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Neidhart S, Vlad B, Hilty M, Högelin KA, Ziegler M, Berenjeno-Correa E, Reichen I, Stridh P, Jelcic I, Khademi M, Kockum I, Sospedra M, Al Nimer F, Martin R, Jelcic I. HLA Associations of Intrathecal IgG Production against Specific Viruses in Multiple Sclerosis. Ann Neurol 2024; 95:1112-1126. [PMID: 38551149 DOI: 10.1002/ana.26921] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/05/2024] [Accepted: 03/04/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Specific human leucocyte antigen (HLA) alleles are not only associated with higher risk to develop multiple sclerosis (MS) and other autoimmune diseases, but also with the severity of various viral and bacterial infections. Here, we analyzed the most specific biomarker for MS, that is, the polyspecific intrathecal IgG antibody production against measles, rubella, and varicella zoster virus (MRZ reaction), for possible HLA associations in MS. METHODS We assessed MRZ reaction from 184 Swiss patients with MS and clinically isolated syndrome (CIS) and 89 Swiss non-MS/non-CIS control patients, and performed HLA sequence-based typing, to check for associations of positive MRZ reaction with the most prevalent HLA alleles. We used a cohort of 176 Swedish MS/CIS patients to replicate significant findings. RESULTS Whereas positive MRZ reaction showed a prevalence of 38.0% in MS/CIS patients, it was highly specific (97.7%) for MS/CIS. We identified HLA-DRB1*15:01 and other tightly linked alleles of the HLA-DR15 haplotype as the strongest HLA-encoded risk factors for a positive MRZ reaction in Swiss MS/CIS (odds ratio [OR], 3.90, 95% confidence interval [CI] 2.05-7.46, padjusted = 0.0004) and replicated these findings in Swedish MS/CIS patients (OR 2.18, 95%-CI 1.16-4.02, padjusted = 0.028). In addition, female MS/CIS patients had a significantly higher probability for a positive MRZ reaction than male patients in both cohorts combined (padjusted <0.005). INTERPRETATION HLA-DRB1*15:01, the strongest genetic risk factor for MS, and female sex, 1 of the most prominent demographic risk factors for developing MS, predispose in MS/CIS patients for a positive MRZ reaction, the most specific CSF biomarker for MS. ANN NEUROL 2024;95:1112-1126.
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Affiliation(s)
- Stephan Neidhart
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Benjamin Vlad
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Marc Hilty
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Klara Asplund Högelin
- Center for Molecular Medicine, Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mario Ziegler
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Ernesto Berenjeno-Correa
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Ina Reichen
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Pernilla Stridh
- Center for Molecular Medicine, Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
| | - Mohsen Khademi
- Center for Molecular Medicine, Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Center for Molecular Medicine, Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mireia Sospedra
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
- Clinical Research Priority Program MS (CRPP) PrecisionMS of the University of Zurich, Zurich, Switzerland
| | - Faiez Al Nimer
- Center for Molecular Medicine, Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
- Clinical Research Priority Program MS (CRPP) PrecisionMS of the University of Zurich, Zurich, Switzerland
- Center for Molecular Medicine, Therapeutic Immune Design Unit, Department of Clinical Neuroscience, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University of Zurich and University Hospital, Zurich, Switzerland
- Clinical Research Priority Program MS (CRPP) PrecisionMS of the University of Zurich, Zurich, Switzerland
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Räuber S, Förster M, Schüller J, Willison A, Golombeck KS, Schroeter CB, Oeztuerk M, Jansen R, Huntemann N, Nelke C, Korsen M, Fischer K, Kerkhoff R, Leven Y, Kirschner P, Kölsche T, Nikolov P, Mehsin M, Marae G, Kokott A, Pul D, Schulten J, Vogel N, Ingwersen J, Ruck T, Pawlitzki M, Meuth SG, Melzer N, Kremer D. The Use of Nitrosative Stress Molecules as Potential Diagnostic Biomarkers in Multiple Sclerosis. Int J Mol Sci 2024; 25:787. [PMID: 38255863 PMCID: PMC10815836 DOI: 10.3390/ijms25020787] [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: 12/02/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) of still unclear etiology. In recent years, the search for biomarkers facilitating its diagnosis, prognosis, therapy response, and other parameters has gained increasing attention. In this regard, in a previous meta-analysis comprising 22 studies, we found that MS is associated with higher nitrite/nitrate (NOx) levels in the cerebrospinal fluid (CSF) compared to patients with non-inflammatory other neurological diseases (NIOND). However, many of the included studies did not distinguish between the different clinical subtypes of MS, included pre-treated patients, and inclusion criteria varied. As a follow-up to our meta-analysis, we therefore aimed to analyze the serum and CSF NOx levels in clinically well-defined cohorts of treatment-naïve MS patients compared to patients with somatic symptom disorder. To this end, we analyzed the serum and CSF levels of NOx in 117 patients (71 relapsing-remitting (RR) MS, 16 primary progressive (PP) MS, and 30 somatic symptom disorder). We found that RRMS and PPMS patients had higher serum NOx levels compared to somatic symptom disorder patients. This difference remained significant in the subgroup of MRZ-negative RRMS patients. In conclusion, the measurement of NOx in the serum might indeed be a valuable tool in supporting MS diagnosis.
