pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon/Bron, France; Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia. Centre d’Esclerosi Múltiple de Catalunya, (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lou Brundin
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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21
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Andravizou A, Siokas V, Artemiadis A, Bakirtzis C, Aloizou AM, Grigoriadis N, Kosmidis MH, Nasios G, Messinis L, Hadjigeorgiou G, Dardiotis E, Peristeri E. Clinically reliable cognitive decline in relapsing remitting multiple sclerosis: Is it the tip of the iceberg? Neurol Res 2020; 42:575-586. [PMID: 32427076 DOI: 10.1080/01616412.2020.1761175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Cognitive impairment is common in multiple sclerosis, but the brain MRI correlates in relapsing remitting multiple sclerosis remain controversial. The current study aimed to investigate whether cognitive decline can be predicted by global and/or regional brain atrophy. METHODS Sixty-three patients with relapsing remitting multiple sclerosis (36 men, mean age 39.9 ± 9.4 years old, mean EDSS 1.4 ± 1.2, mean disease duration 4.9 ± 4.3 years) and 46 healthy controls (21 men, mean age 37.5 ± 10.8 years old) were included. Demographic data were obtained, and a longitudinal neuropsychological and global and regional MRI brain volume assessment was performed. RESULTS The patients performed worse than controls in most neuropsychological tests at baseline. The percentage of patients with clinically meaningful cognitive decline ranged from only 0% to 7.9%. Statistically significant volume reduction was found for all MRI measures except for the left accumbens nucleus. Whole or regional brain atrophy ranged from -0.02% to -0.25%, with subcortical structures showing the largest atrophy rates. A total of 22.2% to 93.7% patients showed atrophy across the brain structures assessed volumetrically. DISCUSSION It was regional rather than whole-brain changes that significantly predicted cognitive decline for the patients in the tasks that tested processing speed, visuo-spatial and inhibition skills. The overall data suggest that the progression of cognitive impairment in relapsing remitting multiple sclerosis as captured by conventional neuropsychological testing is the tip of the iceberg of neurodegenerative sequelae in the disease. Also, regional volumetric changes are better than whole-brain atrophy at predicting cognitive dysfunction.
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Affiliation(s)
- Athina Andravizou
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece
| | - Artemios Artemiadis
- Department of Neurology, Medical School, University of Cyprus , Nicosia, Cyprus
| | - Christos Bakirtzis
- Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina , Ioannina, Greece
| | | | - Georgios Hadjigeorgiou
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece.,Department of Neurology, Medical School, University of Cyprus , Nicosia, Cyprus
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece
| | - Eleni Peristeri
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, University of Thessaly, University Hospital of Larissa , Larissa, Greece
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22
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Lünemann JD, Diaz-Diaz J, Stankoff B, Young C, Siva A, Miller A, Lubetzki C, Wiendl H, Oreja-Guevara C. Highlights from the 2019 European Congress on Treatment and Research in Multiple Sclerosis (ECTRIMS 2019). Mult Scler 2020; 26:859-868. [PMID: 32364431 DOI: 10.1177/1352458520918377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The 2019 ECTRIMS Congress, in Stockholm, has had record-breaking figures for both attendance and scientific production. There were 9361 participants from 100 different countries for a total of 1541 abstracts. Upon invitation of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) executive committee, the authors of this meeting report assessed abstracts from all poster and oral presentations for novelty, scientific quality and relevance for basic and clinical multiple sclerosis (MS) research. The objective of this report is to highlight a selection of basic, translational and clinical studies out of the many outstanding projects that were presented. Abstracts and references cited in our report were chosen at the discretion of the authors and all co-authors and the ECTRIMS executive committee agreed on the selection. In the event of discrepancies between the abstract and the uploaded poster or presentation, we aimed to present data derived from the poster or presentation. All abstracts are accessible through the ECTRIMS online library ( https://onlinelibrary.ectrimscongress.eu/ectrims/#!*menu=36*browseby=3*sortby=2*ce_id=160 ) and also published in this journal (Volume 25 Issue 2_suppl, September 2019; https://journals.sagepub.com/toc/msja/25/2_suppl ). A few additional references from the literature were added but were restricted to the ones that authors considered as absolutely required for an optimized understanding of the topics highlighted.
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Affiliation(s)
- Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Judit Diaz-Diaz
- Department of Neurology, Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - Bruno Stankoff
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, APHP, Paris, France
| | - Carolyn Young
- Walton Centre NHS Trust, Liverpool, UK; University of Liverpool, Liverpool, UK
| | - Aksel Siva
- Istanbul University Cerrahpaşa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Aaron Miller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine Lubetzki
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, APHP, Paris, France
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain/Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM) and IdISSC, Madrid, Spain
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Celarain N, Tomas-Roig J. Aberrant DNA methylation profile exacerbates inflammation and neurodegeneration in multiple sclerosis patients. J Neuroinflammation 2020; 17:21. [PMID: 31937331 PMCID: PMC6961290 DOI: 10.1186/s12974-019-1667-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system characterised by incoordination, sensory loss, weakness, changes in bladder capacity and bowel function, fatigue and cognitive impairment, creating a significant socioeconomic burden. The pathogenesis of MS involves both genetic susceptibility and exposure to distinct environmental risk factors. The gene x environment interaction is regulated by epigenetic mechanisms. Epigenetics refers to a complex system that modifies gene expression without altering the DNA sequence. The most studied epigenetic mechanism is DNA methylation. This epigenetic mark participates in distinct MS pathophysiological processes, including blood-brain barrier breakdown, inflammatory response, demyelination, remyelination failure and neurodegeneration. In this study, we also accurately summarised a list of environmental factors involved in the MS pathogenesis and its clinical course. A literature search was conducted using MEDLINE through PubMED and Scopus. In conclusion, an exhaustive study of DNA methylation might contribute towards new pharmacological interventions in MS by use of epigenetic drugs.
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Affiliation(s)
- Naiara Celarain
- Girona Neuroimmunology and Multiple Sclerosis Unit (UNIEM), Dr. Josep Trueta University Hospital and Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
| | - Jordi Tomas-Roig
- Girona Neuroimmunology and Multiple Sclerosis Unit (UNIEM), Dr. Josep Trueta University Hospital and Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
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Swanberg KM, Landheer K, Pitt D, Juchem C. Quantifying the Metabolic Signature of Multiple Sclerosis by in vivo Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker. Front Neurol 2019; 10:1173. [PMID: 31803127 PMCID: PMC6876616 DOI: 10.3389/fneur.2019.01173] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) offers a growing variety of methods for querying potential diagnostic biomarkers of multiple sclerosis in living central nervous system tissue. For the past three decades, 1H-MRS has enabled the acquisition of a rich dataset suggestive of numerous metabolic alterations in lesions, normal-appearing white matter, gray matter, and spinal cord of individuals with multiple sclerosis, but this body of information is not free of seeming internal contradiction. The use of 1H-MRS signals as diagnostic biomarkers depends on reproducible and generalizable sensitivity and specificity to disease state that can be confounded by a multitude of influences, including experiment group classification and demographics; acquisition sequence; spectral quality and quantifiability; the contribution of macromolecules and lipids to the spectroscopic baseline; spectral quantification pipeline; voxel tissue and lesion composition; T1 and T2 relaxation; B1 field characteristics; and other features of study design, spectral acquisition and processing, and metabolite quantification about which the experimenter may possess imperfect or incomplete information. The direct comparison of 1H-MRS data from individuals with and without multiple sclerosis poses a special challenge in this regard, as several lines of evidence suggest that experimental cohorts may differ significantly in some of these parameters. We review the existing findings of in vivo1H-MRS on central nervous system metabolic abnormalities in multiple sclerosis and its subtypes within the context of study design, spectral acquisition and processing, and metabolite quantification and offer an outlook on technical considerations, including the growing use of machine learning, by future investigations into diagnostic biomarkers of multiple sclerosis measurable by 1H-MRS.
