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Abou-El-Hassan H, Rezende RM, Izzy S, Gabriely G, Yahya T, Tatematsu BK, Habashy KJ, Lopes JR, de Oliveira GLV, Maghzi AH, Yin Z, Cox LM, Krishnan R, Butovsky O, Weiner HL. Vγ1 and Vγ4 gamma-delta T cells play opposing roles in the immunopathology of traumatic brain injury in males. Nat Commun 2023; 14:4286. [PMID: 37463881 DOI: 10.1038/s41467-023-39857-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality. The innate and adaptive immune responses play an important role in the pathogenesis of TBI. Gamma-delta (γδ) T cells have been shown to affect brain immunopathology in multiple different conditions, however, their role in acute and chronic TBI is largely unknown. Here, we show that γδ T cells affect the pathophysiology of TBI as early as one day and up to one year following injury in a mouse model. TCRδ-/- mice are characterized by reduced inflammation in acute TBI and improved neurocognitive functions in chronic TBI. We find that the Vγ1 and Vγ4 γδ T cell subsets play opposing roles in TBI. Vγ4 γδ T cells infiltrate the brain and secrete IFN-γ and IL-17 that activate microglia and induce neuroinflammation. Vγ1 γδ T cells, however, secrete TGF-β that maintains microglial homeostasis and dampens TBI upon infiltrating the brain. These findings provide new insights on the role of different γδ T cell subsets after brain injury and lay down the principles for the development of targeted γδ T-cell-based therapy for TBI.
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Affiliation(s)
- Hadi Abou-El-Hassan
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafael M Rezende
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Saef Izzy
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Galina Gabriely
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Taha Yahya
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruna K Tatematsu
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karl J Habashy
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Juliana R Lopes
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gislane L V de Oliveira
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir-Hadi Maghzi
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhuoran Yin
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura M Cox
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rajesh Krishnan
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Oleg Butovsky
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Vermersch P, Scaramozza M, Levin S, Alroughani R, Deiva K, Pozzilli C, Lyons J, Mokliatchouk O, Pultz J, N’Dure F, Liu S, Badwan R, Branco F, Hood-Humphrey V, Franchimont N, Hanna J, Maghzi AH. Effect of Dimethyl Fumarate vs Interferon β-1a in Patients With Pediatric-Onset Multiple Sclerosis: The CONNECT Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2230439. [PMID: 36169959 PMCID: PMC9520348 DOI: 10.1001/jamanetworkopen.2022.30439] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE With few approved multiple sclerosis therapies in the pediatric population, there is a need for further approved treatment options. Limited data exist for dimethyl fumarate (DMF) treatment in pediatric-onset multiple sclerosis (POMS). OBJECTIVE To compare the efficacy, safety, and tolerability of DMF vs intramuscular interferon β-1a (IFNβ-1a) in POMS. DESIGN, SETTING, AND PARTICIPANTS The CONNECT study was an active-controlled, open-label, rater-blinded 96-week randomized clinical trial in patients with POMS aged 10 to less than 18 years treated between August 2014 and November 2020. Data were analyzed from January through October 2021. INTERVENTIONS Patients were randomized to DMF or IFNβ-1a. MAIN OUTCOMES AND MEASURES The primary end point was the proportion of patients free of new or newly enlarging (N or NE) T2 hyperintense lesions at week 96 among trial completers. Secondary end points included number of N or NE T2 lesions, proportion of patients free of relapse, annualized relapse rate (ARR), and safety. The estimated proportion of participants who were relapse free up to week 96 was calculated based on the Kaplan-Meier method. Adjusted ARR was obtained from a negative binomial regression adjusted for baseline relapse rate, baseline Expanded Disability Status Scale (EDSS) score, and age group. RESULTS Among 150 patients with POMS in the intention-to-treat (ITT) population (median [range] age, 15 [10-17] years; 101 [67.3%] female patients), 78 individuals received DMF and 72 individuals received IFNβ-1a. At week 96, the proportion of patients with no N or NE T2 hyperintense lesions among 103 trial completers was 16.1% (95% CI, 8.0%-27.7%) for DMF vs 4.9% (95% CI, 0.6%-16.5%) for IFNβ-1a, and in a sensitivity analysis among the ITT population, the proportions were 10 patients receiving DMF (12.8%) vs 2 patients receiving IFNβ-1a (2.8%). The estimated proportion of patients who remained relapse free at week 96 was 66.2% for DMF vs 52.3% for IFNβ-1a. Adjusted ARR (95% CI) at week 96 was 0.24 (95% CI, 0.15-0.39) for DMF vs 0.53 (95% CI, 0.33-0.84) for IFNβ-1a; the rate ratio for DMF vs IFNβ-1a was 0.46 (95% CI, 0.26-0.80; P = .006). The number of treatment-emergent adverse events (TEAEs; 74 patients [94.9%] vs 69 patients [95.8%]), serious TEAEs (18 patients [23.1%] vs 21 patients [29.2%]), and treatment discontinuations due to TEAEs (5 patients [6.4%] vs 8 patients [11.1%]) was similar for DMF vs IFNβ-1a. CONCLUSIONS AND RELEVANCE This study found that more pediatric patients with POMS treated with DMF were free of new or newly enlarging T2 lesions and that the adjusted ARR was lower among these patients compared with those treated with interferon β-1a. DMF was well tolerated. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02283853.
