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Murdock BJ, Zhao B, Pawlowski KD, Famie JP, Piecuch CE, Webber-Davis IF, Teener SJ, Feldman EL, Zhao L, Goutman SA. Peripheral Immune Profiles Predict ALS Progression in an Age- and Sex-Dependent Manner. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200241. [PMID: 38626361 PMCID: PMC11087030 DOI: 10.1212/nxi.0000000000200241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/12/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease whose pathobiology associates with peripheral blood immune cell levels and activation patterns in an age and sex-dependent manner. This study's objective was to identify immune profile associations with ALS progression, whether the associations are age and sex-specific, and whether immune profiles can predict a future disease course. METHODS Flow cytometry immune profiles (a combination of 22 peripheral blood immune markers) were generated for 241 participants with ALS and linked to ALS progression, using progression-free survival, which is a composite combining the revised ALS Functional Rating Scale and survival. Participants were first grouped by immune profiles using unsupervised hierarchical clustering, and clusters were associated with subsequent progression-free survival. Next, individual immune markers were associated with progression-free survival using least absolute shrinkage and selection operator-Cox regression. Analyses were stratified by age and sex to identify demographic-specific immune mechanisms. Finally, random forest determined the predictive power of immune profiles on ALS progression in the whole population and again stratified by age and sex. RESULTS Progression-free survival differed between clusters of participants with similar immune profiles, particularly reduced natural killer (NK)-cell activation associated with slower progression. Individual markers such as neutrophil levels and NK-cell NKp46 expression associated with faster ALS progression while overall NK-cell levels and NK-cell subpopulations associated with slower progression; the strength of these associations varied by age and sex. Adding these immune markers to prediction models dramatically increased short-term prediction compared with routine clinical prognostic variables alone, and the addition of NK-cell markers further improved the prediction accuracy in female participants. DISCUSSION Specific immune profiles likely contribute to ALS progression in an age and sex-dependent manner, and peripheral immune markers enhance the prediction of short-term clinical outcomes. These findings suggest a complex milieu of immune profiles associated with ALS progression, and more detailed immunophenotyping in ALS will facilitate personalized immunotherapeutics in ALS.
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Affiliation(s)
- Benjamin J Murdock
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Bangyao Zhao
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Kristen D Pawlowski
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Joshua P Famie
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Caroline E Piecuch
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Ian F Webber-Davis
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Samuel J Teener
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Eva L Feldman
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Lili Zhao
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
| | - Stephen A Goutman
- From the Department of Neurology (B.J.M., K.D.P., J.P.F., C.E.P., I.F.W.-D., S.J.T., E.L.F., S.A.G.); and School of Public Health (B.Z., L.Z.), Biostatistics Department, University of Michigan, Ann Arbor
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Brooks BR, Pioro EP, Sakata T, Takahashi F, Hagan M, Apple S. The effects of intervention with intravenous edaravone in Study 19 on hospitalization, tracheostomy, ventilation, and death in patients with amyotrophic lateral sclerosis. Muscle Nerve 2023; 68:397-403. [PMID: 37525592 DOI: 10.1002/mus.27946] [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: 11/10/2022] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION/AIMS Intravenous (IV) edaravone is a US Food and Drug Administration-approved treatment for amyotrophic lateral sclerosis (ALS), shown in clinical trials to slow physical functional decline. In this study we compared the effect of IV edaravone (edaravone-first group) versus placebo followed by IV edaravone (placebo-first group) on survival and additional milestone events. METHODS This work is a post hoc analysis of Study 19/MCI186-19, which was a randomized, placebo-controlled, phase 3 study investigating IV edaravone versus placebo. Study 19 and its 24-week extension have been described previously (NCT01492686). Edaravone-first versus placebo-first group time to events for specific milestone(s) were analyzed post hoc. Time-to-event composite endpoints were time to death; time to death, tracheostomy, or permanent assisted ventilation (PAV); and time to death, tracheostomy, PAV, or hospitalization. RESULTS The risk for death, tracheostomy, PAV, or hospitalization was 53% lower among patients in the edaravone-first vs placebo-first groups (hazard ratio = 0.47 [95% confidence interval 0.25 to 0.88], P = .02). The overall effect of IV edaravone on ALS progression could be seen in the significant separation of time-to-event curves for time to death, tracheostomy, PAV, or hospitalization. ALS survival composite endpoint analyses (ALS/SURV) suggested a treatment benefit (least-squares mean difference) for the edaravone-first versus the placebo-first group at week 24 (0.15 ± 0.05 [95% confidence interval 0.06 to 0.25], P < .01) and week 48 (0.11 ± 0.05 [95% confidence interval 0.02 to 0.21], P = .02). DISCUSSION These analyses illustrate the value of timely and continued IV edaravone treatment, as earlier initiation was associated with a lower risk of death, tracheostomy, PAV, or hospitalization in patients with ALS.