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Affiliation(s)
- Kelley M Swanberg
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - Karl Landheer
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States.,Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, United States
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25
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Eigel D, Zoupi L, Sekizar S, Welzel PB, Werner C, Williams A, Newland B. Cryogel scaffolds for regionally constrained delivery of lysophosphatidylcholine to central nervous system slice cultures: A model of focal demyelination for multiple sclerosis research. Acta Biomater 2019; 97:216-229. [PMID: 31425890 DOI: 10.1016/j.actbio.2019.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022]
Abstract
The pathology of multiple sclerosis (MS) is typified by focal demyelinated areas of the brain and spinal cord, which results in axonal degeneration and atrophy. Although the field has made much progress in developing immunomodulatory therapies to reduce the occurrence of these focal lesions, there is a conspicuous lack of licensed effective therapies to reduce axonal degeneration or promote repair. Remyelination, carried out by oligodendrocytes, does occur in MS, and is protective against axonal degeneration. Unfortunately, remyelination is not very efficient, and ultimately fails and so there is a research focus to generate new therapeutics to enhance remyelination leading to neuroprotection. To develop these therapies, we need preclinical models that well reflect remyelination in MS. We have previously characterized an ex vivo model that uses lysophosphatidylcholine (LPC) to cause acute and global demyelination of tissue slices, followed by spontaneous remyelination, which has been widely used as a surrogate for in vivo rodent models of demyelination. However, this ex vivo model lacks the focal demyelinated lesions seen in MS, surrounded by normal tissue from which the repairing oligodendrocytes are derived. Therefore, to improve the model, we have developed and characterized small macroporous cryogel scaffolds for controlled/regional delivery of LPC with diameters of either 0.5, 1 or 2 mm. Placement of LPC loaded scaffolds adjacent to ex vivo cultured mouse brain and spinal cord slices induced focal areas of demyelination in proximity to the scaffold. To the best of our knowledge, this is the first such report of spatial mimicry of the in vivo condition in ex vivo tissue culture. This will allow not only the investigation into focal lesions, but also provides a better platform technology with which to test remyelination-promoting therapeutics. STATEMENT OF SIGNIFICANCE: This manuscript is the first report of using macroporous hydrogels (cryogels) as a research tool for lysophosphatidylcholine (LPC) delivery, in order to create an ex vivo model of focal demyelination in the brain and spinal cord, which is of great relevance to multiple sclerosis research. Here, we transform an existing ex vivo model of demyelination by delivering LPC to focal regions of brain and spinal cord slice cultures. We have developed an easy-to-handle cylindrical and macroporous PEG-based sponge-like scaffold material (cryogel) that can deliver LPC only to a small area of the slice. Such cryogels are ideal as a delivery system in this culture model as they exhibit a soft but robust nature, with high mechanical deformability in their dry and swollen state, with no need to stay permanently hydrated. In addition, the synthesis of these cryogels is simple and easy to reproduce via photochemical cryopolymerisation using a PEG-diacrylate monomer and a photoinitiator, which are both commercially available. This more accurate model of demyelination will not only allow researchers to gain a better understanding of the CNS remyelination process in diseases such as MS, but also provides a platform technology, which could be utilized to screen and test pro-remyelination compounds which may help to find new therapeutics for progressive MS.
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Affiliation(s)
- Dimitri Eigel
- Leibniz-Institut für Polymerforschung Dresden e.V., Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, D-01069 Dresden, Germany
| | - Lida Zoupi
- MRC-Centre for Regenerative Medicine, University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, EH16 4UU Edinburgh, UK
| | - Sowmya Sekizar
- MRC-Centre for Regenerative Medicine, University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, EH16 4UU Edinburgh, UK
| | - Petra B Welzel
- Leibniz-Institut für Polymerforschung Dresden e.V., Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, D-01069 Dresden, Germany
| | - Carsten Werner
- Leibniz-Institut für Polymerforschung Dresden e.V., Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, D-01069 Dresden, Germany
| | - Anna Williams
- MRC-Centre for Regenerative Medicine, University of Edinburgh, Edinburgh BioQuarter, 5 Little France Drive, EH16 4UU Edinburgh, UK.
| | - Ben Newland
- Leibniz-Institut für Polymerforschung Dresden e.V., Max Bergmann Center of Biomaterials Dresden, Hohe Straße 6, D-01069 Dresden, Germany; School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, UK.
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Barkhof F, Kappos L, Wolinsky JS, Li DKB, Bar-Or A, Hartung HP, Belachew S, Han J, Julian L, Sauter A, Napieralski J, Koendgen H, Hauser SL. Onset of clinical and MRI efficacy of ocrelizumab in relapsing multiple sclerosis. Neurology 2019; 93:e1778-e1786. [PMID: 31484710 PMCID: PMC6946481 DOI: 10.1212/wnl.0000000000008189] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/30/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the onset of ocrelizumab efficacy on brain MRI measures of disease activity in the phase II study in relapsing-remitting multiple sclerosis (RRMS), and relapse rate in the pooled phase III studies in relapsing multiple sclerosis (RMS). Methods Brain MRI activity was determined in the phase II trial at monthly intervals in patients with RRMS receiving placebo, ocrelizumab (600 mg), or intramuscular interferon (IFN) β-1a (30 μg). Annualized relapse rate (ARR; over various epochs) and time to first relapse were analyzed in the pooled population of the phase III OPERA (A Study of Ocrelizumab in Comparison With Interferon Beta-1a [Rebif] in Participants With Relapsing Multiple Sclerosis) I and OPERA II trials in patients with RMS receiving ocrelizumab (600 mg) or subcutaneous IFN-β-1a (44 μg). Results In patients with RRMS, ocrelizumab reduced the number of new T1 gadolinium-enhancing lesions by week 4 vs placebo (p = 0.042) and by week 8 vs intramuscular IFN-β-1a (p < 0.001). Ocrelizumab also reduced the number of new or enlarging T2 lesions appearing between weeks 4 and 8 vs both placebo and IFN-β-1a (both p < 0.001). In patients with RMS, ocrelizumab significantly reduced ARR (p = 0.005) and the probability of time to first protocol-defined relapse (p = 0.014) vs subcutaneous IFN-β-1a within the first 8 weeks. Conclusion Epoch analysis of MRI-measured lesion activity in the phase II study and relapse rate in the phase III studies consistently revealed a rapid suppression of acute MRI and clinical disease activity following treatment initiation with ocrelizumab in patients with RRMS and RMS, respectively. Classification of evidence This study provides Class II evidence that for patients with RRMS and RMS, ocrelizumab suppressed MRI activity within 4 weeks and clinical disease activity within 8 weeks.
