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Bollo L, Arrambide G, Cobo-Calvo A, Alvarez JV, Alberich M, Cabello S, Castilló J, Galan I, Midaglia LS, Acevedo BR, Zabalza A, Pappolla A, Mongay Ochoa N, Tintore M, Rio J, Comabella M, Tur C, Auger C, Sastre-Garriga J, Rovira A, Montalban X, Pareto D, Vidal-Jordana A. Trans-Synaptic Degeneration in the Visual Pathway in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Neurology 2024;102:e209156. [PMID: 38447105 DOI: 10.1212/wnl.0000000000209156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/27/2023] [Indexed: 03/08/2024] Open

Abstract

BACKGROUND AND OBJECTIVES

We aimed to assess the presence of retinal neurodegeneration independent of optic neuritis (ON) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to investigate the development of trans-synaptic anterograde degeneration in these patients after ON.

METHODS

Cross-sectional, retrospective study of 34 adult patients with MOGAD and 23 healthy controls (HC). Clinical, optical coherence tomography (OCT), and MRI data were collected. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GCIPL) were obtained using Heidelberg Spectralis. FreeSurfer7 was used to obtain the lateral geniculate nucleus (LGN), occipital volume fractions (to total estimated intracranial volume), and occipital cortical thickness. For the anterior visual pathway, the analysis was conducted using eyes, classified based on the history of ON (Eye-ON and Eye-NON) and compared with Eye-HC. The analysis of OCT and brain volumetric measures was conducted comparing MOGAD-ON, MOGAD-NON, and HC groups. The analysis of covariance with a Bonferroni-adjusted post hoc test was used to test differences between groups and linear regression analysis to evaluate OCT/MRI associations; age and sex were considered as covariates.

RESULTS

24 (70.5%) patients had a prior ON. Median pRNFL and GCIPL thickness (um) was significantly reduced in Eye-ON vs EyeNON and HC (pRNFL: 69.4 (17.3), 89.6 (13.7), 98.2 (11.7), p < 0.001; GCIPL: 55.8 (8.7), 67.39 (8.7), 72.6 (4.5), p < 0.001). pRNFL and GCIPL thickness had a negative correlation with the number of ON episodes (p = 0.025 and p = 0.031, respectively). LGN volume fraction was significantly lower in patients with MOGAD-ON than in HC (0.33 (0.05) vs 0.39 (0.04), p = 0.002). The occipital cortical thickness was lower in MOGAD-ON compared with MOGAD-NON and HC (p = 0.010). In patients with MOGAD-ON, pRNFL correlated with LGN volume (p = 0.006), occipital thickness (p = 0.002), and the medial occipital cortex (p = 0.002), but not the lateral occipital lobe.

DISCUSSION

Compared with HC, MOGAD-ON exhibits reduced retinal thickness, primarily influenced by the presence and the number of prior ON episodes. Moreover, MOGAD-ON demonstrates significant atrophy in the retinal, subcortical, and cortical regions of the visual pathway, distinguishing them from MOGAD-NON and HC. These findings suggest that in patients with MOGAD neurodegeneration is tightly correlated with damage to the involved pathway.

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Affiliation(s)

Luca Bollo From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Georgina Arrambide From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Alvaro Cobo-Calvo From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Javier V Alvarez From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Manel Alberich From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Sergio Cabello From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Joaquín Castilló From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Ingrid Galan From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Luciana S Midaglia From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Breogan Rodriguez Acevedo From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Ana Zabalza From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Agustin Pappolla From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Neus Mongay Ochoa From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Mar Tintore From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Jordi Rio From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Manuel Comabella From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Carmen Tur From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Cristina Auger From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Jaume Sastre-Garriga From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Alex Rovira From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Xavier Montalban From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Deborah Pareto From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Angela Vidal-Jordana From the Neurology Department (L.B., G.A., A.C.-C., J.V.A., S.C., J.C., I.G., L.S.M., B.R.A., A.Z., A.P., N.M.O., M.T., J.R., M.C., C.T., J.S.-G., X.M., A.V.-J.), Centro d'Esclerosi Múltiple de Catalunya (Cemcat); and Secció de Neuroradiologia (M.A., C.A., A.R., D.P.), Servei de Radiologia (IDI), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain