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Affiliation(s)
- Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Moritz Förster
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology, Kliniken Maria Hilf GmbH, Academic Teaching Hospital of the RWTH Aachen University Hospital, 41063 Moenchengladbach, Germany
| | - Julia Schüller
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Alice Willison
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Kristin S. Golombeck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Christina B. Schroeter
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Menekse Oeztuerk
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Robin Jansen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Christopher Nelke
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Melanie Korsen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Katinka Fischer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Ruth Kerkhoff
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology, Kliniken Maria Hilf GmbH, Academic Teaching Hospital of the RWTH Aachen University Hospital, 41063 Moenchengladbach, Germany
| | - Yana Leven
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Patricia Kirschner
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Tristan Kölsche
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Petyo Nikolov
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Mohammed Mehsin
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Gelenar Marae
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Alma Kokott
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Duygu Pul
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Julius Schulten
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Niklas Vogel
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Tobias Ruck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Nico Melzer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - David Kremer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology and Neurorehabilitation, Hospital Zum Heiligen Geist, Academic Teaching Hospital of the Heinrich Heine University Düsseldorf, 47906 Kempen, Germany
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Abstract
Autoimmunity is defined by the presence of antibodies and/or T cells directed against self-components. Although of unknown etiology, autoimmunity commonly is associated with environmental factors such as infections, which have been reported to increase the risk of developing autoimmune diseases. Occasionally, similarities between infectious non-self and self-tissue antigens may contribute to immunological cross-reactivity in autoimmune diseases. These reactions may be interpreted as molecular mimicry, which describes cross-reactivity between foreign pathogens and self-antigens that have been reported to cause tissue damage and to contribute to the development of autoimmunity. By focusing on the nature of antibodies, cross-reactivity in general, and antibody-antigen interactions, this review aims to characterize the nature of potential cross-reactive immune reactions between infectious non-self and self-tissue antigens which may be associated with autoimmunity but may not actually be the cause of disease onset.
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Affiliation(s)
- Nicole Hartwig Trier
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Gunnar Houen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Gåsland H, Trier NH, Kyllesbech C, Draborg AH, Slibinskas R, Ciplys E, Frederiksen JL, Houen G. Antibodies to expanded virus antigen panels show elevated diagnostic sensitivities in multiple sclerosis and optic neuritis. Immunol Lett 2023; 254:54-64. [PMID: 36764611 DOI: 10.1016/j.imlet.2023.02.003] [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: 09/15/2021] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
An antigen panel consisting of Epstein-Barr, measles, mumps, varicella zoster and rubella viruses (EMMRZ) was recently presented, which may aid in the diagnosis of multiple sclerosis (MS). The aim of this study was to validate and extend the EMMRZ panel. Various candidates, such as Cytomegalovirus and John Cunningham virus were analysed in relapsing-remitting MS (RRMS) and optic neuritis (ON) samples by enzyme-linked immunosorbent assay. IgG levels were elevated in RRMS samples and correlations were found between serum and cerebrospinal fluid levels. Cohort-dependent optimized panels were obtained for RRMS and ON, which obtained the highest sensitivity when combined with the status of oligoclonal bands.
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Affiliation(s)
- Helena Gåsland
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Nicole H Trier
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Cecilie Kyllesbech
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anette H Draborg
- Department of Autoimmunology, Statens Serum Institut, Ørestads boulevard 5, 2300 Copenhagen S, Denmark
| | - Rimantas Slibinskas
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, 10257 Vilnius, Lithuania
| | - Evaldas Ciplys
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, 10257 Vilnius, Lithuania
| | - Jette L Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Gunnar Houen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Autoimmunology, Statens Serum Institut, Ørestads boulevard 5, 2300 Copenhagen S, Denmark.
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5
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Pankratz B, von Zedtwitz K, Runge K, Denzel D, Nickel K, Schlump A, Pitsch K, Maier S, Dersch R, Voderholzer U, Domschke K, Tebartz van Elst L, Schiele MA, Prüss H, Endres D. Cerebrospinal fluid findings in adult patients with obsessive-compulsive disorder: A retrospective analysis of 54 samples. World J Biol Psychiatry 2022; 24:292-302. [PMID: 35904379 DOI: 10.1080/15622975.2022.2104457] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Obsessive-compulsive disorder (OCD) can rarely be associated with immunological aetiologies, most notably in Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections and possibly in autoimmune encephalitis. As cerebrospinal fluid (CSF) analysis is a sensitive method for assessing neuroinflammation, this retrospective study analysed basic CSF parameters and well-characterised as well as novel neuronal autoantibodies in OCD to screen for signs of autoimmunity. METHODS Basic CSF findings of 54 adult OCD patients suspected of an organic aetiology were retrospectively compared to a control group of mentally healthy patients (N = 39) with idiopathic intracranial hypertension. Further subgroup analysis included testing for well-characterised neuronal IgG autoantibodies and tissue-based assays using indirect immunofluorescence to screen for novel brain autoantibodies. RESULTS Elevated protein in the CSF of OCD patients compared to the control group (p = 0.043) was identified. Inflammatory markers (pleocytosis/oligoclonal bands/increased IgG-index) were detected in 7% of all patients with OCD. Well-characterised neuronal autoantibodies were not found in any OCD patient, whereas 6/18 (33%) CSF samples showed binding on mouse brain sections in tissue-based assays (binding to neuropil in the basal ganglia/brainstem, cilia of granule cells, blood vessels, nuclear/perinuclear structures). CONCLUSIONS While elevated CSF protein is merely a weak indicator of blood CSF barrier dysfunction, the presence of inflammatory CSF changes and novel brain autoantibodies in CSF may indicate OCD subtypes with inflammatory pathomechanism and supports the hypothesis of a rare "autoimmune OCD" subtype.