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Affiliation(s)
- Frederik Barkhof
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA.
| | - Ludwig Kappos
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jerry S Wolinsky
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - David K B Li
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Amit Bar-Or
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Hans-Peter Hartung
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Shibeshih Belachew
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jian Han
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Laura Julian
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Annette Sauter
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Julie Napieralski
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Harold Koendgen
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Stephen L Hauser
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
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Martin SJ, McGlasson S, Hunt D, Overell J. Cerebrospinal fluid neurofilament light chain in multiple sclerosis and its subtypes: a meta-analysis of case-control studies. J Neurol Neurosurg Psychiatry 2019; 90:1059-1067. [PMID: 31123141 PMCID: PMC6820150 DOI: 10.1136/jnnp-2018-319190] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 02/13/2019] [Accepted: 04/16/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Neurofilament is a biomarker of axonal injury proposed as a useful adjunct in the monitoring of patients with multiple sclerosis (MS). We conducted a systematic review and meta-analysis of case-control studies that have measured neurofilament light chain (NfL) levels in cerebrospinal fluid (CSF) of people with MS (pwMS), in order to determine whether, and to what degree, CSF NfL levels differentiate MS from controls, or the subtypes or stages of MS from each other. METHODS Guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Electronic databases were searched for published and 'grey' literature, with 151 hits. Of 51 full articles screened, 20 were included in qualitative analysis, and 14 in meta-analysis. RESULTS CSF NfL was higher in 746 pwMS than 435 (healthy and disease) controls, with a moderate effect size of 0.61 (p < 0.00001). Mean CSF NfL levels were significantly higher in 176 pwMS with relapsing disease than 92 with progressive disease (2124.8 ng/L, SD 3348.9 vs 1121.4 ng/L, SD 947.7, p = 0.0108). CSF NfL in 138 pwMS in relapse (irrespective of MS subtype) was double that seen in 268 pwMS in remission (3080.6 ng/L, SD 4715.9 vs 1541.7 ng/L, SD 2406.5, p < 0.0001). CONCLUSIONS CSF NfL correlates with MS activity throughout the course of MS, reflecting the axonal damage in pwMS. Relapse is more strongly associated with elevated CSF NfL levels than the development of progression, and NfL may be most useful as a marker of disease 'activity' rather than as a marker of disability or disease stage.
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Affiliation(s)
- Sarah-Jane Martin
- Anne Rowling Centre for Regenerative Neurology, University of Edinburgh, Edinburgh, UK .,University of Glasgow, Glasgow, UK
| | - Sarah McGlasson
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - James Overell
- University of Glasgow, Glasgow, UK.,Glasgow Multiple Sclerosis Clinical Research Centre, Queen Elizabeth University Hospital, Glasgow, UK
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28
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Cisneros-Mejorado AJ, Garay E, Ortiz-Retana J, Concha L, Moctezuma JP, Romero S, Arellano RO. Demyelination-Remyelination of the Rat Caudal Cerebellar Peduncle Evaluated with Magnetic Resonance Imaging. Neuroscience 2019; 439:255-267. [PMID: 31299350 DOI: 10.1016/j.neuroscience.2019.06.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 01/20/2023]
Abstract
Remyelination is common under physiological conditions and usually occurs as a response to a pathological demyelinating event. Its potentiation is an important goal for the development of therapies against pathologies such as multiple sclerosis and white matter injury. Visualization and quantification in vivo of demyelination and remyelination processes are essential for longitudinal studies that will allow the testing and development of pro-myelinating strategies. In this study, ethidium bromide (EB) was stereotaxically injected into the caudal cerebellar peduncle (c.c.p.) in rats to produce demyelination; the resulting lesion was characterized (i) transversally through histology using Black-Gold II (BGII) staining, and (ii) longitudinally through diffusion-weighted magnetic resonance imaging (dMRI), by computing fractional anisotropy (FA) and diffusivity parameters to detect microstructural changes. Using this characterization, we evaluated, in the lesioned c.c.p., the effect of N-butyl-β-carboline-3-carboxylate (β-CCB), a potentiator of GABAergic signaling in oligodendrocytes. The dMRI analysis revealed significant changes in the anisotropic and diffusivity properties of the c.c.p. A decreased FA and increased radial diffusivity (λ⊥) were evident following c.c.p. lesioning. These changes correlated strongly with an apparent decrease in myelin content as evidenced by BGII. Daily systemic β-CCB administration for 2 weeks in lesioned animals increased FA and decreased λ⊥, suggesting an improvement in myelination, which was supported by histological analysis. This study shows that structural changes in the demyelination-remyelination of the caudal cerebellar peduncle (DRCCP) model can be monitored longitudinally by MRI, and it suggests that remyelination is enhanced by β-CCB treatment. This article is part of a Special Issue entitled: Honoring Ricardo Miledi - outstanding neuroscientist of XX-XXI centuries.
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Affiliation(s)
- Abraham J Cisneros-Mejorado
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Edith Garay
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Juan Ortiz-Retana
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Luis Concha
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Juan P Moctezuma
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Samuel Romero
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico
| | - Rogelio O Arellano
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Juriquilla Querétaro, CP 76230, Querétaro, Mexico.
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Hiratsuka D, Kurganov E, Furube E, Morita M, Miyata S. VEGF- and PDGF-dependent proliferation of oligodendrocyte progenitor cells in the medulla oblongata after LPC-induced focal demyelination. J Neuroimmunol 2019; 332:176-186. [DOI: 10.1016/j.jneuroim.2019.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 12/27/2022]
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30
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Yarraguntla K, Bao F, Lichtman-Mikol S, Razmjou S, Santiago-Martinez C, Seraji-Bozorgzad N, Sriwastava S, Bernitsas E. Characterizing Fatigue-Related White Matter Changes in MS: A Proton Magnetic Resonance Spectroscopy Study. Brain Sci 2019; 9:E122. [PMID: 31137831 DOI: 10.3390/brainsci9050122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/20/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022] Open
Abstract
Few cross-sectional studies have investigated the correlation between neurochemical changes and multiple sclerosis (MS) fatigue, but little is known on the fatigue-related white matter differences between time points. We aim to investigate the longitudinal neurometabolite profile of white matter in MS fatigue. Forty-eight relapsing remitting multiple sclerosis (RRMS) patients with an expanded disability status scale (EDSS) ≤ 4 underwent high field 1H-multivoxel magnetic resonance spectroscopy (MRS) at baseline and year 1. Fatigue severity was evaluated by the fatigue severity scale (FSS). Patients were divided into low (LF, FSS ≤ 3), moderate (MF, FSS = 3.1–5), and high fatigue (HF, FSS ≥ 5.1) groups. In a two-way analysis of variance (ANOVA), we observed a decline in the ratio of the sum of N-acetylaspartate (NAA) and N-acetylaspartylglutamate (NAAG) to the sum of creatine (Cr) and phosphocreatine (PCr) in the right anterior quadrant (RAQ) and left anterior quadrant (LAQ) of the MRS grid in the HF group at baseline and year 1. This decline was significant when compared with the LF group (p = 0.018 and 0.020). In a one-way ANOVA, the fatigue group effect was significant and the ratio difference in the right posterior quadrant (RPQ) and left posterior quadrant (LPQ) of the HF group was also significant (p = 0.012 and 0.04). Neurochemical changes in the bilateral frontal white matter and possibly parietooccipital areas were noted in the HF group at two different time points. Our findings may shed some light on the pathology of MS fatigue.