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Affiliation(s)
- Patrick Vermersch
- University Lille, Inserm, Centre Hospitalier Universitaire de Lille, Fédératif Hospitalo-Universitaire Precise, Lille, France
| | | | | | | | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Pediatric Neurology Department, University Hospitals Paris Saclay, Bicêtre Hospital, Le Kremlin Bicêtre, France
- French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, France
| | - Carlo Pozzilli
- Sant’ Andrea Multiple Sclerosis Center, Sapienza University, Rome, Italy
| | | | | | - Joe Pultz
- Biogen, Cambridge, Massachusetts
- Now with CR Medicon, Orange, Connecticut
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Maghzi AH, Levin S, Alroughani R, Deiva K, Pozzilli C, Lyons J, Mokliatchouk O, Pultz J, Liu S, Badwan R, Branco F, Franchimont N, Hanna J, Scaramozza M, Vermersch P, N’Dure F. CONNECT : étude ouverte, avec contrôle actif, portant sur le diméthylfumarate (DMF) chez des patients pédiatriques atteints de sclérose en plaques récurrente-rémittente. Rev Neurol (Paris) 2022. [DOI: 10.1016/j.neurol.2022.02.391] [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: 10/18/2022]
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Barzegar M, Mirmosayyeb O, Gajarzadeh M, Afshari-Safavi A, Nehzat N, Vaheb S, Shaygannejad V, Maghzi AH. COVID-19 Among Patients With Multiple Sclerosis: A Systematic Review. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e1001. [PMID: 34016734 PMCID: PMC8142838 DOI: 10.1212/nxi.0000000000001001] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We systematically reviewed the literature on COVID-19 in patients with multiple sclerosis (MS). METHODS We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Google Scholar, and World Health Organization database from December 1, 2019, to December 18, 2020. Three conference abstract databases were also searched. We included any types of studies that reported characteristics of patients with MS with COVID-19. RESULTS From an initial 2,679 publications and 3,138 conference abstracts, 87 studies (67 published articles and 20 abstracts) consisting of 4,310 patients with suspected/confirmed COVID-19 with MS met the inclusion criteria. The female/male ratio was 2.53:1, the mean (SD) age was 44.91 (4.31) years, the mean disease duration was 12.46 (2.27), the mean Expanded Disability Status Scale score was 2.54 (0.81), the relapsing/progressive ratio was 4.75:1, and 32.9% of patients had at least 1 comorbidity. The most common symptoms were fever (68.8%), followed by cough (63.9%), fatigue/asthenia (51.2%), and shortness of breath (39.5%). In total, 837 of 4,043 patients with MS with suspected/confirmed COVID-19 (20.7%) required hospitalization, and 130 of 4,310 (3.0%) died of COVID-19. Among suspected/confirmed patients, the highest hospitalization and mortality rates were in patients with no disease-modifying therapies (42.9% and 8.4%), followed by B cell-depleting agents (29.2% and 2.5%). CONCLUSION Our study suggested that MS did not significantly increase the mortality rate from COVID-19. These data should be interpreted with caution as patients with MS are more likely female and younger compared with the general population where age and male sex seem to be risk factors for worse disease outcome.