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Affiliation(s)
- Benjamin Pankratz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina von Zedtwitz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik Denzel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea Schlump
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karoline Pitsch
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Prien am Chiemsee, Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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6
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Konen FF, Hannich MJ, Schwenkenbecher P, Grothe M, Gag K, Jendretzky KF, Gingele S, Sühs K, Witte T, Skripuletz T, Süße M. Diagnostic Cerebrospinal Fluid Biomarker in Early and Late Onset Multiple Sclerosis. Biomedicines 2022; 10:1629. [PMID: 35884934 PMCID: PMC9312908 DOI: 10.3390/biomedicines10071629] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background: The intrathecal humoral response is the characteristic diagnostic finding in the cerebrospinal fluid (CSF) analysis of patients with multiple sclerosis (MS). Although the average age of MS patients increases, little is known about the sensitivity of diagnostic markers in elderly MS patients. Methods: In this retrospective two-center study, intrathecal free light chains kappa fraction (FLCk IF) and oligoclonal bands (OCB) were studied in a large cohort of patients with early and late onset relapsing (RMS) and progressive (PMS) MS. Furthermore, the humoral immune profile in CSF was analyzed, including the polyspecific intrathecal immune response measured as the MRZ reaction. Results: While the frequency of CSF-specific OCB did not differ between early and late onset RMS and PMS, the sensitivity of positive FLCk IF and absolute FLCk IF values were lower in PMS. The positivity of the MRZ reaction was equally frequent in early and late onset RMS and PMS. PMS patients had higher local IgA concentrations than RMS patients (p = 0.0123). Conclusions: OCB are slightly superior to FLCk IF in progressive MS in terms of sensitivity for detecting intrathecal immunoglobulin synthesis. The MRZ reaction, as the most specific parameter for MS, is also applicable in patients with late onset and progressive MS.
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7
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Kyllesbech C, Trier N, Slibinskas R, Ciplys E, Tsakiri A, Frederiksen J, Houen G. Virus-specific antibody indices may supplement the total IgG index in diagnostics of multiple sclerosis. J Neuroimmunol 2022; 367:577868. [DOI: 10.1016/j.jneuroim.2022.577868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 12/01/2022]
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8
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Abstract
Multiple Sclerosis (MS) is a neurological disease that affects the central nervous system (CNS). The diagnosis of the disease is quite challenging due to its variation among patients. As a result, the need to enhance diagnostic procedures, evaluate objective prognostic markers and promote effective monitoring of patients' responses to treatment has prompted the identification of many biomarkers. To present up-to-date knowledge on potential biomarkers for MS used to assess disease activity, progression, and therapeutic responses. The search for articles was conducted in various databases, namely, PubMed, Cochrane Library, and CINAHL, using an identical search strategy and terms that included "Multiple Sclerosis," "MS," "biomarkers," "potential," "magnetic resonance spectroscopy," "progress," "marker," "predict," "disability," "indicator," and "mass spectrometry." Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed when scrutinizing the articles for inclusion in the study. The search process identified 75 articles that were used in this systematic review. MS biomarkers consisted of laboratory biomarkers, imaging biomarkers, and genetic and immunogenetic biomarkers. The efficacy, which leads to their potential classification, relies on numerous factors, such as sensitivity, specificity, clinical rationale, predictability, practicality, biological rationale, reproducibility, and correlations with prognosis and disability. Oligoclonal bands (OCBs) and magnetic resonance imaging (MRI) features are the most established biomarkers so far, although kappa free light chains (kFLCs), the measles-rubella-zoster (MRZ) reaction, and neurofilament light chains (NfLs) might show potential in the near future after more studies are conducted.
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9
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Kouchaki E, Dashti F, Mirazimi SMA, Alirezaei Z, Jafari SH, Hamblin MR, Mirzaei H. Neurofilament light chain as a biomarker for diagnosis of multiple sclerosis. EXCLI J 2021; 20:1308-1325. [PMID: 34602928 PMCID: PMC8481790 DOI: 10.17179/excli2021-3973] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
The treatments for multiple sclerosis (MS) have improved over the past 25 years, but now the main question for physicians is deciding who should receive treatment, for how long, and when to switch to other options. These decisions are typically based on treatment tolerance and a reasonable expectation of long-term efficacy. A significant unmet need is the lack of accurate laboratory measurements for diagnosis, and monitoring of treatment response, including deterioration and disease progression. There are few validated biomarkers for MS, and in practice, physicians employ two biomarkers discovered fifty years ago for MS diagnosis, often in combination with MRI scans. These biomarkers are intrathecal IgG and oligoclonal bands in the CSF (cerebrospinal fluid). Neurofilament light chain (NfL) is a relatively new biomarker for MS diagnosis and follow up. Neurofilaments are neuron-specific cytoskeleton proteins that can be measured in various body compartments. NfL is a new biomarker for MS that can be measured in serum samples, but this still needs further study to specify the laboratory cut-off values in clinical practice. In the present review we discuss the evidence for NfL as a reliable biomarker for the early detection and management of MS. Moreover, we highlight the correlation between MRI and NfL, and ask whether they can be combined.