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Nolan-Kenney RC, Liu M, Akhand O, Calabresi PA, Paul F, Petzold A, Balk L, Brandt AU, Martínez-Lapiscina EH, Saidha S, Villoslada P, Al-Hassan AA, Behbehani R, Frohman EM, Frohman T, Havla J, Hemmer B, Jiang H, Knier B, Korn T, Leocani L, Papadopoulou A, Pisa M, Zimmermann H, Galetta SL, Balcer LJ. Optimal intereye difference thresholds by optical coherence tomography in multiple sclerosis: An international study. Ann Neurol 2019; 85:618-629. [PMID: 30851125 DOI: 10.1002/ana.25462] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the optimal thresholds for intereye differences in retinal nerve fiber and ganglion cell + inner plexiform layer thicknesses for identifying unilateral optic nerve lesions in multiple sclerosis. Current international diagnostic criteria for multiple sclerosis do not include the optic nerve as a lesion site despite frequent involvement. Optical coherence tomography detects retinal thinning associated with optic nerve lesions. METHODS In this multicenter international study at 11 sites, optical coherence tomography was measured for patients and healthy controls as part of the International Multiple Sclerosis Visual System Consortium. High- and low-contrast acuity were also collected in a subset of participants. Presence of an optic nerve lesion for this study was defined as history of acute unilateral optic neuritis. RESULTS Among patients (n = 1,530), receiver operating characteristic curve analysis demonstrated an optimal peripapillary retinal nerve fiber layer intereye difference threshold of 5μm and ganglion cell + inner plexiform layer threshold of 4μm for identifying unilateral optic neuritis (n = 477). Greater intereye differences in acuities were associated with greater intereye retinal layer thickness differences (p ≤ 0.001). INTERPRETATION Intereye differences of 5μm for retinal nerve fiber layer and 4μm for macular ganglion cell + inner plexiform layer are robust thresholds for identifying unilateral optic nerve lesions. These thresholds may be useful in establishing the presence of asymptomatic and symptomatic optic nerve lesions in multiple sclerosis and could be useful in a new version of the diagnostic criteria. Our findings lend further validation for utilizing the visual system in a multiple sclerosis clinical trial setting. Ann Neurol 2019;85:618-629.
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Affiliation(s)
- Rachel C Nolan-Kenney
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY.,Department of Neurology, New York University School of Medicine, New York, NY
| | - Mengling Liu
- Department of Population Health, Sackler Institute for Biomedical Sciences, New York University School of Medicine, New York, NY
| | - Omar Akhand
- Department of Neurology, New York University School of Medicine, New York, NY
| | | | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Lisanne Balk
- Moorfields Eye Hospital, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery & UCL Institute of Neurology, Queen Square, London, United Kingdom.,Neuro-ophthalmology Expertise Center & Multiple Sclerosis Center, Amsterdam UMC, The Netherlands
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA
| | - Elena H Martínez-Lapiscina
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Pablo Villoslada
- Center of Neuroimmunology and Department of Neurology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain
| | | | | | - Elliot M Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Teresa Frohman
- Department of Neurology and Ophthalmology, University of Texas at Austin, Austin, TX
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany.,Data Integration for Future Medicine Consortium, Ludwig Maximilian University, Munich, Germany
| | | | - Hong Jiang
- Bascom Palmer Eye Institute, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Thomas Korn
- Munich Cluster for Systems Neurology, Munich, Germany.,Technical University of Munich, Munich, Germany
| | - Letizia Leocani
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Athina Papadopoulou
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University Hospital of Basel, Basel, Switzerland
| | - Marco Pisa
- Vita-Salute San Raffaele University and San Raffaele Hospital, Milan, Italy
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY.,Department of Ophthalmology, New York University School of Medicine, New York, NY.,Department of Population Health, New York University School of Medicine, New York, NY
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Marques VD, Passos GRD, Mendes MF, Callegaro D, Lana-Peixoto MA, Comini-Frota ER, Vasconcelos CCF, Sato DK, Ferreira MLB, Parolin MKF, Damasceno A, Grzesiuk AK, Muniz A, Matta APDC, Oliveira BESD, Tauil CB, Maciel DRK, Diniz DS, Corrêa EC, Coronetti F, Jorge FMH, Sato HK, Gonçalves MVM, Sousa NADC, Nascimento OJM, Gama PDD, Domingues R, Simm RF, Thomaz RB, Morales RDR, Dias RM, Apóstolos-Pereira SD, Machado SCN, Junqueira TDF, Becker J. Brazilian Consensus for the Treatment of Multiple Sclerosis: Brazilian Academy of Neurology and Brazilian Committee on Treatment and Research in Multiple Sclerosis. Arq Neuropsiquiatr 2019; 76:539-554. [PMID: 30231128 DOI: 10.1590/0004-282x20180078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/16/2018] [Indexed: 12/21/2022]
Abstract
The expanding therapeutic arsenal in multiple sclerosis (MS) has allowed for more effective and personalized treatment, but the choice and management of disease-modifying therapies (DMTs) is becoming increasingly complex. In this context, experts from the Brazilian Committee on Treatment and Research in Multiple Sclerosis and the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology have convened to establish this Brazilian Consensus for the Treatment of MS, based on their understanding that neurologists should be able to prescribe MS DMTs according to what is better for each patient, based on up-to-date evidence and practice. We herein propose practical recommendations for the treatment of MS, with the main focus on the choice and management of DMTs, as well as present a review of the scientific rationale supporting therapeutic strategies in MS.
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Affiliation(s)
- Vanessa Daccach Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto SP, Brasil
| | | | - Maria Fernanda Mendes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brasil
| | - Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brasil
| | - Marco Aurélio Lana-Peixoto
- Universidade Federal de Minas Gerais, Centro de Investigação em Esclerose Múltipla de Minas Gerais, Belo Horizonte MG, Brasil
| | | | | | | | | | | | | | | | | | | | | | - Carlos Bernardo Tauil
- Universidade de Brasília, Brasília DF, Brasil.,Universidade Católica de Brasília, Brasília DF, Brasil
| | | | | | | | | | - Frederico M H Jorge
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brasil
| | | | | | | | | | | | - Renan Domingues
- Senne Líquor Diagnóstico, São Paulo SP, Brasil.,Hospital Cruz Azul, São Paulo SP, Brasil.,Faculdade São Leopoldo Mandic, Campinas SP, Brasil
| | - Renata Faria Simm
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brasil
| | | | | | | | | | | | | | - Jefferson Becker
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre RS, Brasil.,Universidade Federal Fluminense, Niterói RJ, Brasil
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33
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Affiliation(s)
- Marisa McGinley
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Hiratsuka D, Furube E, Taguchi K, Tanaka M, Morita M, Miyata S. Remyelination in the medulla oblongata of adult mouse brain during experimental autoimmune encephalomyelitis. J Neuroimmunol 2018; 319:41-54. [DOI: 10.1016/j.jneuroim.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/10/2018] [Accepted: 03/23/2018] [Indexed: 10/17/2022]
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35
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Scalfari A, Romualdi C, Nicholas RS, Mattoscio M, Magliozzi R, Morra A, Monaco S, Muraro PA, Calabrese M. The cortical damage, early relapses, and onset of the progressive phase in multiple sclerosis. Neurology 2018; 90:e2107-e2118. [PMID: 29769373 DOI: 10.1212/wnl.0000000000005685] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the relationship among cortical radiologic changes, the number of early relapses (ERs), and the long-term course of multiple sclerosis (MS). METHODS In this cohort study, we assessed the number of cortical lesions (CLs) and white matter (WM) lesions and the cortical thickness (Cth) at clinical onset and after 7.9 mean years among 219 patients with relapsing remitting (RR) MS with 1 (Low-ER), 2 (Mid-ER), and ≥3 (High-ER) ERs during the first 2 years. Kaplan-Meier and Cox regression analyses investigated early factors influencing the risk of secondary progressive (SP) MS. RESULTS Fifty-nine patients (27%) converted to SPMS in 6.1 mean years. A larger number of CLs at onset predicted a higher risk of SPMS (hazard ratio [HR] 2.16, 4.79, and 12.3 for 2, 5, and 7 CLs, respectively, p < 0.001) and shorter latency to progression. The High-ER compared to the Low-ER and Mid-ER groups had a larger volume of WM lesions and CLs at onset, accrued more CLs, experienced more severe cortical atrophy over time, and entered the SP phase more rapidly. In the multivariate model, older age at onset (HR 1.97, p < 0.001), a larger baseline CL (HR 2.21, p = 0.005) and WM lesion (HR 1.32, p = 0.03) volume, early changes of global Cth (HR 1.36, p = 0.03), and ≥3 ERs (HR 6.08, p < 0.001) independently predicted a higher probability of SP. CONCLUSIONS Extensive cortical damage at onset is associated with florid inflammatory clinical activity and predisposes to a rapid occurrence of the progressive phase. Age at onset, the number of early attacks, and the extent of baseline focal cortical damage can identify groups at high risk of progression who may benefit from more active therapy.