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Affiliation(s)
- Mahdi Barzegar
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Omid Mirmosayyeb
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mahsa Gajarzadeh
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alireza Afshari-Safavi
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nasim Nehzat
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeed Vaheb
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vahid Shaygannejad
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Amir-Hadi Maghzi
- From the Department of Neurology (M.B., O.M., N.N., S.V., V.S.), School of Medicine, Isfahan University of Medical Sciences; Universal Council of Epidemiology (UCE) (M.G.), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences; Department of Biostatistics and Epidemiology (A.A.-S.), Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Barzegar M, Mirmosayyeb O, Nehzat N, Sarrafi R, Khorvash F, Maghzi AH, Shaygannejad V. COVID-19 infection in a patient with multiple sclerosis treated with fingolimod. Neurol Neuroimmunol Neuroinflamm 2020; 7:e753. [PMID: 32371550 PMCID: PMC7217655 DOI: 10.1212/nxi.0000000000000753] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/20/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Mahdi Barzegar
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Omid Mirmosayyeb
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nasim Nehzat
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Reza Sarrafi
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Farzin Khorvash
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Amir-Hadi Maghzi
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vahid Shaygannejad
- From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Ghajarzadeh M, Mirmosayyeb O, Barzegar M, Nehzat N, Vaheb S, Shaygannejad V, Maghzi AH. Favorable outcome after COVID-19 infection in a multiple sclerosis patient initiated on ocrelizumab during the pandemic. Mult Scler Relat Disord 2020; 43:102222. [PMID: 32464586 PMCID: PMC7245286 DOI: 10.1016/j.msard.2020.102222] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Mahsa Ghajarzadeh
- Universal council of epidemiology (UCE), universal scientific education and research network (USERN), Tehran University of medical sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Universal council of epidemiology (UCE), universal scientific education and research network (USERN), Tehran University of medical sciences, Tehran, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasim Nehzat
- Universal council of epidemiology (UCE), universal scientific education and research network (USERN), Tehran University of medical sciences, Tehran, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amir-Hadi Maghzi
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Rezende RM, Nakagaki BN, Moreira TG, Lopes JR, Kuhn C, Tatematsu BK, Boulenouar S, Maghzi AH, Rubino S, Menezes GB, Chitnis T, Weiner HL. γδ T Cell-Secreted XCL1 Mediates Anti-CD3-Induced Oral Tolerance. J Immunol 2019; 203:2621-2629. [PMID: 31578268 DOI: 10.4049/jimmunol.1900784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/16/2019] [Indexed: 12/21/2022]
Abstract
Oral tolerance is defined as the specific suppression of cellular and/or humoral immune responses to an Ag by prior administration of the Ag through the oral route. Although the investigation of oral tolerance has classically involved Ag feeding, we have found that oral administration of anti-CD3 mAb induced tolerance through regulatory T (Treg) cell generation. However, the mechanisms underlying this effect remain unknown. In this study, we show that conventional but not plasmacytoid dendritic cells (DCs) are required for anti-CD3-induced oral tolerance. Moreover, oral anti-CD3 promotes XCL1 secretion by small intestine lamina propria γδ T cells that, in turn, induces tolerogenic XCR1+ DC migration to the mesenteric lymph node, where Treg cells are induced and oral tolerance is established. Consistent with this, TCRδ-/- mice did not develop oral tolerance upon oral administration of anti-CD3. However, XCL1 was not required for oral tolerance induced by fed Ags, indicating that a different mechanism underlies this effect. Accordingly, oral administration of anti-CD3 enhanced oral tolerance induced by fed MOG35-55 peptide, resulting in less severe experimental autoimmune encephalomyelitis, which was associated with decreased inflammatory immune cell infiltration in the CNS and increased Treg cells in the spleen. Thus, Treg cell induction by oral anti-CD3 is a consequence of the cross-talk between γδ T cells and tolerogenic DCs in the gut. Furthermore, anti-CD3 may serve as an adjuvant to enhance oral tolerance to fed Ags.
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Affiliation(s)
- Rafael M Rezende
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Brenda N Nakagaki
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and.,Center for Gastrointestinal Biology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Thais G Moreira
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Juliana R Lopes
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Chantal Kuhn
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Bruna K Tatematsu
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Selma Boulenouar
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Amir-Hadi Maghzi
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Stephen Rubino
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Gustavo B Menezes
- Center for Gastrointestinal Biology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115; and
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Maghzi AH, Sahai S, Zimnowodzki S, Baloh RH. Palatal tremor as a presenting symptom of amyotrophic lateral sclerosis. Neurology 2018; 90:801-802. [PMID: 29572285 DOI: 10.1212/wnl.0000000000005363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
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9
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Saraste M, Atula S, Hedman K, Hurme S, Jalkanen A, Sneck M, Surcel HM, Maghzi AH, Airas L. Humoral response to John Cunningham virus during pregnancy in multiple sclerosis. Mult Scler Relat Disord 2018; 21:11-18. [PMID: 29454151 DOI: 10.1016/j.msard.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/18/2018] [Accepted: 02/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pregnancy induces an immunosuppressive state in the mother to ensure immunological acceptance of the foetus. Impairment of cell-mediated immune responses may render the mother susceptible to intracellular pathogens. It is not presently known whether pregnancy alters the immunosurveillance for John Cunningham virus (JCV), an opportunistic pathogen associated with natalizumab treatment for multiple sclerosis (MS). OBJECTIVE To evaluate whether the humoral immune response to JCV is altered during pregnancy among MS patients and healthy controls to get insight to potential pregnancy-induced alterations related to immune response to JCV during pregnancy. METHODS Serum anti-JCV-antibody-indices (JCV-Ab-index) were determined by a two-step second-generation enzyme-linked immunosorbent assay in 49 MS patients during and after pregnancy and in 49 healthy controls during pregnancy. For comparison, total IgG levels and antibodies against Epstein-Barr, cytomegalo and measles viruses were similarly measured. RESULTS The JCV-Ab-indices of MS patients were not altered during the pregnancy (1st vs. 3rd trimester, 0.62 vs. 0.77, p = 0.99). Contrary to this, in the healthy controls JCV-Ab-indices (p = 0.005), antibody levels to the other viruses, and total IgG levels (p < 0.0001) decreased significantly during pregnancy. CONCLUSIONS JCV-Ab levels remain unaltered during MS pregnancy, while the total IgG concentration is reduced/diluted due to increasing plasma volumes during the course of pregnancy. This may imply a biologically significant alteration in the immune response to JCV during MS pregnancy.