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Affiliation(s)
- Ebrahim Kouchaki
- MS Fellowship, Department of Neurology, School of Medicine, Physiology Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Dashti
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyed Mohammad Ali Mirazimi
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Alirezaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Paramedical School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Seyed Hamed Jafari
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR, Iran
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10
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Rice EM, Thakolwiboon S, Avila M. Geographic heterogeneity in the association of varicella-zoster virus seropositivity and multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 53:103024. [PMID: 34148006 DOI: 10.1016/j.msard.2021.103024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/09/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although there has long been a suspected association between varicella-zoster virus (VZV) and multiple sclerosis (MS), the connection has remained unclear. In this study, we performed a meta-analysis in an attempt to assess the association between VZV IgG serostatus and MS. METHODS A literature search was performed using three databases: MEDLINE, EMBASE, and Cochrane. Eligible results included observational studies investigating the seroprevalence of VZV immunoglobulin G (IgG) in adults with MS versus non-MS controls. Two authors performed a screen of the search results, evaluating them for quality and relevant outcomes. Using a random-effect model, we estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The literature search yielded 1,268 articles, 8 of which (2,266 MS patients and 1,818 controls) were eligible for inclusion in the meta-analysis. Evaluation of all included studies together showed no significant association between VZV IgG seropositivity and MS (OR 1.439; 95%CI, 0.503-4.118; p 0.497). However, when analyzed in subgroups based on geographical area, studies performed in Asian countries showed VZV IgG seropositivity was more common in MS patients than in controls (OR 4.470; 95%CI 1.959-10.203; p < 0.001). No significant association was found in European countries. CONCLUSIONS This study found evidence of an association between VZV IgG seropositivity and MS in Asian countries. Additional studies are warranted to ascertain factors impacting this association.
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11
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Abstract
Multiple sclerosis (MS) is a neurologic disease affecting myelinated nerves in the central nervous system (CNS). The disease often debuts as a clinically isolated syndrome, e.g., optic neuritis (ON), which later develops into relapsing-remitting (RR) MS, with temporal attacks or primary progressive (PP) MS. Characteristic features of MS are inflammatory foci in the CNS and intrathecal synthesis of immunoglobulins (Igs), measured as an IgG index, oligoclonal bands (OCBs), or specific antibody indexes. Major predisposing factors for MS are certain tissue types (e.g., HLA DRB1*15:01), vitamin D deficiency, smoking, obesity, and infection with Epstein-Barr virus (EBV). Many of the clinical signs of MS described above can be explained by chronic/recurrent EBV infection and current models of EBV involvement suggest that RRMS may be caused by repeated entry of EBV-transformed B cells to the CNS in connection with attacks, while PPMS may be caused by more chronic activity of EBV-transformed B cells in the CNS. In line with the model of EBV's role in MS, new treatments based on monoclonal antibodies (MAbs) targeting B cells have shown good efficacy in clinical trials both for RRMS and PPMS, while MAbs inhibiting B cell mobilization and entry to the CNS have shown efficacy in RRMS. Thus, these agents, which are now first line therapy in many patients, may be hypothesized to function by counteracting a chronic EBV infection.
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Affiliation(s)
- Gunnar Houen
- Institute of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | | | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Robinson T, Abdelhak A, Bose T, Meinl E, Otto M, Zettl UK, Dersch R, Tumani H, Rauer S, Huss A. Cerebrospinal Fluid Biomarkers in Relation to MRZ Reaction Status in Primary Progressive Multiple Sclerosis. Cells 2020; 9:cells9122543. [PMID: 33255854 PMCID: PMC7761295 DOI: 10.3390/cells9122543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
The MRZ reaction (MRZR) comprises the three antibody indices (AIs) against measles, rubella, and varicella zoster virus, reflecting an intrathecal polyspecific B cell response highly specific for multiple sclerosis (MS). Thus, MRZR can be used to confirm a diagnosis of primary progressive MS (PPMS) but its pathophysiological and wider clinical relevance is unclear. This study aimed to investigate whether PPMS patients with a positive MRZR (MRZR+) differ from those with a negative MRZR (MRZR-) according to cerebrospinal fluid (CSF) biomarkers of B cell activity, neuroaxonal damage or glial activity, and clinical features. (1) Methods: In a multicenter PPMS cohort (n = 81) with known MRZR status, we measured B cell-activating factor (BAFF), chemokine CXC ligand 13 (CXCL-13), soluble B cell maturation antigen (sBCMA), soluble transmembrane activator and CAML interactor (sTACI), and chitinase-3-like protein 1 (CHI3L1) in the CSF with enzyme-linked immunosorbent assays (ELISAs). Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) were detected in serum and CSF using single molecule array (SIMOA) technology. (2) Results: MRZR+ patients (45.7% of all PPMS patients) revealed higher levels of NfL in CSF compared to MRZR- patients (54.3%). There were positive correlations between each of sBCMA, sTACI, and intrathecal immunoglobin G (IgG) synthesis. Additionally, NfL concentrations in serum positively correlated with those in CSF and those of GFAP in serum. However, MRZR+ and MRZR- patients did not differ concerning clinical features (e.g., age, disease duration, Expanded Disability Status Scale (EDSS) at diagnosis and follow-up); CSF routine parameters; CSF concentrations of BAFF, CXCL-13, sBCMA, sTACI, CHI3L1, and GFAP; or serum concentrations of GFAP and NfL. (3) Conclusions: In PPMS patients, MRZR positivity might indicate a more pronounced axonal damage. Higher levels of the soluble B cell receptors BCMA and transmembrane activator and CAML interactor (TACI) in CSF are associated with a stronger intrathecal IgG synthesis in PPMS.
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Affiliation(s)
- Tilman Robinson
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - Ahmed Abdelhak
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
| | - Tanima Bose
- Biomedical Center and Klinikum Grosshadern, Institute of Clinical Neuroimmunology, Ludwig Maximilian University, 81377 Munich, Germany; (T.B.); (E.M.)
| | - Edgar Meinl
- Biomedical Center and Klinikum Grosshadern, Institute of Clinical Neuroimmunology, Ludwig Maximilian University, 81377 Munich, Germany; (T.B.); (E.M.)