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Affiliation(s)
- Antonio Scalfari
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Chiara Romualdi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Richard S Nicholas
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Miriam Mattoscio
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Roberta Magliozzi
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Aldo Morra
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Salvatore Monaco
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Paolo A Muraro
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy
| | - Massimiliano Calabrese
- From the Division of Neuroscience (A.S., R.S.N., M.M., P.M.), Imperial College, London, UK; Biology Department (C.R.), University of Padua; Department of Neurological, Biomedicine and Movement Sciences (R.M., S.M., M.C.), University of Verona; and Neuroradiology Unit (A.M.), Euganea Medica, Padua, Italy.
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36
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Heider RM, Smestad JA, Lemus HN, Wilbanks B, Warrington AE, Peters JP, Rodriguez M, Maher LJ. An Assay that Predicts In Vivo Efficacy for DNA Aptamers that Stimulate Remyelination in a Mouse Model of Multiple Sclerosis. Mol Ther Methods Clin Dev 2018; 9:270-277. [PMID: 29707601 PMCID: PMC5918178 DOI: 10.1016/j.omtm.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/17/2018] [Indexed: 01/30/2023]
Abstract
Multiple sclerosis (MS) is a debilitating disease for which regenerative therapies are sought. We have previously described human antibodies and DNA aptamer-streptavidin conjugates that promote remyelination after systemic injection into mice infected by Theiler's murine encephalomyelitis virus. Here, we report an in vitro assay of myelin binding with results that correlate with remyelination outcome in vivo, as shown for data from a set of DNA aptamer complexes of different size and formulation. This in vitro assay will be valuable for future screening of MS regenerative therapies targeting remyelination.
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Affiliation(s)
- Robin M Heider
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - John A Smestad
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA.,Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Hernan Nicolas Lemus
- Departments of Neurology and Immunology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Brandon Wilbanks
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Arthur E Warrington
- Departments of Neurology and Immunology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Justin P Peters
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - Moses Rodriguez
- Departments of Neurology and Immunology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
| | - L James Maher
- Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
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37
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Alonso R, Gonzalez-Moron D, Garcea O. Optical coherence tomography as a biomarker of neurodegeneration in multiple sclerosis: A review. Mult Scler Relat Disord 2018; 22:77-82. [PMID: 29605802 DOI: 10.1016/j.msard.2018.03.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 12/27/2022]
Abstract
Neurodegeneration is one the most important pathological factors which contributes to permanent disability in multiple sclerosis (MS). Optical coherence tomography (OCT) measurements of macular ganglion cell layer (mGCL) and retinal nerve fiber layer (RNFL) have been proposed as biomarkers of axonal damage in MS. The aim of this review is to describe the most relevant findings regarding OCT and axonal damage in MS. We have selected studies that describe retina impairment in MS patients, and those which quantitatively assess the relationship between OCT and physical disability, cognitive impairment and relationship between OCT and magnetic resonance imaging (MRI). Results show that there is a relationship between the degree of retinal layers reduction and physical or cognitive disability and degenerative changes in MRI.
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Affiliation(s)
- Ricardo Alonso
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina.
| | - Dolores Gonzalez-Moron
- Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina; Department of Clinical Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Orlando Garcea
- Multiple Sclerosis Clinic, Department of Neurology, Ramos Mejía Hospital, Buenos Aires, Argentina
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38
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Singhal NK, Alkhayer K, Shelestak J, Clements R, Freeman E, McDonough J. Erythropoietin Upregulates Brain Hemoglobin Expression and Supports Neuronal Mitochondrial Activity. Mol Neurobiol 2018; 55:8051-8058. [PMID: 29498007 DOI: 10.1007/s12035-018-0971-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/19/2018] [Indexed: 01/09/2023]
Abstract
Multiple sclerosis (MS) is a neuro-inflammatory and demyelinating disease. Downregulation of neuronal mitochondrial gene expression and activity have been reported in several studies of MS. We have previously shown that hemoglobin-β (Hbb) signals to the nucleus of neurons and upregulates H3K4me3, a histone mark involved in regulating cellular metabolism and differentiation. The present study was undertaken to evaluate the effect of erythropoietin (EPO) on the upregulation of hemoglobin and mitochondrial-associated neuroprotection. We found that administering EPO (5000 IU/kg intraperitoneally) to mice upregulated brain Hbb expression, levels of H3K4me3, expression of mitochondrial complex III, complex V, and mitochondrial respiration. We also found that the neuronal mitochondrial metabolite N-acetylaspartate (NAA), a marker of neuronal mitochondrial activity, was increased with EPO treatment. Further, we measured the effects of EPO on preventing mitochondrial deficits in the cuprizone toxic demyelinating mouse model of MS. We found that EPO prevented cuprizone-mediated decreases in Hbb, complex III, and NAA. Our data suggest that EPO mediated regulation of Hbb supports neuronal energetics and may provide neuroprotection in MS and other neurodegenerative diseases where a dysfunction of mitochondria contributes to disease.
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Affiliation(s)
- N K Singhal
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
| | - K Alkhayer
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J Shelestak
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - R Clements
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - E Freeman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J McDonough
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
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Ingwersen J, De Santi L, Wingerath B, Graf J, Koop B, Schneider R, Hecker C, Schröter F, Bayer M, Engelke AD, Dietrich M, Albrecht P, Hartung HP, Annunziata P, Aktas O, Prozorovski T. Nimodipine confers clinical improvement in two models of experimental autoimmune encephalomyelitis. J Neurochem 2018; 146:86-98. [PMID: 29473171 DOI: 10.1111/jnc.14324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/31/2022]
Abstract
Multiple sclerosis is characterised by inflammatory neurodegeneration, with axonal injury and neuronal cell death occurring in parallel to demyelination. Regarding the molecular mechanisms responsible for demyelination and axonopathy, energy failure, aberrant expression of ion channels and excitotoxicity have been suggested to lead to Ca2+ overload and subsequent activation of calcium-dependent damage pathways. Thus, the inhibition of Ca2+ influx by pharmacological modulation of Ca2+ channels may represent a novel neuroprotective strategy in the treatment of secondary axonopathy. We therefore investigated the effects of the L-type voltage-gated calcium channel blocker nimodipine in two different models of mouse experimental autoimmune encephalomyelitis (EAE), an established experimental paradigm for multiple sclerosis. We show that preventive application of nimodipine (10 mg/kg per day) starting on the day of induction had ameliorating effects on EAE in SJL/J mice immunised with encephalitic myelin peptide PLP139-151 , specifically in late-stage disease. Furthermore, supporting these data, administration of nimodipine to MOG35-55 -immunised C57BL/6 mice starting at the peak of pre-established disease, also led to a significant decrease in disease score, indicating a protective effect on secondary CNS damage. Histological analysis confirmed that nimodipine attenuated demyelination, axonal loss and pathological axonal β-amyloid precursor protein accumulation in the cerebellum and spinal cord in the chronic phase of disease. Of note, we observed no effects of nimodipine on the peripheral immune response in EAE mice with regard to distribution, antigen-specific proliferation or activation patterns of lymphocytes. Taken together, our data suggest a CNS-specific effect of L-type voltage-gated calcium channel blockade to inflammation-induced neurodegeneration.