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Affiliation(s)
- M Saraste
- Department of Neurology, University of Turku, Turku, Finland.
| | - S Atula
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Hedman
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - A Jalkanen
- Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland
| | - M Sneck
- HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - H-M Surcel
- National Institute for Health and Welfare, Oulu, Finland
| | - A H Maghzi
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - L Airas
- Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Turku, Finland
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10
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Maghzi H, Shaygannejad V, Minagar A, Hassanzadeh A, Maghzi AH. Consanguinity and multiple sclerosis susceptibility: A case control study. Mult Scler Relat Disord 2016; 10:179-180. [PMID: 27919486 DOI: 10.1016/j.msard.2016.09.013] [Citation(s) in RCA: 8] [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: 04/21/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several lines of evidence point towards the importance of genetic risk factors in the susceptibility to multiple sclerosis (MS). We aimed to compare the rates of consanguineous marriages between first cousins among parents of MS patients and a healthy unrelated control group. METHOD This study is a cross-sectional hospital registry based study, which was performed by analyzing the clinical records of patients registered with the Kashani hospital database, and also a control group of randomly selected healthy individuals. RESULT MS patients were significantly less an offspring of a consanguineous union than the control group (MS patients=26.1%, vs Control=32.7%, p=0.03; OR=0.730 95%CI: 0.55-0.97) CONCLUSION: Offspring of consanguineous unions seems to have a lower risk of MS compared to offspring of unrelated parents. This may have implications for inheritance mode of protective alleles in MS.
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Affiliation(s)
- Helia Maghzi
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir-Hadi Maghzi
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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11
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Maghzi H, Ataei B, Khorvash F, Yaran M, Maghzi AH. Association Between Acute Infectious Mononucleosis and Vitamin D Deficiency. Viral Immunol 2016; 29:398-400. [PMID: 27505106 DOI: 10.1089/vim.2016.0038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Epstein-Barr virus and vitamin D both have been implicated in the pathogenesis of autoimmune diseases, especially multiple sclerosis (MS). Vitamin D influences both innate and adaptive immune responses and has been linked to increased susceptibility to other viral infections such as influenza. Here we aimed to examine the association between vitamin D and acute infectious mononucleosis (IM).This study is a case-control study that was conducted on IM patients and a control group of healthy individuals at infectious disease clinics of Isfahan University of Medical Sciences. Patients were recruited from January to December 2014. The viral capsid antigen (VCA) IgM titer and vitamin D levels were measured at the time of acute infection in IM patients. We also measured vitamin D levels in healthy controls recruited during the same period of time. A total number of 60 IM patients with the mean age of 23.26 ± 7.59 and a healthy control group with the mean age of 25.13 ± 6.72 were enrolled. In the IM patients, there was no significant association between 25(OH) D3 levels and VCA IgM titers (r = 0.190, p = 0.146). Mean 25(OH) D3 levels in IM patients were significantly lower than in the control group (15.61 ± 9.72 vs. 21.41 ± 12.64, p = 0.006). Our findings showed significantly lower vitamin D levels in IM patients at the time of infection than in the control group, providing some evidence that the two major risk factors for autoimmune diseases (e.g., MS) might not be independent risk factors.