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, Medical Center of the University of Rostock, 18051 Rostock, Germany;
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - Hayrettin Tumani
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
- Specialty Hospital Dietenbronn, 88477 Schwendi, Germany
- Correspondence:
| | - Sebastian Rauer
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - André Huss
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
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13
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Abstract
Recent psychoneuroimmunology research has provided new insight into the etiology and pathogenesis of severe mental disorders (SMDs). The mild encephalitis (ME) hypothesis was developed with the example of human Borna disease virus infection years ago and proposed, that a subgroup SMD patients, mainly from the broad schizophrenic and affective spectrum, could suffer from mild neuroinflammation, which remained undetected because hard to diagnose with available diagnostic methods. Recently, in neurology an emerging new subgroup of autoimmune encephalitis (AE) cases suffering from various neurological syndromes was described in context with the discovery of an emerging list of Central Nervous System (CNS) autoantibodies. Similarly in psychiatry, consensus criteria of autoimmune psychosis (AP) were developed for patients presenting with CNS autoantibodies together with isolated psychiatric symptoms and paraclinical findings of (mild) neuroinflammation, which in fact match also the previously proposed ME criteria. Nevertheless, identifying mild neuroinflammation in vivo in the individual SMD case remains still a major clinical challenge and the possibility that further cases of ME remain still under diagnosed appears an plausible possibility. In this paper a critical review of recent developments and remaining challenges in the research and clinical diagnosis of mild neuroinflammation in SMDs and in general and in transdisciplinary perspective to psycho-neuro-immunology and neuropsychiatry is given. Present nosological classifications of neuroinflammatory disorders are reconsidered with regard to findings from experimental and clinical research. A refined grading list of clinical states including "classical" encephalitis, AE, AP/ME,and newly proposed terms like parainflammation, stress-induced parainflammation and neuroprogression, and their respective relation to neurodegeneration is presented, which may be useful for further research on the possible causative role of mild neuroinflammation in SMDs. Beyond, an etiology-focused subclassification of ME subtypes, like autoimmune ME or infectious ME, appears to be required for differential diagnosis and individualized treatment. The present status of the clinical diagnosis of mild neuroinflammatory mechanisms involved in SMDs is outlined with the example of actual diagnosis and therapy in AP. Ideas for future research to unravel the contribution of mild neuroinflammation in the causality of SMDs and the difficulties expected to come to novel immune modulatory, anti-infectious or anti-inflammatory therapeutic principles in the sense of precision medicine are discussed.
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Affiliation(s)
- Karl Bechter
- Department for Psychiatry and Psychotherapy II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
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14
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Houen G, Heiden J, Trier NH, Draborg AH, Benros ME, Zinkevičiūtė R, Petraitytė-Burneikienė R, Ciplys E, Slibinskas R, Frederiksen JL. Antibodies to Epstein-Barr virus and neurotropic viruses in multiple sclerosis and optic neuritis. J Neuroimmunol 2020; 346:577314. [PMID: 32682138 DOI: 10.1016/j.jneuroim.2020.577314] [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] [Received: 04/26/2020] [Revised: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
Antibody indices to Measles, Mumps, Varicella Zoster (MRZ) are of diagnostic value in multiple sclerosis (MS). Here, we have investigated, if this panel could be extended to increase diagnostic value. Samples from relapsing-remitting (RR) MS and optic neuritis (ON) patients were tested for reactivity to antigens from Epstein-Barr, Varicella Zoster, Measles, Mumps and Rubella (EMMRZ) viruses. Increased IgG levels in serum and cerebrospinal fluid (CSF) were found in RRMS patients, along with a significant correlation between serum and CSF. The sensitivity of the EMMRZ panel was increased approximately 40% compared to the MRZ panel, suggesting that the EMMRZ panel may be useful in MS and ON diagnostics.
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Affiliation(s)
- Gunnar Houen
- Department of Autoimmunology, Statens Serum Institut, Ørestads Boulevard 5, 2300 Copenhagen S, Denmark; Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark.
| | - Julie Heiden
- Department of Autoimmunology, Statens Serum Institut, Ørestads Boulevard 5, 2300 Copenhagen S, Denmark; Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Nicole H Trier
- Department of Autoimmunology, Statens Serum Institut, Ørestads Boulevard 5, 2300 Copenhagen S, Denmark; Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Anette H Draborg
- Department of Autoimmunology, Statens Serum Institut, Ørestads Boulevard 5, 2300 Copenhagen S, Denmark
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900 Hellerup, Copenhagen, Denmark
| | - Rūta Zinkevičiūtė
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, LT-10257 Vilnius, Lithuania
| | | | - Evaldas Ciplys
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, LT-10257 Vilnius, Lithuania
| | - Rimantas Slibinskas
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, LT-10257 Vilnius, Lithuania
| | - Jette L Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark.
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15
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Abstract
The search for an ideal multiple sclerosis biomarker with good diagnostic value, prognostic reference and an impact on clinical outcome has yet to be realized and is still ongoing. The aim of this review is to establish an overview of the frequent biomarkers for multiple sclerosis that exist to date. The review summarizes the results obtained from electronic databases, as well as thorough manual searches. In this review the sources and methods of biomarkers extraction are described; in addition to the description of each biomarker, determination of the prognostic, diagnostic, disease monitoring and treatment response values besides clinical impact they might possess. We divided the biomarkers into three categories according to the achievement method: laboratory markers, genetic-immunogenetic markers and imaging markers. We have found two biomarkers at the time being considered the gold standard for MS diagnostics. Unfortunately, there does not exist a single solitary marker being able to present reliable diagnostic value, prognostic value, high sensitivity and specificity as well as clinical impact. We need more studies to find the best biomarker for MS.