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Cobo-Calvo A, Tur C, Otero-Romero S, Carbonell-Mirabent P, Ruiz M, Pappolla A, Villacieros Alvarez J, Vidal-Jordana A, Arrambide G, Castilló J, Galan I, Rodríguez Barranco M, Midaglia LS, Nos C, Rodriguez Acevedo B, Zabalza de Torres A, Mongay N, Rio J, Comabella M, Auger C, Sastre-Garriga J, Rovira A, Tintore M, Montalban X. Association of Very Early Treatment Initiation With the Risk of Long-term Disability in Patients With a First Demyelinating Event. Neurology 2023;101:e1280-e1292. [PMID: 37468284 PMCID: PMC10558169 DOI: 10.1212/wnl.0000000000207664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open

Abstract

BACKGROUND AND OBJECTIVES

Early treatment is associated with better long-term outcomes in patients with a first demyelinating event and early multiple sclerosis (MS). However, magnetic resonance (MR) findings are not usually integrated to construct propensity scores (PSs) when evaluating outcomes. We assessed the association of receiving very early treatment with the risk of long-term disability including an MR score (MRS) in patients with a first demyelinating event.

METHODS

We included 580 patients with a first demyelinating event prospectively collected between 1994 and 2021, who received at least 1 disease-modifying drug (DMD). Patients were classified into tertiles according to the cohort's distribution of the time from the first demyelinating event to the first DMD: first tertile (FT) or very early treatment (6 months; n = 194), second tertile (6.1-16 months, n = 192), and third tertile (TT) (16.1 months, n = 194). A 5-point MRS was built according to the sum of the following indicators: ≥9 brain lesions (1 point); ≥1 infratentorial lesion (1 point); ≥1 spinal cord (SC) lesion (1 point); ≥1 contrast-enhancing (CE) brain lesion (1 point); and ≥1 CE SC lesion (1 point). PS based on covariates and the MRS was computed for each of the outcomes. Inverse PS-weighted Cox and linear regression models assessed the risk of different outcomes between tertile groups. Finally, to confirm the role of MR in treatment decision, we studied the time elapsed from the first demyelinating event to treatment initiation according to the MRS in all patients with radiologic available information, renamed as raw-MRS.

RESULTS

Very early treatment decreased the risk of reaching Expanded Disability Status Scale 3.0 (hazard ratio [HR] 0.55, 95% CI 0.32-0.97), secondary progressive MS (HR 0.40, 95% CI 0.19-0.85), and sustained disease progression at 12 months after treatment initiation (HR 0.50, 95% CI 0.29-0.84), when compared with patients from the TT group. Patients from the FT group had a lower disability progression rate (β estimate -0.009, 95% CI -0.016 to -0.002) and a lower severe disability measured by the Patient-Determined Disease Step (β estimate -0.52, 95% CI -0.91 to -0.13) than the TT group. Finally, there was a 62.4% reduction in the median time between the first demyelinating event and the first-ever treatment initiation from patients displaying a raw-MRS 1 to patients with a raw-MRS 5.

DISCUSSION

Using PS models with and without MRS, we showed that treatment initiation at very early stages is associated with a reduction in the risk of long-term disability accrual in patients with a first demyelinating event.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that earlier treatment of patients with MS presenting with a first demyelinating event is associated with improved clinical outcomes.

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Affiliation(s)

Alvaro Cobo-Calvo From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Carmen Tur From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Susana Otero-Romero From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Pere Carbonell-Mirabent From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Mariano Ruiz From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Agustin Pappolla From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Javier Villacieros Alvarez From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Angela Vidal-Jordana From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Georgina Arrambide From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Joaquín Castilló From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Ingrid Galan From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Marta Rodríguez Barranco From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Luciana Soledad Midaglia From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Carlos Nos From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Breogan Rodriguez Acevedo From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Ana Zabalza de Torres From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Neus Mongay From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Jordi Rio From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Manuel Comabella From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Cristina Auger From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Jaume Sastre-Garriga From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Alex Rovira From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Mar Tintore From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Xavier Montalban From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain

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Malhotra S, Hurtado-Navarro L, Pappolla A, Villar LMM, Río J, Montalban X, Pelegrin P, Comabella M. Increased NLRP3 Inflammasome Activation and Pyroptosis in Patients With Multiple Sclerosis With Fingolimod Treatment Failure. Neurol Neuroimmunol Neuroinflamm 2023;10:10/3/e200100. [PMID: 36973075 PMCID: PMC10042441 DOI: 10.1212/nxi.0000000000200100] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/12/2023] [Indexed: 03/29/2023]