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Affiliation(s)
- Helia Maghzi
- 1 Multiple Sclerosis Research Committee, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Behrooz Ataei
- 2 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Farzin Khorvash
- 3 Nosocomial Infection Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Majid Yaran
- 4 Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences , Isfahan, Iran
| | - Amir-Hadi Maghzi
- 5 Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California
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12
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Nourbakhsh B, Azevedo C, Maghzi AH, Spain R, Pelletier D, Waubant E. Subcortical grey matter volumes predict subsequent walking function in early multiple sclerosis. J Neurol Sci 2016; 366:229-233. [DOI: 10.1016/j.jns.2016.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/04/2016] [Accepted: 04/28/2016] [Indexed: 01/28/2023]
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13
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Maghzi AH, Revirajan N, Julian LJ, Spain R, Mowry EM, Liu S, Jin C, Green AJ, McCulloch CE, Pelletier D, Waubant E. Magnetic resonance imaging correlates of clinical outcomes in early multiple sclerosis. Mult Scler Relat Disord 2014; 3:720-7. [DOI: 10.1016/j.msard.2014.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/12/2014] [Accepted: 07/15/2014] [Indexed: 11/25/2022]
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14
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Waubant E, Maghzi AH, Revirajan N, Spain R, Julian L, Mowry EM, Marcus J, Liu S, Jin C, Green A, McCulloch CE, Pelletier D. A randomized controlled phase II trial of riluzole in early multiple sclerosis. Ann Clin Transl Neurol 2014; 1:340-7. [PMID: 25356404 PMCID: PMC4184685 DOI: 10.1002/acn3.60] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 01/26/2014] [Revised: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 12/22/2022] Open
Abstract
Objectives We evaluated the effect of riluzole versus placebo added to weekly IM interferon beta-1a in early multiple sclerosis (MS). Methods This is a randomized (1:1), double-blind, placebo-controlled trial of riluzole 50 mg twice daily in subjects with MS onset less than 1 year prior. Trial participation was up to 3 years. The primary endpoint was change in percent brain volume change. Secondary endpoints included changes in normalized gray and normal-appearing white matter volumes, retinal nerve fiber layer thickness (RNFL), MS Functional Composite and Symbol Digit Modalities Test scores. Mixed model regression analysis was used to compare the changes over time between groups. Results Forty-three subjects were randomized to study drug (22 riluzole, 21 placebo). Baseline characteristics were overall similar between groups except for older age (P = 0.042), higher normalized cerebrospinal fluid volume (P = 0.050), lower normalized gray matter volume (P = 0.14), and thinner RNFL (P = 0.043) in the riluzole group. In the primary analysis, percent brain volume change in the placebo group decreased at a rate of 0.49% per year whereas the riluzole group decreased by 0.86% per year (0.37% more per year; 95% CI −0.78, 0.024; P = 0.065). Although age did not influence the rate of brain volume decline, the difference between groups was attenuated after adjustment for baseline normalized gray matter and lesion volume (0.26% more per year in riluzole group; 95% CI −0.057, 0.014; P = 0.22). Analyses of secondary outcomes showed no differences between groups. Interpretation This trial provides class 1 evidence that riluzole treatment does not meaningfully reduce brain atrophy progression in early MS.
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Affiliation(s)
- Emmanuelle Waubant
- MS Center, Neurology Department, University of California San Francisco San Francisco, California ; Department of Pediatrics, University of California San Francisco San Francisco, California
| | - Amir-Hadi Maghzi
- MS Center, Neurology Department, University of California San Francisco San Francisco, California
| | - Nisha Revirajan
- MS Center, Neurology Department, University of California San Francisco San Francisco, California
| | - Rebecca Spain
- Portland VA Medical Center & Oregon Health & Science University Portland, Oregon
| | - Laura Julian
- MS Center, Neurology Department, University of California San Francisco San Francisco, California
| | - Ellen M Mowry
- Department of Neurology, Hopkins MS Center Baltimore, Maryland
| | - Jacqueline Marcus
- MS Center, Neurology Department, University of California San Francisco San Francisco, California
| | - Shuang Liu
- Department of Neurology, Yale University School of Medicine New Haven, Connecticut
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco San Francisco, California
| | - Ari Green
- MS Center, Neurology Department, University of California San Francisco San Francisco, California ; Department of Ophthalmology, University of California San Francisco San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco San Francisco, California
| | - Daniel Pelletier
- Department of Neurology, Yale University School of Medicine New Haven, Connecticut
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15
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Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that is pathologically characterized by inflammatory demyelination and neurodegeneration. Axonal damage, along with neuronal loss, occurs from disease onset and may lead to progressive and permanent disability. In contrast with the inflammatory pathways, the molecular mechanisms leading to MS neurodegeneration remain largely elusive. With improved understanding of these mechanisms, new potential therapeutic targets for neuroprotection have emerged. We review the current understanding of neurodegenerative processes at play in MS and discuss potential outcome measures and targets for neuroprotection trials.
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Affiliation(s)
- Amir-Hadi Maghzi
- Multiple Sclerosis Center, Department of Neurology, University of California San Francisco (UCSF), 675 Nelson Rising Lane, 2nd floor, Room 221F, Box 3206, 94158, San Francisco, CA, USA,
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16
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Maghzi AH, Sahraian MA, Shaygannejad V, Minagar A. Is the Iranian Revolution to Blame for the Increasing Incidence of Multiple Sclerosis in Iran? Neuroepidemiology 2013; 40:68-9. [DOI: 10.1159/000341848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/19/2022] Open
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17
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Etemadifar M, Abtahi MA, Razmjoo H, Abtahi SH, Dehghani AR, Abtahi ZA, Akbari M, Mazaheri S, Maghzi AH. Anti-aquaporin-4 IgG in Patients Presenting with Unilateral Optic Neuritis: A Cohort Study. Int J Prev Med 2012; 3:612-5. [PMID: 23024849 PMCID: PMC3445276] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/26/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optic neuritis (ON) can be the first presentation of multiple sclerosis (MS) or neuromyelitis optica (NMO). Anti-aquaporin-4 IgG (AQP4 IgG) is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON (SION). METHODS A cohort of 41 consecutive patients experiencing severe (< 20 / 200) SION (not fulfilling the diagnostic criteria for MS or NMO), was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. RESULTS The seroprevalence among the initial ON patients was 9.7% (4 / 41). The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2 / 4 (50%) vs. 2 / 41 (4.9%); P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. CONCLUSION AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION.