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Miller KD, Matullo CM, Milora KA, Williams RM, O'Regan KJ, Rall GF. Immune-Mediated Control of a Dormant Neurotropic RNA Virus Infection. J Virol 2019; 93:e00241-19. [PMID: 31270232 DOI: 10.1128/JVI.00241-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/22/2019] [Indexed: 01/08/2023] Open
Abstract
Genomic material from many neurotropic RNA viruses (e.g., measles virus [MV], West Nile virus [WNV], Sindbis virus [SV], rabies virus [RV], and influenza A virus [IAV]) remains detectable in the mouse brain parenchyma long after resolution of the acute infection. The presence of these RNAs in the absence of overt central nervous system (CNS) disease has led to the suggestion that they are viral remnants, with little or no potential to reactivate. Here we show that MV RNA remains detectable in permissive mouse neurons long after challenge with MV and, moreover, that immunosuppression can cause RNA and protein synthesis to rebound, triggering neuropathogenesis months after acute viral control. Robust recrudescence of viral transcription and protein synthesis occurs after experimental depletion of cells of the adaptive immune response and is associated with a loss of T resident memory (Trm) lymphocytes within the brain. The disease associated with loss of immune control is distinct from that seen during the acute infection: immune cell-depleted, long-term-infected mice display severe gait and motor problems, in contrast to the wasting and lethal disease that occur during acute infection of immunodeficient hosts. These results illuminate the potential consequences of noncytolytic, immune-mediated viral control in the CNS and demonstrate that what were once considered "resolved" RNA viral infections may, in fact, induce diseases later in life that are distinct from those caused by acute infection.IMPORTANCE Viral infections of neurons are often not cytopathic; thus, once-infected neurons survive, and viral RNAs can be detected long after apparent viral control. These RNAs are generally considered viral fossils, unlikely to contribute to central nervous system (CNS) disease. Using a mouse model of measles virus (MV) neuronal infection, we show that MV RNA is maintained in the CNS of infected mice long after acute control and in the absence of overt disease. Viral replication is suppressed by the adaptive immune response; when these immune cells are depleted, viral protein synthesis recurs, inducing a CNS disease that is distinct from that observed during acute infection. The studies presented here provide the basis for understanding how persistent RNA infections in the CNS are controlled by the host immune response, as well as the pathogenic consequences of noncytolytic viral control.
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Venhoff N, Thiel J, Rizzi M, Venhoff A, Rauer S, Endres D, Hentze C, Staniek J, Huzly D, Voll RE, Salzer U, Hottenrott T. The MRZ-Reaction and Specific Autoantibody Detection for Differentiation of ANA-Positive Multiple Sclerosis From Rheumatic Diseases With Cerebral Involvement. Front Immunol 2019; 10:514. [PMID: 30941143 PMCID: PMC6433788 DOI: 10.3389/fimmu.2019.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/10/2019] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Rheumatic diseases with involvement of the central nervous system (RDwCNS) may mimic multiple sclerosis (MS). Inversely, up to 60% of MS-patients have antinuclear autoantibodies (ANAs) and may be misdiagnosed as RDwCNS. The detection of antibodies against extractable nuclear antigens (ENA) and oligoclonal bands (OCB) are established valuable diagnostic tools in the differential diagnosis of RDwCNS and MS. The MRZ-reaction (MRZR) is defined by three antibody indices (AIs) against neurotropic viruses and is frequently positive in MS. To investigate the added value of MRZR combined with testing for antibodies against ENAs and OCB detection to distinguish RDwCNS from ANA positive MS. Methods: MRZR was evaluated in RDwCNS (n = 40) and 68 ANA positive MS-patients. Two stringency levels, MRZR-1 and MRZR-2 (at least one respectively two of three AIs positive) were applied. Autoantibody testing included ANA plus ENA and anti-dsDNA antibodies, antiphospholipid antibodies, and anti-neutrophil cytoplasmic antibodies. Results: Most of the RDwCNS patients (n = 32; 80%) suffered from systemic lupus erythematosus. Within the RDwCNS group 20% had a positive MRZR-1 and 8.5% a positive MRZR-2 compared to 80.9 and 60%, respectively within the MS-group (p < 0.0001 for both comparisons). Oligoclonal bands were found in 28.6% of the RDwCNS patients and 94.3% of the MS-patients (p < 0.0001). Conversely, autoantibodies to specific nuclear antigens or phospholipids were found more frequently in RDwCNS. A positive MRZR in conjunction with the absence of ENA autoantibodies distinguished MS from RDwCNS with high specificity (97.5%). Conclusions: We suggest combining MRZR, OCBs, and specific autoantibody diagnostics to differentiate RDwCNS from MS.