Abstract

BACKGROUND AND OBJECTIVES

Inflammasomes are involved in the pathogenesis of different neuroimmune and neurodegenerative diseases, including multiple sclerosis (MS). In a previous study by our group, the nucleotide-binding oligomerization domain, leucine-rich repeat receptor and pyrin-domain-containing 3 (NLRP3) inflammasome was reported to be associated with the response to interferon-beta in MS. Based on recent data showing the potential for the oral therapy fingolimod to inhibit NLRP3 inflammasome activation, here we investigated whether fingolimod could also be implicated in the response to this therapy in patients with MS.

METHODS

NLRP3 gene expression levels were measured by real-time PCR in peripheral blood mononuclear cells at baseline and after 3, 6, and 12 months in a cohort of patients with MS treated with fingolimod (N = 23), dimethyl fumarate (N = 21), and teriflunomide (N = 21) and classified into responders and nonresponders to the treatment according to clinical and radiologic criteria. In a subgroup of fingolimod responders and nonresponders, the percentage of monocytes with an oligomer of ASC was determined by flow cytometry, and the levels of interleukin (IL)-1β, IL-18, IL-6, tumor necrosis factor (TNF)α, and galectin-3 were quantified by ELISA.

RESULTS

NLPR3 expression levels were significantly increased in fingolimod nonresponders after 3 (p = 0.03) and 6 months (p = 0.008) of treatment compared with the baseline but remained similar in responders at all time points. These changes were not observed in nonresponders to the other oral therapies tested. The formation of an oligomer of ASC in monocytes after lipopolysaccharide and adenosine 5'-triphosphate stimulation was significantly decreased in responders (p = 0.006) but increased in nonresponders (p = 0.0003) after 6 months of fingolimod treatment compared with the baseline. Proinflammatory cytokine release from stimulated peripheral blood mononuclear cells was comparable between responders and nonresponders, but galectin-3 levels on cell supernatants, as a marker of cell damage, were significantly increased in fingolimod nonresponders (p = 0.02).

DISCUSSION

The differential effect of fingolimod on the formation of an inflammasome-triggered ASC oligomer in monocytes between responders and nonresponders could be used as a response biomarker after 6 months of fingolimod treatment and suggests that fingolimod may exert their beneficial effects by reducing inflammasome signaling in a subset of patients with MS.

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Affiliation(s)

Sunny Malhotra From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Laura Hurtado-Navarro From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Agustin Pappolla From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Luisa M M Villar From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Jordi Río From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Xavier Montalban From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Pablo Pelegrin From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain
Manuel Comabella From the Servei de Neurologia-Neuroimmunologia (S.M., A.P., J.R., X.M., M.C.), Centre d´Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d´Hebron (VHIR), Hospital Universitari Vall d´Hebron, Universitat Autònoma de Barcelona, Spain; Biomedical Research Institute of Murcia (IMIB-Arrixaca) (L.H.-N., P.P.), University Clinical Hospital Virgen de la Arrixaca, Spain; Departments of Neurology and Immunology (L.M.M.V.), Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigacion Sanitaria, Madrid, Spain; and Department of Biochemistry and Molecular Biology B and Immunology (P.P.), Faculty of Medicine, University of Murcia, Murcia, Spain.

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Fissolo N, Pappolla A, Rio J, Villar LM, Perez-Hoyos S, Sanchez A, Gutierrez L, Montalban X, Comabella M. Serum Levels of CXCL13 Are Associated With Teriflunomide Response in Patients With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2022;10:10/1/e200050. [PMID: 36411079 PMCID: PMC9679885 DOI: 10.1212/nxi.0000000000200050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]

Affiliation(s)

Nicolás Fissolo From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain.
Agustin Pappolla From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Jordi Rio From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Luisa M Villar From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Santiago Perez-Hoyos From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Alex Sanchez From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Lucía Gutierrez From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Xavier Montalban From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain
Manuel Comabella From the Servei de Neurologia, Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron (N.F., A.P., J.R., L.G., X.M., M.C.); Departments of Immunology and Neurology (L.M.V.), Multiple Sclerosis Unit, Hospital Ramon y Cajal, (IRYCIS), Madrid; Statistics and Bioinformatics Unit, Vall d'Hebron Institut de Recerca (VHIR) (S.P.-H., A.S.); and Genetics, Microbiology and Statistics Department (A.S.), Universitat de Barcelona, Spain