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Affiliation(s)
- Masoud Etemadifar
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Ali Abtahi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Hassan Razmjoo
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Seyed-Hossein Abtahi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,,Correspondence to: Mr. Seyed-Hossein Abtahi, S.H.A. Research Center of Neurological–Ophthalmological Sciences (SHARNOS Co.), No. 9, Boroomand St., Seyed-Alikhan, Chaharbagh Abbasi St., Isfahan 81448-14581, Iran. E-mail:
| | - Ali-Reza Dehghani
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Zahra-Alsadat Abtahi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Mojtaba Akbari
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Amir-Hadi Maghzi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Neuroimmunology Unit, Center for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
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18
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Etemadifar M, Abtahi SH, Razmjoo H, Abtahi MA, Dehghani A, Salari M, Maghzi AH, Akbari M. 25-hydroxyvitamin D Concentrations in Patients with Optic Neuritis as a Clinically Isolated Syndrome and Healthy Controls. Int J Prev Med 2012; 3:313-7. [PMID: 22708027 PMCID: PMC3372073] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/21/2011] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The onset of multiple sclerosis in the majority of the cases occurs as a clinically isolated syndrome (CIS). We sought to assess serum levels of 25-hydroxyvitamin D (25-OHD) in CIS patients and healthy controls. METHODS In this cross-sectional study 40 patients (36 women and 4 men) with CIS manifesting as a single isolated optic neuritis and 40 Age- and sex-matched healthy controls (35 women and 5 men) were enrolled between late October 2010 and early March 2011. General vitamin D deficiency was defined as serum 25-OHD levels of lower than 20 ng/ml and was classified as mild (15 < 25-OHD <20 ng/ml), moderate (8 < 25-OHD <15 ng/ml), and severe (25-OHD <8 ng/ml). RESULTS We found no difference in the median interquartile range [IQR] between CIS patients and controls (17.95 [10.40-29.13] vs. 17.00 [12.25-31.00]; P=0.57). However, when stratified by the levels of deficiency, among CIS patients a significantly higher proportion had severe vitamin D deficiency in comparison to healthy controls (20% vs. 2.5%; P=0.034). Nevertheless, the frequency of general (62.5% vs. 60%, P=0.82), mild (25% vs. 30%, P=0.80), and moderate (17.5% vs. 27.5%, P=0.42) vitamin D deficiency were not different between the two groups. CONCLUSIONS Our findings do not indicate any significant difference of serum 25-OHD between CIS patients and healthy controls. However, in our series severe vitamin D deficiency was more frequent among CIS patients.
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Affiliation(s)
- Masoud Etemadifar
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed-Hossein Abtahi
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Ophthalmology Ward, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Dr. Seyed-Hossein Abtahi, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran. SHARNOS and Co. No. 9, Boroomand. Seyed-Alikhan, Chaharbagh Abbasi, Isfahan, 81448-14581, Iran. E-mail:
| | - Hassan Razmjoo
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Ophthalmology Ward, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Ali Abtahi
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Ophthalmology Ward, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Dehghani
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Ophthalmology Ward, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir-Hadi Maghzi
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran,,Neuroimmunology Unit, Center for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
| | - Mojtaba Akbari
- Isfahan Eye Research Center (IERC), Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Etemadifar M, Mollabashi M, Chitsaz A, Behnamfar O, Bahrami E, Minagar A, Maghzi AH. Seroprevalence of NMO-IgG among patients with neuromyelitis optica and opticospinal multiple sclerosis. Clin Neurol Neurosurg 2012; 114:17-20. [DOI: 10.1016/j.clineuro.2011.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 11/30/2022]
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20
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Abstract
To date, there are no reports studying the rate of amyotrophic lateral sclerosis (ALS) in relatives of multiple sclerosis (MS) patients and vice versa. This study was designed to look into this issue using two population-based databases of MS and ALS in Isfahan province of Iran. We have searched for any first, second or third degree familial kinship between the Isfahan MS Society database and Isfahan ALS population. We compared the rate of ALS among the population of first degree relatives of MS patients, with the crude prevalence of ALS in the general population of Isfahan. On the other hand, a reverse analysis was carried out to compare the prevalence of MS in Isfahan with its rate amongst the first degree relatives of ALS patients. We found 10 families among which five had first degree kinship. The rate of the diseases was significantly higher in both comparisons among the family members (p < 0.00001) and an odds ratios of more than 67 in both calculations showed a several-fold increase of ALS occurrence in the first degree relatives of MS patients and vice versa. In our study relatives of MS patients were significantly more prone to ALS and vice versa. This could give clues about the common features that the two disease share. Both diseases have an environmental and genetic component and these results mostly point toward genetic similarities.