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Affiliation(s)
- Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ana Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Hentze
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Julian Staniek
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniela Huzly
- Faculty of Medicine, Institute of Virology, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
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Vasilj M, Kes VB, Vrkic N, Vukasovic I. Relevance of KFLC quantification to differentiate clinically isolated syndrome from multiple sclerosis at clinical onset. Clin Neurol Neurosurg 2018; 174:220-9. [DOI: 10.1016/j.clineuro.2018.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/13/2018] [Accepted: 09/22/2018] [Indexed: 11/22/2022]
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Feki S, Gargouri S, Mejdoub S, Dammak M, Hachicha H, Hadiji O, Feki L, Hammami A, Mhiri C, Karray H, Masmoudi H. The intrathecal polyspecific antiviral immune response (MRZ reaction): A potential cerebrospinal fluid marker for multiple sclerosis diagnosis. J Neuroimmunol 2018; 321:66-71. [PMID: 29957390 DOI: 10.1016/j.jneuroim.2018.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/07/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 12/20/2022]
Abstract
We tested the performance of MRZ-reaction, an intrathecal humoral immune response against-Measles (M), Rubella (R) and Varicella Zoster (Z) viruses, in multiple sclerosis (MS) diagnosis. The MRZ-reaction was significantly more positive in MS than in non-MS group with a specificity of 91.9%. In MS group, the RZ-profile was the most prevalent and the R-specific antibody-index was correlated to the number of oligoclonal bands (OCB) in CSF. Interestingly, the MRZ-reaction was detected in 53% of OCB-negative-MS patients. The MRZ-reaction seems to be a relevant CSF diagnostic marker of MS disease. The likely relation between its positivity and the vaccination status deserves to be investigated.
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Affiliation(s)
- Sawsan Feki
- Laboratory of Immunology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia.
| | - Saba Gargouri
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Sabrina Mejdoub
- Laboratory of Immunology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Mariem Dammak
- Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Hend Hachicha
- Laboratory of Immunology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Olfa Hadiji
- Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Lamia Feki
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Adnen Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Chokri Mhiri
- Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Hela Karray
- Laboratory of Microbiology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
| | - Hatem Masmoudi
- Laboratory of Immunology, Habib Bourguiba University Hospital, Faculty of Medicine, University of Sfax, Tunisia
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Hottenrott T, Schorb E, Fritsch K, Dersch R, Berger B, Huzly D, Rauer S, Tebartz van Elst L, Endres D, Stich O. The MRZ reaction and a quantitative intrathecal IgG synthesis may be helpful to differentiate between primary central nervous system lymphoma and multiple sclerosis. J Neurol 2018; 265:1106-1114. [DOI: 10.1007/s00415-018-8779-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 01/04/2023]
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Keep RF, Jones HC, Drewes LR. Progress in brain barriers and brain fluid research in 2017. Fluids Barriers CNS 2018; 15:6. [PMID: 29391031 DOI: 10.1186/s12987-018-0091-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 12/11/2022] Open
Abstract
The past year, 2017, has seen many important papers published in the fields covered by Fluids and Barriers of the CNS. This article from the Editors highlights some.
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Hottenrott T, Dersch R, Berger B, Endres D, Huzly D, Thiel J, Rauer S, Stich O, Salzer U, Venhoff N. The MRZ reaction helps to distinguish rheumatologic disorders with central nervous involvement from multiple sclerosis. BMC Neurol 2018; 18:14. [PMID: 29386006 PMCID: PMC5793342 DOI: 10.1186/s12883-018-1018-3] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/18/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Some rheumatologic disorders may initially manifest with central nervous system (CNS) affection, mimicking the clinical, magnetic resonance imaging, and cerebrospinal fluid findings of multiple sclerosis (MS). The MRZ reaction (MRZR), composed of the three respective antibody indices (AIs) against measles, rubella, and varicella zoster virus, has been found positive frequently in MS patients. However, it is unclear whether the MRZR is helpful to distinguish rheumatologic disorders with CNS involvement (RDwCNS) from MS. METHODS The MRZR was evaluated in patients with RDwCNS (n = 23), MS (n = 46; age and sex matched to patients with RDwCNS), and other inflammatory autoimmune neurological diseases affecting the CNS (OIND; n = 48). Both the stringency levels that have been used in previous MRZR studies, MRZR-1 (≥ 1 of 3 AIs positive) and MRZR-2 (≥ 2 of 3 AIs positive), were applied. RESULTS There was no statistically significant difference in the prevalence of positive MRZR between patients with RDwCNS (MRZR-1: 13.0% and MRZR-2: 8.7%, respectively) and OIND (MRZR-1: 22.9% and MRZR-2: 8.3%, respectively). Compared to these two study cohorts, the MS group exhibited significantly higher prevalences of positive MRZR (MRZR-1: 82.6%, MRZR-2: 63.0%; p < 0.005 each). CONCLUSIONS Considering the high specificity of MRZR-2 for MS found in this study, MRZR-2 can be a useful diagnostic tool for distinguishing MS from RDwCNS or OIND.
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Affiliation(s)
- Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany.
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Hauptstraße 5, D-79104, Freiburg, Germany
| | - Daniela Huzly
- Institute of Virology, University Medical Center Freiburg, Hermann-Herder-Strasse 11, D-79104, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Strasse 64, D-79106, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany
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23
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Endres D, Huzly D, Dersch R, Stich O, Berger B, Schuchardt F, Perlov E, Venhoff N, Hellwig S, Fiebich BL, Erny D, Hottenrott T, Tebartz van Elst L. Do patients with schizophreniform and bipolar disorders show an intrathecal, polyspecific, antiviral immune response? A pilot study. Fluids Barriers CNS 2017; 14:34. [PMID: 29212505 PMCID: PMC5719745 DOI: 10.1186/s12987-017-0082-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/31/2017] [Indexed: 02/06/2023] Open
Abstract
Background We previously described inflammatory cerebrospinal fluid (CSF) alterations in a subgroup of patients with schizophreniform disorders and the synthesis of polyspecific intrathecal antibodies against different neurotropic infectious pathogens in some patients with bipolar disorders. Consequently, we have measured the prevalence of a positive MRZ reaction (MRZR)—a marker for a polyspecific, antiviral, intrathecal, humoral immune response composed of three antibody indices for the neurotropic viruses of measles (M), rubella (R), and varicella zoster (Z)—in these patients. Methods We analyzed paired CSF and serum samples of 39 schizophreniform and 39 bipolar patients. For comparison, we used a group of 48 patients with other inflammatory neurological disorders (OIND) and a cohort of 203 multiple sclerosis (MS) patients. Results We found a positive MRZR in two patients with schizophreniform disorders (5.1%); both suffered from schizodepressive disorders without any other signs suggestive of MS. None of the bipolar patients (0%) and four members of the OIND group (8.3%) showed a positive MRZR. In the MS cohort, a positive MRZR was found significantly more frequently [in 99 patients (48.8%)] than in the other patient groups (p > 0.001). In summary, we did not find a positive MRZR in a relevant subgroup of patients with schizophreniform or bipolar disorders. Conclusions Our results indicate that the MRZR is highly specific to MS. Nevertheless, two schizodepressive patients also had a positive MRZR. This finding corresponds to the few MRZR-positive patients with OIND or other autoimmune disorders with central nervous involvement, implicating that the MRZR specificity for MS is high, but not 100%.
