8
|
O'Connor KS, Read SA, Wang M, Schibeci S, Eslam M, Ong A, Weltman MD, Douglas MW, Mazzola A, Craxì A, Petta S, Stewart GJ, Liddle C, George J, Ahlenstiel G, Booth DR. IFNL3/4 genotype is associated with altered immune cell populations in peripheral blood in chronic hepatitis C infection. Genes Immun 2016; 17:328-34. [PMID: 27307212 PMCID: PMC5399140 DOI: 10.1038/gene.2016.27] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/15/2022]
Abstract
Single-nucleotide polymorphisms near the interferon lambda 3 (IFNL3) gene predict outcomes to infection and anti-viral treatment in hepatitis C virus (HCV) infection. To identify IFNL3 genotype effects on peripheral blood, we collected phenotype data on 400 patients with genotype 1 chronic hepatitis C (CHC). The IFNL3 responder genotype predicted significantly lower white blood cells (WBCs), as well as lower absolute numbers of monocytes, neutrophils and lymphocytes for both rs8099917 and rs12979860. We sought to define the WBC subsets driving this association using flow cytometry of 67 untreated CHC individuals. Genotype-associated differences were seen in the ratio of CD4CD45RO+ to CD4CD45RO-; CD8CD45RO+ to CD8CD45RO-, NK CD56 dim to bright and monocyte numbers and percentages. Whole blood expression levels of IFNL3, IFNLR1 (interferon lambda receptor 1), IFNLR1-mem (a membrane-associated receptor), IFNLR1-sol (a truncated soluble receptor), MxA and T- and NK (natural killer) cell transcription factors TBX21, GATA3, RORC, FOXP3 and EOMES in two subjects were also determined. CHC patients demonstrated endogenous IFN activation with higher levels of MxA, IFNLR1, IFNLR1-mem and IFNLR1-sol, and IFNL3 genotype-associated differences in transcription factors. Taken together, these data provide evidence of an IFNL3 genotype association with differences in monocyte, T- and NK cell levels in the peripheral blood of patients with CHC. This could underpin genotype associations with spontaneous and treatment-induced HCV clearance and hepatic necroinflammation.
Collapse
Affiliation(s)
- K S O'Connor
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - S A Read
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - M Wang
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - S Schibeci
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - M Eslam
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - A Ong
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - M D Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Sydney, NSW, Australia
| | - M W Douglas
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - A Mazzola
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - A Craxì
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - S Petta
- Sezione di Gastroenterologia, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - G J Stewart
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - C Liddle
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - J George
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - G Ahlenstiel
- Storr Liver Centre, Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - D R Booth
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
10
|
De Mercanti S, Rolla S, Cucci A, Bardina V, Cocco E, Vladic A, Soldo-Butkovic S, Habek M, Adamec I, Horakova D, Annovazzi P, Novelli F, Durelli L, Clerico M. Alemtuzumab long-term immunologic effect: Treg suppressor function increases up to 24 months. Neurol Neuroimmunol Neuroinflamm 2016; 3:e194. [PMID: 26819963 PMCID: PMC4723135 DOI: 10.1212/nxi.0000000000000194] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/30/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze changes in T-helper (Th) subsets, T-regulatory (Treg) cell percentages and function, and mRNA levels of immunologically relevant molecules during a 24-month follow-up after alemtuzumab treatment in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Multicenter follow-up of 29 alemtuzumab-treated patients with RRMS in the Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis (CARE-MS) I and CARE-MS II trials. Peripheral blood (PB) samples were obtained at months 0, 6, 12, 18, and 24. We evaluated (1) mRNA levels of 26 immunologic molecules (cytokines, chemokines, chemokine receptors, and transcriptional factors); (2) Th1, Th17, and Treg cell percentages; and (3) myelin basic protein (MBP)-specific Treg suppressor activity. RESULTS We observed 12 relapses in 9 patients. mRNA levels of the anti-inflammatory cytokines interleukin (IL)-10, IL-27, and transforming growth factor-β persistently increased whereas those of proinflammatory molecules related to the Th1 or Th17 subsets persistently decreased after alemtuzumab administration throughout the follow-up period. PB CD4+ cell percentage remained significantly lower than baseline while that of Th1 and Th17 cells did not significantly change. A significant increase in Treg cell percentage was observed at month 24 and was accompanied by an increase in Treg cell suppressive activity against MBP-specific Th1 and Th17 cells. CONCLUSIONS The long-lasting therapeutic benefit of alemtuzumab in RRMS may involve a shift in the cytokine balance towards inhibition of inflammation associated with a reconstitution of the PB CD4+ T-cell subsets that includes expansion of Treg cells with increased suppressive function.
Collapse
Affiliation(s)
- Stefania De Mercanti
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Simona Rolla
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Angele Cucci
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Valentina Bardina
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Eleonora Cocco
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Anton Vladic
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Silva Soldo-Butkovic
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Mario Habek
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Ivan Adamec
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Dana Horakova
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Pietro Annovazzi
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Francesco Novelli
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Luca Durelli
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| | - Marinella Clerico
- Division of Neurology (S.D.M., S.R., A.C., L.D., M.C.) and the Department of Clinical and Biological Sciences (S.D.M., A.C., L.D., M.C.), University of Torino, San Luigi Gonzaga University Hospital, Orbassano; Center for Experimental Research and Medical Studies (CERMS) (S.R., V.B., F.N.), Azienda Ospedaliera Città della Salute e della Scienza di Torino; Department of Molecular Biotechnology and Health Sciences (V.B., F.N.), Università degli Studi di Torino; Multiple Sclerosis Center (E.C.), Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Italy; Department of Neurology (A.V., S.S.-B.), Clinical Hospital Sveti Duh Zagreb; Medical Faculty University (A.V., S.S.-B.), J.J. Strossmayer Osijek; Department of Neurology (M.H., I.A.), Referral Center for Demyelinating Diseases of the Central Nervous System, University Hospital Center Zagreb, Croatia; Department of Neurology and Center of Clinical Neuroscience (D.H.), Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic; and Multiple Sclerosis Study Center (P.A.), AO S. Antonio Abate, Gallarate (VA), Italy
| |
Collapse
|