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21
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Maghzi AH, Etemadifar M, Heshmat-Ghahdarijani K, Nonahal S, Minagar A, Moradi V. Cesarean delivery may increase the risk of multiple sclerosis. Mult Scler 2011; 18:468-71. [DOI: 10.1177/1352458511424904] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Prenatal and perinatal factors are believed to contribute to the risk of developing multiple sclerosis (MS). Objective: This study was designed to evaluate whether mode of delivery (vaginal versus cesarean section), as a perinatal factor, affects susceptibility to MS. Methods: MS patients were recruited from the MS registry of Isfahan Multiple Sclerosis Society (IMSS) and were compared with their healthy siblings. Data regarding mode of delivery, birth order, and gestation week of birth were obtained through a specially designed questionnaire. Preterm or post term deliveries were excluded. We used conditional logistic regression statistics and adjusted for gender and birth order. Results: This study included 1349 participants (449 MS patients and 900 controls). Subjects who were born by cesarean section had significant risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI: 1.43–4.41; p = 0.001). There was significant MS risk for females who were born by cesarean section (OR = 2.69, 95% CI: 1.30–5.58; p = 0.008), but not for males (OR = 2.25, 95% CI: 0.90–5.63; p = 0.082). The mean age at onset was lower in MS patients born by cesarean section (24.58 ± 6.33) compared with that of patients born by vaginal delivery (27.59 ± 7.97; p = 0.041). There was no significant difference between the two groups for birth order ( p = 0.417). Conclusion: Our results suggest that those born by vaginal delivery are at a lower risk of subsequent MS. These preliminary findings will need to be addressed in a much larger and preferably prospective study.
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Affiliation(s)
- Amir-Hadi Maghzi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Iran
- Neuroimmunology Unit, Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, UK
- Medical School, Isfahan University of Medical Sciences, Iran
| | - Masoud Etemadifar
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Iran
- Department of Neurology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Iran
| | - Kiyan Heshmat-Ghahdarijani
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Iran
- Medical School, Isfahan University of Medical Sciences, Iran
| | - Safieh Nonahal
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Iran
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, USA
| | - Vahab Moradi
- Department of Statistics, Faculty of Basic Science, University of Mazandaran, Iran
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22
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Kargarfard M, Eetemadifar M, Mehrabi M, Maghzi AH, Hayatbakhsh MR. Fatigue, depression, and health-related quality of life in patients with multiple sclerosis in Isfahan, Iran. Eur J Neurol 2011; 19:431-7. [PMID: 21967324 DOI: 10.1111/j.1468-1331.2011.03535.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Quality of life (QoL) of patients with multiple sclerosis (MS) is worse than that of other chronic diseases. There is a need to examine the impact of fatigue and depression on the QoL independent of level of physical disability in MS. The aim of this study is to explore physical, psychological, and social aspects of health-related QoL (HRQoL) of MS patients in association with physical disability, fatigue, and depression. METHODS In a cross-sectional study, 281 (63.4% women, 36.6% men) patients with MS participated in the study. The HRQoL was assessed by the Persian version of the multiple sclerosis quality of life (MSQoL-54) questionnaires. Other covariates included in the study were disease type, physical disability, fatigue, disease impact, and depression. RESULTS In univariate analysis disease type, physical disability, fatigue, disease impact, and depression were significantly associated with both physical and mental health composite summaries of MSQoL-54. In multivariate regression analysis, patients' physical disability remained significantly associated with both components of MSQoL-54, whilst fatigue and depression were associated with physical and mental composite summaries, respectively. CONCLUSIONS Our findings suggest that MS-related physical disability, fatigue, and depression affect the HRQoL of MS patients, independently of each other and other potential confounding factors. Effective interventions that target fatigue and depression may help improve the QoL of patients, regardless of their disease type and level of disability.
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Affiliation(s)
- M Kargarfard
- Faculty of Physical Education and Sport Sciences, University of Isfahan, Isfahan, Iran.
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23
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Alexander JS, Zivadinov R, Maghzi AH, Ganta VC, Harris MK, Minagar A. Multiple sclerosis and cerebral endothelial dysfunction: Mechanisms. ACTA ACUST UNITED AC 2011; 18:3-12. [PMID: 20663648 DOI: 10.1016/j.pathophys.2010.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 03/30/2010] [Accepted: 04/08/2010] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) is believed to be an immune-mediated neurodegenerative disorder of the human central nervous system which usually affects younger adults with certain genetic backgrounds. The causes and cure for MS remain elusive. Based on the recent advances in our understanding of the pathogenic mechanisms of MS, it appears to represents a heterogeneous group of disorders with dissimilar pathophysiology and neuropathology. Currently, there is no unifying hypothesis to explain the pathogenesis of this complex disease. The three prevailing concepts on the pathogenesis of MS include viral, immunological, and vascular hypotheses. This review presents MS as a neuroinflammatory disease with a significant vascular component and examines the existing evidence for the role of cerebral endothelial cell dysfunction in the pathogenesis of this progressive central nervous system (CNS) inflammatory disorder.