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Affiliation(s)
- Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Daniela Huzly
- Institute for Virology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rick Dersch
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Stich
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Berger
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Schuchardt
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Evgeniy Perlov
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine Hellwig
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd L Fiebich
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tilman Hottenrott
- Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ruprecht K, Wildemann B, Jarius S. Low intrathecal antibody production despite high seroprevalence of Epstein-Barr virus in multiple sclerosis: a review of the literature. J Neurol 2017; 265:239-252. [PMID: 29098417 DOI: 10.1007/s00415-017-8656-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/03/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) frequently have an intrathecal production of antibodies to different common viruses, which can be detected by elevated antiviral antibody indices (AIs). There is a strong and consistent association of MS and Epstein-Barr virus (EBV) infection. OBJECTIVE To systematically compare the frequencies of intrathecal antibody production to EBV, measles virus, rubella virus, varicella zoster virus (VZV) and herpes simplex virus (HSV) in patients with MS. METHODS Review of the English and German literature on the frequencies of intrathecal immunoglobulin (Ig)G antibody production, as defined by an elevated AI, to EBV, measles virus, rubella virus, VZV and HSV in adult and pediatric patients with MS. RESULTS In nine original studies identified, the frequencies of an intrathecal production of antibodies to Epstein-Barr nuclear antigen-1 (33/340, 9.7%), EBV viral capsid antigen (12/279, 4.3%) and antigens from EBV-infected cell lines (14/90, 15.6%) in adult patients with MS were clearly lower (p ≤ 0.03 for all pairwise comparisons) than the frequencies of an intrathecal production of antibodies to measles virus (612/922, 66.4%), rubella virus (521/922, 56.5%), VZV (470/922, 51%; data from 17 original studies) and HSV (78/291, 26.8%; data from 6 original studies). Though based on a lower number of original studies and patients, findings in children with MS were essentially similar. As in adults and children with MS the seroprevalence of EBV is higher than the seroprevalences of the other investigated viruses, the lower frequency of elevated EBV AIs became even more pronounced after correction of the frequencies of elevated antiviral AIs for the seroprevalences of the respective viruses. CONCLUSIONS Given the very high seroprevalence of EBV in MS, the frequency of intrathecally produced antibodies to EBV in patients with MS is paradoxically low compared to that of other common viruses. These findings are compatible with the recently proposed hypothesis that in individuals going on to develop MS antiviral antibody-producing cells may invade the brain predominantly at the time of and triggered by acute primary EBV infection, before anti-EBV IgG producing cells have yet occurred.
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Affiliation(s)
- Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Abdelhak A, Hottenrott T, Mayer C, Hintereder G, Zettl UK, Stich O, Tumani H. CSF profile in primary progressive multiple sclerosis: Re-exploring the basics. PLoS One 2017; 12:e0182647. [PMID: 28797088 PMCID: PMC5552348 DOI: 10.1371/journal.pone.0182647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/11/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this study was to report the basic cerebrospinal fluid (CSF) profile in patients with primary progressive multiple sclerosis (PPMS). Methods The results of CSF analysis from 254 patients with PPMS were collected at four university hospitals in Germany. Routine CSF parameters and different indices of intrathecal immunoglobulin synthesis were evaluated. We assessed possible correlations between the various CSF parameters and the expanded disability status scale (EDSS) both at the time of lumbar puncture and during the course of the disease. Results The median cell count and albumin concentration in the CSF did not deviate from normal values. The CSF-serum albumin-quotient (QALB) was elevated in 29.6% of the patients, while intrathecal immunoglobulin G (IgG) oligoclonal bands (OCBs) were detected in 91.1% of the patients. CSF-lactate levels as well as local IgM- and IgA-synthesis were correlated with the yearly disease progression rate, as assessed by EDSS. Conclusion We present the results of the hitherto largest and most detailed CSF biomarker profile in a cohort of 254 patients with PPMS. As reported previously, OCBs are the most sensitive marker for intrathecal IgG synthesis. CSF-lactate concentrations are positively correlated with the progression rate, which might suggest that mitochondrial dysfunction plays a relevant role in PPMS. The negative correlation between intrathecally produced IgM and IgA and disease progression may indicate their hitherto unexplored protective role.
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Affiliation(s)
| | - Tilman Hottenrott
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
| | - Christoph Mayer
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Gudrun Hintereder
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University Hospital Rostock, Rostock, Germany
| | - Oliver Stich
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
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