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Affiliation(s)
- Jens Ingwersen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Lorenzo De Santi
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Britta Wingerath
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jonas Graf
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Barbara Koop
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Reiner Schneider
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Hecker
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Friederike Schröter
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mary Bayer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Dorothee Engelke
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Dietrich
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Pasquale Annunziata
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Prozorovski
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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40
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Abstract
Magnetic resonance imaging has been crucial in the development of anti-inflammatory disease-modifying treatments. The current landscape of multiple sclerosis clinical trials is currently expanding to include testing not only of anti-inflammatory agents, but also neuroprotective, remyelinating, neuromodulating, and restorative therapies. This is especially true of therapies targeting progressive forms of the disease where neurodegeneration is a prominent feature. Imaging techniques of the brain and spinal cord have rapidly evolved in the last decade to permit in vivo characterization of tissue microstructural changes, connectivity, metabolic changes, neuronal loss, glial activity, and demyelination. Advanced magnetic resonance imaging techniques hold significant promise for accelerating the development of different treatment modalities targeting a variety of pathways in MS.
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Affiliation(s)
- Kedar R Mahajan
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, 9500 Euclid Avenue, U-10, Cleveland, OH, 44195, USA.
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41
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Zeydan B, Rodriguez M, Kantarci OH. Timing of Future Remyelination Therapies and Their Potential to Stop Multiple Sclerosis Progression. Adv Exp Med Biol 2017; 958:161-70. [PMID: 28093713 DOI: 10.1007/978-3-319-47861-6_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Prior to the onset of demyelination in multiple sclerosis (MS), early oligodendrocyte injury, axonal degeneration and astroglial scarring occur. The irreversible progressive phase of MS begins when the axonal loss threshold is reached. Progressive disease onset has the highest impact on a poor prognosis in MS. Conversion to progressive disease is essentially an age-dependent process independent of disease duration and initial disease course. Although prevention of relapses has been the primary approach in the disease management, incomplete recovery from even the first relapse correlates with the long-term neurodegenerative phenotype of progressive MS onset. Therefore, the provider should review each patient's potential for relapse-related disability and start DMDs with the goal of preventing relapses. Existing immunomodulatory medications used to prevent MS relapses do not prevent long-term disability, which requires agents focused on remyelination and axonal repair. If applied immediately after a relapse rather than during the progressive phase of MS, remyelination-stimulating strategies may result in full recovery and prevention of long-term neurodegeneration and progressive disease course.
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42
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Duan Y, Liu Z, Liu Y, Huang J, Ren Z, Sun Z, Chen H, Dong H, Ye J, Li K. Metabolic changes in normal-appearing white matter in patients with neuromyelitis optica and multiple sclerosis: a comparative magnetic resonance spectroscopy study. Acta Radiol 2017; 58:1132-1137. [PMID: 28173728 DOI: 10.1177/0284185116683575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Previous studies with a small sample size have not reported metabolic changes in neuromyelitis optica (NMO). Metabolic changes, such as decreased N-acetylaspartate (NAA), are well-established in patients with multiple sclerosis (MS). It remains unknown whether different patterns of metabolic changes occur in NMO and MS. Purpose To investigate the metabolic changes in normal-appearing white matter (NAWM) in NMO, compared with MS patients and healthy controls (HC), and correlate these changes with clinical disability. Material and Methods We recruited 27 patients with NMO, 24 patients with MS, and 24 HC. Each participant underwent chemical shift imaging with a 1H-MR spectroscopy operating in a 1.5 T magnetic resonance imaging (MRI) scanner. The absolute concentrations of NAA, choline (Cho), creatine (Cr) as well as the metabolite ratios of NAA/Cr, Cho/Cr, and NAA/Cho were measured and compared among the groups. The correlations between the metabolic concentrations, disease duration, and clinical disability (Expanded Disability Status Scale, EDSS) were further explored. Results Compared with HC, a mild increase of Cho without significant NAA changes was observed in NMO patients, while both a significant reduction of NAA and an increase of Cho were observed in MS patients. The absolute concentration of NAA and NAA/Cho ratio were significantly decreased in MS patients in a direct comparison with NMO patients. In MS patients, the EDSS was correlated with the NAA/Cr and Cho/Cr ratios. Conclusion A reduction of NAA was not observed in NMO, implying axonal or neuronal damage may be absent in NAWM for NMO, which is different from MS. A mild increase in Cho was observed in NAWM of NMO patients, suggesting that subtle metabolic changes occur in NMO.
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Affiliation(s)
- Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zhuoqiong Ren
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, PR China
- Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
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Galea MP, Cofré Lizama LE, Butzkueven H, Kilpatrick TJ. Gait and balance deterioration over a 12-month period in multiple sclerosis patients with EDSS scores ≤ 3.0. NeuroRehabilitation 2017; 40:277-284. [PMID: 28222549 DOI: 10.3233/nre-161413] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE It is not currently known whether gait and balance measures are responsive to deterioration of motor function in multiple sclerosis (MS) patients with low EDSS scores (≤3.0). The aim of this study was to quantify MS-related gait and balance deterioration over a 12-month period. METHODS Thirty-eight participants with MS (33 female, mean age: 41.1 ± 8.3 years), mean time since diagnosis 2.2 ± 4.1 years, EDSS score ≤3.0 and without clinical evidence of gait deterioration, were recruited. Participants performed walking trials and Functional and Lateral Reach Tests. Kinematics of the ankle and knee, and electromyography of the tibialis anterior and medial gastrocnemius muscles were also measured. RESULTS Three participants reported relapses with worsening EDSS scores and 4 non-relapsing participants had worse EDSS scores at 12 months. There were significant decreases in mean gait speed, stride length and balance scores, and a significant increase in double support. Marked changes in ankle kinematics, with decreased medial gastrocnemius activity were observed. CONCLUSION Gait and balance performance of non-disabled RRMS participants may progressively decline, even in the absence of both acute clinical relapse and change in clinical status measured by the EDSS.