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Giménez MV, Pappolla A, Varela L, Brusztyn M, Kohan D, Patrucco L. Uveitis intermedia as the initial presentation of a primary lymphoma of the central nervous system. Arch Soc Esp Oftalmol (Engl Ed) 2022;97:168-171. [PMID: 35248399 DOI: 10.1016/j.oftale.2020.12.013] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/15/2020] [Indexed: 06/14/2023]

Zabalza A, Arrambide G, Tagliani P, Cárdenas-Robledo S, Otero-Romero S, Esperalba J, Fernandez-Naval C, Trocoli Campuzano J, Martínez Gallo M, Castillo M, Bonastre M, Resina Sallés M, Beltran J, Carbonell-Mirabent P, Rodríguez-Barranco M, López-Maza S, Melgarejo Otálora PJ, Ruiz-Ortiz M, Pappolla A, Rodríguez Acevedo B, Midaglia L, Vidal-Jordana A, Cobo-Calvo A, Tur C, Galán I, Castilló J, Río J, Espejo C, Comabella M, Nos C, Sastre-Garriga J, Tintore M, Montalban X. Humoral and Cellular Responses to SARS-CoV-2 in Convalescent COVID-19 Patients With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2022;9:9/2/e1143. [PMID: 35105687 PMCID: PMC8808353 DOI: 10.1212/nxi.0000000000001143] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/21/2021] [Indexed: 01/22/2023]

Abstract

Background and Objectives

Information about humoral and cellular responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and antibody persistence in convalescent (COVID-19) patients with multiple sclerosis (PwMS) is scarce. The objectives of this study were to investigate factors influencing humoral and cellular responses to SARS-CoV-2 and its persistence in convalescent COVID-19 PwMS.

Methods

This is a retrospective study of confirmed COVID-19 convalescent PwMS identified between February 2020 and May 2021 by SARS-CoV-2 antibody testing. We examined relationships between demographics, MS characteristics, disease-modifying therapy (DMT), and humoral (immunoglobulin G against spike and nucleocapsid proteins) and cellular (interferon-gamma [IFN-γ]) responses to SARS-CoV-2.

Results

A total of 121 (83.45%) of 145 PwMS were seropositive, and 25/42 (59.5%) presented a cellular response up to 13.1 months after COVID-19. Anti–CD20-treated patients had lower antibody titers than those under other DMTs (p < 0.001), but severe COVID-19 and a longer time from last infusion increased the likelihood of producing a humoral response. IFN-γ levels did not differ among DMT. Five of 7 (71.4%) anti-–CD20-treated seronegative patients had a cellular response. The humoral response persisted for more than 6 months in 41/56(81.13%) PwMS. In multivariate analysis, seropositivity decreased due to anti-CD20 therapy (OR 0.08 [95% CI 0.01–0.55]) and increased in males (OR 3.59 [1.02–12.68]), whereas the cellular response decreased in those with progressive disease (OR 0.04 [0.001–0.88]). No factors were associated with antibody persistence.

Discussion

Humoral and cellular responses to SARS-CoV-2 are present in COVID-19 convalescent PwMS up to 13.10 months after COVID-19. The humoral response decreases under anti-CD20 treatment, although the cellular response can be detected in anti–CD20-treated patients, even in the absence of antibodies.

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Barboza A, Gaitán MI, Alonso R, Ysrraelit MC, Luetic G, Liwacki S, Patrucco L, Halfon MJ, Burgos M, Mainella C, Pierdabuena R, Recchia L, Steinberg J, Tkachuk VA, Zanga G, Carra A, Chertcoff A, Fernandez Liguori N, Lazaro L, Menichini ML, Miguez J, Orzuza G, Palavecino A, Pappolla A, Pigretti S, Pita C, Ruiz E, Silva B, Zentil G. Rebound activity after fingolimod cessation: A case - control study. Mult Scler Relat Disord 2022;57:103329. [PMID: 35158443 DOI: 10.1016/j.msard.2021.103329] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 01/06/2023]

Affiliation(s)