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Affiliation(s)
- Benjamin Rix Brooks
- Clinical Trials Planning LLC, Charlotte, North Carolina, USA
- Atrium Health Neuroscience Institute, Neuromuscular/ALS-MDA Care Center and ALSA Center of Excellence, Department of Neurology, Carolinas Medical Center, University of North Carolina School of Medicine-Charlotte Campus, Charlotte, North Carolina, USA
| | - Erik P Pioro
- Neuromuscular Division, Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Melissa Hagan
- Mitsubishi Tanabe Pharma America, Inc., Jersey City, New Jersey, USA
| | - Stephen Apple
- Mitsubishi Tanabe Pharma America, Inc., Jersey City, New Jersey, USA
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Obrenovich M, Jaworski H, Tadimalla T, Mistry A, Sykes L, Perry G, Bonomo RA. The Role of the Microbiota-Gut-Brain Axis and Antibiotics in ALS and Neurodegenerative Diseases. Microorganisms 2020; 8:microorganisms8050784. [PMID: 32456229 PMCID: PMC7285349 DOI: 10.3390/microorganisms8050784] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
The human gut hosts a wide and diverse ecosystem of microorganisms termed the microbiota, which line the walls of the digestive tract and colon where they co-metabolize digestible and indigestible food to contribute a plethora of biochemical compounds with diverse biological functions. The influence gut microbes have on neurological processes is largely yet unexplored. However, recent data regarding the so-called leaky gut, leaky brain syndrome suggests a potential link between the gut microbiota, inflammation and host co-metabolism that may affect neuropathology both locally and distally from sites where microorganisms are found. The focus of this manuscript is to draw connection between the microbiota–gut–brain (MGB) axis, antibiotics and the use of “BUGS AS DRUGS” for neurodegenerative diseases, their treatment, diagnoses and management and to compare the effect of current and past pharmaceuticals and antibiotics for alternative mechanisms of action for brain and neuronal disorders, such as Alzheimer disease (AD), Amyotrophic Lateral Sclerosis (ALS), mood disorders, schizophrenia, autism spectrum disorders and others. It is a paradigm shift to suggest these diseases can be largely affected by unknown aspects of the microbiota. Therefore, a future exists for applying microbial, chemobiotic and chemotherapeutic approaches to enhance translational and personalized medical outcomes. Microbial modifying applications, such as CRISPR technology and recombinant DNA technology, among others, echo a theme in shifting paradigms, which involve the gut microbiota (GM) and mycobiota and will lead to potential gut-driven treatments for refractory neurologic diseases.
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Affiliation(s)
- Mark Obrenovich
- Research Service, Louis Stokes Cleveland, Department of Veteran’s Affairs Medical Center, Cleveland, OH 44106, USA; (H.J.); (T.T.); (R.A.B.)
- Departments of Chemistry, Biochemistry, Pathology and Molecular Biology, Case Western Reserve University, Cleveland, OH 44106, USA
- The Gilgamesh Foundation for Medical Science and Research, Cleveland, OH 44116, USA
- Department of Medicinal and Biological Chemistry, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH 43606, USA
- Cleveland State University Departments of Chemistry and Engineering, Cleveland, OH 44115, USA;
- Correspondence:
| | - Hayden Jaworski
- Research Service, Louis Stokes Cleveland, Department of Veteran’s Affairs Medical Center, Cleveland, OH 44106, USA; (H.J.); (T.T.); (R.A.B.)
- Cleveland State University Departments of Chemistry and Engineering, Cleveland, OH 44115, USA;
| | - Tara Tadimalla
- Research Service, Louis Stokes Cleveland, Department of Veteran’s Affairs Medical Center, Cleveland, OH 44106, USA; (H.J.); (T.T.); (R.A.B.)
- Departments of Chemistry, Biochemistry, Pathology and Molecular Biology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Adil Mistry
- Cleveland State University Departments of Chemistry and Engineering, Cleveland, OH 44115, USA;
| | - Lorraine Sykes
- Department of Laboratory Medicine, Metro Health Medical Center, Cleveland, OH 44109, USA;
| | - George Perry
- Department of Biology University of Texas San Antonio, San Antonio, TX 78249, USA;
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland, Department of Veteran’s Affairs Medical Center, Cleveland, OH 44106, USA; (H.J.); (T.T.); (R.A.B.)
- Departments of Chemistry, Biochemistry, Pathology and Molecular Biology, Case Western Reserve University, Cleveland, OH 44106, USA
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