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Affiliation(s)
- Mary P Galea
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Helmut Butzkueven
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Trevor J Kilpatrick
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, Australia
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Zhang HK, Ye Y, Zhao ZN, Li KJ, Du Y, Hu QM, He JF. Neuroprotective effects of gypenosides in experimental autoimmune optic neuritis. Int J Ophthalmol 2017; 10:541-549. [PMID: 28503425 DOI: 10.18240/ijo.2017.04.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022] Open
Abstract
AIM To determine whether gypenosides have protective effects in experimental autoimmune optic neuritis (EAON). METHODS Mice were randomly divided into seven groups: control group, model group, three different density gypenosides monotherapy, methylprednisolone monotherapy, combination of gypenosides and methylprednisolone group. The control group was subcutaneously injected with oil emulsion adjuvant and all other groups were subcutaneously immunized with an emulsified mixture of myelin oligodendrocyte glycoprotein (MOG) 35-55 peptide to induce EAON. Mice in the gypenosides groups were administered injections daily with three concentrations (15 mg/kg, 30 mg/kg, 45 mg/kg) of gypenosides respectively. Mice in the methylprednisolone group and the combination treatment group were injected daily with methylprednisolone (20 mg/kg) or methylprednisolone (20 mg/kg) + gypenosides (30 mg/kg), respectively. After MOG immunization, visual evoked potential (VEP), optical coherence tomography (OCT), and histopathologic examination were performed at 14, 20, 30, and 40d post-inoculation (p.i.). All results were expressed as mean±SEM. The data were evaluated by one-way ANOVA followed by Tukey or Games-Howell test. RESULTS Compared with the control group, p2 latency was prolonged in the model group (P=0.041). Combination treatment can alleviated the change in VEP at 20d p.i. (P=0.012). Average peripapillary retinal nerve fiber layer (RNFL) thickness was reduced in the model group (P=0.000, 30d; P=0.000, 40d) and gypenosides treatment remarkably diminished the degree of RNFL degeneration at 30d and 40d p.i (P=0.000, 30d; P=0.000, 40d). The pathomorphological results showed a decrease in demye-lination (P=0.020) and inflammatory reactions in the combination group compared with the model group (20d p.i.). Gypenosides treatment also alleviated the degree of axonal loss (40d p.i.) (P=0.003). CONCLUSION Treatment with gypenosides exerts protective effects on retinal nerve fibers and axons in EAON. When combined with gypenosides, methylprednisolone reduces demyelination in the acute stage of EAON.
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Affiliation(s)
- Hong-Kan Zhang
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yuan Ye
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhen-Ni Zhao
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Kai-Jun Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yi Du
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qiu-Ming Hu
- Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jian-Feng He
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Wyss PO, Hock A, Kollias S. The Application of Human Spinal Cord Magnetic Resonance Spectroscopy to Clinical Studies: A Review. Semin Ultrasound CT MR 2017; 38:153-162. [DOI: 10.1053/j.sult.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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46
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Yamamura T, Ashtamker N, Ladkani D, Fukazawa T, Houzen H, Tanaka M, Miura T, Knappertz V. Once-daily glatiramer acetate decreases magnetic resonance imaging disease activity in Japanese patients with relapsing-remitting multiple sclerosis. ACTA ACUST UNITED AC 2017; 8:129-137. [PMID: 28706565 PMCID: PMC5485168 DOI: 10.1111/cen3.12383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) prevalence, clinical patterns, and treatment responses vary between races and geographical latitudes. Glatiramer acetate (GA; Copaxone) has provided a safe, effective treatment option for relapsing-remitting MS patients in the USA, European nations, and other countries for decades. The objective of the present study was to assess the safety and efficacy of GA in reducing magnetic resonance imaging disease activity in Japanese patients with active relapsing-remitting MS. METHODS This phase 2, multicenter, open-label, single-arm, 52-week study measured the effect of GA 20 mg once-daily on magnetic resonance imaging disease activity. GA efficacy was evaluated through week 36, and safety through week 52. The primary end-point was change in the mean number of T1-weighted gadolinium-enhancing (GdE) lesions from pretreatment (weeks -8, -4 and baseline) to weeks 28, 32 and 36. Secondary end-points included a change in mean number of new T2-weighted lesions, GdE lesion and T2 lesion volumes, annualized relapse rate, and Expanded Disability Status Scale scores. RESULTS GA therapy reduced the number of new GdE lesions by 65.66% (95% CI 33.19-82.35%). The number of new T2 lesions and GdE lesion volume were also reduced from pretreatment. The annualized relapse rate was reduced by 42% compared with the 1 year before treatment. Changes in T2 lesion volume and Expanded Disability Status Scale scores were favorable, but less pronounced. Most common adverse events were injection-site reactions. CONCLUSIONS The present study confirmed the well-established safety, tolerability and efficacy profile of GA in Japanese MS patients.
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Affiliation(s)
- Takashi Yamamura
- Department of Immunology National Center of Neurology and Psychiatry National Institute of Neuroscience, and Multiple Sclerosis Center Tokyo Japan
| | - Natalia Ashtamker
- Research and Development Teva Pharmaceutical Industries Netanya Israel
| | - David Ladkani
- Research and Development Teva Pharmaceutical Industries Netanya Israel
| | | | - Hideki Houzen
- Department of Neurology Obihiro Kosei General Hospital Hokkaido Japan
| | - Masami Tanaka
- Multiple Sclerosis Center Kyoto Min-iren Chuo Hospital Kyoto Japan.,Department of Neurology Kaikoukai Josai Hospital Nagoya Japan.,Department of Neurology School of Medicine Fujita Health University Aichi Japan
| | - Toshiro Miura
- Research and Development Teva Pharmaceutical K.K. Tokyo Japan
| | - Volker Knappertz
- Research and Development Teva Pharmaceutical Industries Frazer PA USA.,Department of Neurology Heinrich Heine University Düsseldorf Germany
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47
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Kroksveen AC, Guldbrandsen A, Vaudel M, Lereim RR, Barsnes H, Myhr KM, Torkildsen Ø, Berven FS. In-Depth Cerebrospinal Fluid Quantitative Proteome and Deglycoproteome Analysis: Presenting a Comprehensive Picture of Pathways and Processes Affected by Multiple Sclerosis. J Proteome Res 2016; 16:179-194. [PMID: 27728768 DOI: 10.1021/acs.jproteome.6b00659] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the current study, we conducted a quantitative in-depth proteome and deglycoproteome analysis of cerebrospinal fluid (CSF) from relapsing-remitting multiple sclerosis (RRMS) and neurological controls using mass spectrometry and pathway analysis. More than 2000 proteins and 1700 deglycopeptides were quantified, with 484 proteins and 180 deglycopeptides significantly changed between pools of RRMS and pools of controls. Approximately 300 of the significantly changed proteins were assigned to various biological processes including inflammation, extracellular matrix organization, cell adhesion, immune response, and neuron development. Ninety-six significantly changed deglycopeptides mapped to proteins that were not found changed in the global protein study. In addition, four mapped to the proteins oligo-myelin glycoprotein and noelin, which were found oppositely changed in the global study. Both are ligands to the nogo receptor, and the glycosylation of these proteins appears to be affected by RRMS. Our study gives the most extensive overview of the RRMS affected processes observed from the CSF proteome to date, and the list of differential proteins will have great value for selection of biomarker candidates for further verification.