Andres Barboza Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina.
María Inés Gaitán Department of Neurology, FLENI, Buenos Aires, Argentina
Ricardo Alonso Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina; Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
María Célica Ysrraelit Department of Neurology, FLENI, Buenos Aires, Argentina
Geraldine Luetic Instituto de Neurociencias de Rosario, Santa Fe, Argentina
Susana Liwacki Department of Neurology, Hospital Cordoba, Cordoba, Argentina; Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
Liliana Patrucco Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Mario Javier Halfon Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
Marcos Burgos Department of Neurology, Hospital San Bernardo, Salta, Argentina
Carolina Mainella Department of Neurology, Hospital Español de Rosario, Santa Fe, Argentina
Raul Pierdabuena Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
Luciano Recchia Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
Judith Steinberg Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
Veronica Analia Tkachuk Department of Neurology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
Gisela Zanga Department of Neurology, ENERI, Buenos Aires, Argentina
Adriana Carra Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
Aníbal Chertcoff Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
Nora Fernandez Liguori Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
Luciana Lazaro Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
Maria Laura Menichini Instituto de Neurociencias de Rosario, Santa Fe, Argentina
Jimena Miguez Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Gabriela Orzuza Department of Neurology, Hospital San Bernardo, Salta, Argentina
Alfredo Palavecino Department of Neurology, Hospital San Bernardo, Salta, Argentina
Agustin Pappolla Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Santiago Pigretti Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
Cacilia Pita Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
Emiliano Ruiz Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
Berenice Silva Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
Guillermo Zentil Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina

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Pappolla A, Cristina ZM, Rugiero M, Christiansen S, Rivello HG. Meningeal Involvement as Initial Presentation of Waldenström Macroglobulinemia (Bing-Neel Syndrome). Neurol India 2021;69:1459-1460. [PMID: 34747845 DOI: 10.4103/0028-3886.329587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]

Giménez MV, Pappolla A, Varela L, Bursztyn M, Kohan D, Patrucco L. Uveitis intermedia as the initial presentation of a primary lymphoma of the central nervous system. Arch Soc Esp Oftalmol (Engl Ed) 2021;97:S0365-6691(21)00015-0. [PMID: 33640210 DOI: 10.1016/j.oftal.2020.12.006] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]

Pappolla A, Albacete FS, Luzzi A, Zurru MC, Rugiero M. Rapidly Progressive Dementia as a Clinical Feature of Multiple Dural Arteriovenous Fistulas. Neurol India 2020;68:939-940. [PMID: 32859850 DOI: 10.4103/0028-3886.293466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]

Marrodan M, Bensi C, Pappolla A, Rojas JI, Gaitán MI, Ysrraelit MC, Negrotto L, Fiol MP, Patrucco L, Cristiano E, Farez MF, Correale J. Disease activity impacts disability progression in primary progressive multiple sclerosis. Mult Scler Relat Disord 2020;39:101892. [PMID: 31846866 DOI: 10.1016/j.msard.2019.101892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]

Sosa-Albacete F, Pappolla A, Hem S, Kohan D, Otero V, Zurru-Ganen MC, Rugiero M. [Primary neurolymphomatosis in the cauda equina as the initial symptom of human immunodeficiency virus]. Rev Neurol 2019;69:301-302. [PMID: 31559629 DOI: 10.33588/rn.6907.2019244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]

Pappolla A, Sosa-Albacete F, Rugiero M, Christiansen S, Garcia-Rivello H, Miquelini A. [Hypothalamic intravascular B-cell lymphoma in an immunocompetent patient]. Rev Neurol 2019;68:131-132. [PMID: 30687922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]

Pappolla A, Miquelini L, Zurrú-Ganen MC, Pigretti S, Silveira F, Patrucco L, Cristiano E. WITHDRAWN: Ischemic stroke as initial manifestation of Takayasu's arteritis. Interdisciplinary Neurosurgery 2018. [DOI: 10.1016/j.inat.2018.04.007] [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] [Indexed: 11/29/2022] Open

Pappolla A, Christiansen S, Garcia-Rivello H, Zurru-Ganen MC, Patrucco L, Cristiano E. [Primary lymphoma of the anterior pituitary in an immunocompetent patient]. Rev Neurol 2017;65:238-239. [PMID: 28849868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]

Pappolla A, Zurru-Ganen MC, Pigretti SG, Balian NR, Michelangelo H, Cristiano E. [Reversible posterior leukoencephalopathy syndrome with isolated involvement of the brainstem and spinal cord]. Rev Neurol 2017;64:525-526. [PMID: 28555459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]