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Affiliation(s)
- Ann Cathrine Kroksveen
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Astrid Guldbrandsen
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Marc Vaudel
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Ragnhild Reehorst Lereim
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Harald Barsnes
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Kjell-Morten Myhr
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Øivind Torkildsen
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
| | - Frode S Berven
- Proteomics Unit (PROBE), Department of Biomedicine, ‡The KG Jebsen Centre for MS Research, Department of Clinical Medicine, §KG Jebsen Center for Diabetes Research, Department of Clinical Science, and ⊥Computational Biology Unit, Department of Informatics, University of Bergen , Bergen N-5009, Norway.,Center for Medical Genetics and Molecular Medicine and ∥The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital , Bergen N-5021, Norway
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48
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Singhal NK, Huang H, Li S, Clements R, Gadd J, Daniels A, Kooijman EE, Bannerman P, Burns T, Guo F, Pleasure D, Freeman E, Shriver L, McDonough J. The neuronal metabolite NAA regulates histone H3 methylation in oligodendrocytes and myelin lipid composition. Exp Brain Res 2016; 235:279-292. [PMID: 27709268 DOI: 10.1007/s00221-016-4789-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/27/2016] [Indexed: 01/01/2023]
Abstract
The neuronal mitochondrial metabolite N-acetylaspartate (NAA) is decreased in the multiple sclerosis (MS) brain. NAA is synthesized in neurons by the enzyme N-acetyltransferase-8-like (NAT8L) and broken down in oligodendrocytes by aspartoacylase (ASPA) into acetate and aspartate. We have hypothesized that NAA links the metabolism of axons with oligodendrocytes to support myelination. To test this hypothesis, we performed lipidomic analyses using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and high-performance thin-layer chromatography (HPTLC) to identify changes in myelin lipid composition in postmortem MS brains and in NAT8L knockout (NAT8L-/-) mice which do not synthesize NAA. We found reduced levels of sphingomyelin in MS normal appearing white matter that mirrored decreased levels of NAA. We also discovered decreases in the amounts of sphingomyelin and sulfatide lipids in the brains of NAT8L-/- mice compared to controls. Metabolomic analysis of primary cultures of oligodendrocytes treated with NAA revealed increased levels of α-ketoglutarate, which has been reported to regulate histone demethylase activity. Consistent with this, NAA treatment resulted in alterations in the levels of histone H3 methylation, including H3K4me3, H3K9me2, and H3K9me3. The H3K4me3 histone mark regulates cellular energetics, metabolism, and growth, while H3K9me3 has been linked to alterations in transcriptional repression in developing oligodendrocytes. We also noted the NAA treatment was associated with increases in the expression of genes involved in sulfatide and sphingomyelin synthesis in cultured oligodendrocytes. This is the first report demonstrating that neuronal-derived NAA can signal to the oligodendrocyte nucleus. These data suggest that neuronal-derived NAA signals through epigenetic mechanisms in oligodendrocytes to support or maintain myelination.
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Affiliation(s)
- N K Singhal
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - H Huang
- Department of Chemistry and Biology, University of Akron, Akron, OH, 44325, USA
| | - S Li
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - R Clements
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - J Gadd
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - A Daniels
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - E E Kooijman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - P Bannerman
- Department of Cell Biology and Human Anatomy, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - T Burns
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - F Guo
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - D Pleasure
- Department of Neurology, UC Davis School of Medicine, Sacramento, CA, 95817, USA
| | - E Freeman
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA
| | - L Shriver
- Department of Chemistry and Biology, University of Akron, Akron, OH, 44325, USA
| | - J McDonough
- Department of Biological Sciences and School of Biomedical Sciences, Kent State University, Kent, OH, 44242, USA.
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49
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Francis JS, Wojtas I, Markov V, Gray SJ, McCown TJ, Samulski RJ, Bilaniuk LT, Wang DJ, De Vivo DC, Janson CG, Leone P. N-acetylaspartate supports the energetic demands of developmental myelination via oligodendroglial aspartoacylase. Neurobiol Dis 2016; 96:323-334. [PMID: 27717881 DOI: 10.1016/j.nbd.2016.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 12/13/2022] Open
Abstract
Breakdown of neuro-glial N-acetyl-aspartate (NAA) metabolism results in the failure of developmental myelination, manifest in the congenital pediatric leukodystrophy Canavan disease caused by mutations to the sole NAA catabolizing enzyme aspartoacylase. Canavan disease is a major point of focus for efforts to define NAA function, with available evidence suggesting NAA serves as an acetyl donor for fatty acid synthesis during myelination. Elevated NAA is a diagnostic hallmark of Canavan disease, which contrasts with a broad spectrum of alternative neurodegenerative contexts in which levels of NAA are inversely proportional to pathological progression. Recently generated data in the nur7 mouse model of Canavan disease suggests loss of aspartoacylase function results in compromised energetic integrity prior to oligodendrocyte death, abnormalities in myelin content, spongiform degeneration, and motor deficit. The present study utilized a next-generation "oligotropic" adeno-associated virus vector (AAV-Olig001) to quantitatively assess the impact of aspartoacylase reconstitution on developmental myelination. AAV-Olig001-aspartoacylase promoted normalization of NAA, increased bioavailable acetyl-CoA, and restored energetic balance within a window of postnatal development preceding gross histopathology and deteriorating motor function. Long-term effects included increased oligodendrocyte numbers, a global increase in myelination, reversal of vacuolation, and rescue of motor function. Effects on brain energy observed following AAV-Olig001-aspartoacylase gene therapy are shown to be consistent with a metabolic profile observed in mild cases of Canavan disease, implicating NAA in the maintenance of energetic integrity during myelination via oligodendroglial aspartoacylase.
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Affiliation(s)
- Jeremy S Francis
- Department of Cell Biology, Cell & Gene Therapy Center, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Ireneusz Wojtas
- Department of Cell Biology, Cell & Gene Therapy Center, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Vladimir Markov
- Department of Cell Biology, Cell & Gene Therapy Center, Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Steven J Gray
- Department of Ophthalmology, UNC, Chapel Hill, NC, USA
| | | | - R Jude Samulski
- Department of Pharmacology and Gene Therapy Center, UNC, Chapel Hill, NC, USA
| | - Larissa T Bilaniuk
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dah-Jyuu Wang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Christopher G Janson
- Department of Neurology & Rehabilitation, University of Illinois at Chicago, Chicago, USA
| | - Paola Leone
- Department of Cell Biology, Cell & Gene Therapy Center, Rowan School of Osteopathic Medicine, Stratford, NJ, USA.
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50
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Obert D, Helms G, Sättler MB, Jung K, Kretzschmar B, Bähr M, Dechent P, Diem R, Hein K. Brain Metabolite Changes in Patients with Relapsing-Remitting and Secondary Progressive Multiple Sclerosis: A Two-Year Follow-Up Study. PLoS One 2016; 11:e0162583. [PMID: 27636543 PMCID: PMC5026363 DOI: 10.1371/journal.pone.0162583] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/25/2016] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance spectroscopy (MRS) provides the unique ability to monitor several disease-related pathological processes via their characteristic metabolic markers in vivo. In the present study metabolic compositions were assessed every six months over the period of two years in 36 patients with Multiple Sclerosis (MS) including 21 relapsing-remitting (RR), 15 secondary progressive (SP) patients and 12 normal subjects. The concentrations of the main MRS-detectable metabolites N-acetylaspartate and N-acetylaspartylglutamate (tNAA), creatine and phosphocreatine (tCr), choline containing compounds (Cho), myo-Inositol (Ins), glutamine and glutamate (Glx) and their ratios were calculated in the normal appearing white matter (NAWM) and in selected non-enhancing white matter (WM) lesions. Association between metabolic concentrations in the NAWM and disability were investigated. Concentration of tNAA, a marker for neuroaxonal integrity, did not show any difference between the investigated groups. However, the patients with SPMS showed significant reduction of tNAA in the NAWM over the investigation period of two years indicating diffuse neuroaxonal loss during the disease course. Furthermore, we found a significant increase of Ins, Ins/tCr and Ins/tNAA in WM lesions independently from the course of the disease suggesting ongoing astrogliosis in silent-appearing WM lesions. Analyzing correlations between MRS metabolites in the NAWM and patients clinical status we found the positive correlation of Ins/tNAA with disability in patients with RRMS. In SPMS positive correlation of Cho with disability was found.
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Affiliation(s)
- Dorothea Obert
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Gunther Helms
- Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Muriel B. Sättler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Klaus Jung
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- Institute for Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Benedikt Kretzschmar
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Mathias Bähr
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Dechent
- Department of Cognitive Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Ricarda Diem
- Department of Neurology, University Clinic Heidelberg, Heidelberg, Germany
| | - Katharina Hein
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- * E-mail:
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