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Affiliation(s)
- J Steven Alexander
- Department of Cellular and Molecular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
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Sahraian MA, Maghzi AH, Etemadifar M, Minagar A. Dalfampridine: review of its efficacy in improving gait in patients with multiple sclerosis. J Cent Nerv Syst Dis 2011; 3:87-93. [PMID: 23861641 PMCID: PMC3663610 DOI: 10.4137/jcnsd.s4868] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive immune-mediated neurodegenerative disease of human central nervous system (CNS), which causes irreversible disability in young adults. The cause and cure for MS remain unknown. Pathophysiology of MS includes two arms: inflammatory demyelination and neurodegeneration. The inflammatory demyelination of MS which is mainly promoted by a massive activation of the immune system against putative CNS antigen(s) leads to loss of oligodendrocyte/myelin complex which slows down or halts impulse conduction in denuded axons. Practically, loss of myelin significantly reduces signal conduction along the demyelinated axons through alterations in the distribution of axonal ion channels. Dalfampridine (4-aminopyridine or 4-AP) is an oral potassium channel blocker, which was recently approved by FDA for symptomatic treatment of MS. Dalfampridine, which acts at the central and peripheral nervous systems, enhances conduction in demyelinated axons and improves walking ability of MS patients. A number of clinical trials have evaluated the safety and efficacy of fampridine in MS patients with the degree of gait improvement as the main outcome. The objective of this manuscript is to provide an overview of the pharmacology, pharmacokinetics, clinical trials, side effects and interactions of dalfampridine used in treatment of MS patients.
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Affiliation(s)
- M A Sahraian
- Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Komijani M, Bouzari M, Etemadifar M, Zarkesh-Esfahani H, Shaykh-Baygloo N, Ghazimorad A, Mostajeran M, Nasr-Azadani A, Maghzi AH. Torque teno mini virus infection and multiple sclerosis. Int J Neurosci 2011; 121:437-41. [PMID: 21545307 DOI: 10.3109/00207454.2011.569039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multiple sclerosis (MS) is a disease of young adults which is characterized by autoimmune demyelination of the central nervous system. Interaction of genetics and environmental factors are required to cause MS. Among the proposed environmental factors for MS, viral infections are thought to play a role in the pathogenesis of the disease. Torque teno mini virus (TTMV), which has recently been shown to infect humans, is a member of circoviridae, and has a circular DNA with 2860 nucleotides. Since there are a few data about the pathogenicity of this virus, this study sought to investigate the presence of TTMV in sera from MS patients and healthy individuals. We studied 149 serum samples from MS patients and 150 sera of healthy individuals. Serum DNA was extracted using phenol-chloroform and was subjected to nested polymerase chain reaction. TTMV-DNA was detected in 24 (16%) sera of the healthy blood donors and in 21 (14.1%) samples of the MS patients, where the difference did not reach significance (p > .05). The result of this study could not establish an association between TTMV infection and MS.
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Affiliation(s)
- Majid Komijani
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan, Iran
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Abstract
Background: The epidemiology of multiple sclerosis (MS) has changed in recent decades. Objectives: This study aimed to give an update on the prevalence and incidence of MS in Isfahan, Iran. Methods: The study population was all residents of Isfahan province during the period from April 2003 to July 2010. In April 2003, a registry of MS patients was created at the Isfahan MS Society (IMSS), which is the only referral center for MS patients in the province. Nearly all MS patients in Isfahan province are now registered with IMSS and were included in the analysis. Results: Among the 3522 registered patients, 2716 were female and 806 were male (sex ratio: 3.37 : 1), and 431 were diagnosed in 2009. This results in a prevalence figure of 73.3 (95% CI: 70.9–75.8) and an incidence of 9.1 (95% CI: 8.3–10.0) per 100,000. Conclusion: The reported prevalence and incidence figures in our study were higher than in our previous report of 2007, in which the prevalence and incidence of MS were reported to be 43.8 and 3.64 per 100,000, respectively. This dramatic increase in the prevalence of MS puts Isfahan amongst the regions with the highest prevalence of MS in Asia and Oceania and is mostly due to changing environmental factors, amongst which vitamin D deficiency seems an important factor in our population.
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Affiliation(s)
- Masoud Etemadifar
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir-Hadi Maghzi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
- Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK
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Abstract
BACKGROUND Numerous studies have assessed risk factors for multiple sclerosis (MS), although none have been conducted previously in Iran. OBJECTIVE The objective of this study was to study lifestyle and environmental risk factors of MS in the Iranian population. METHODS A case-control study, including 394 MS cases and 394 matched controls, was conducted in MS clinics in different Iranian cities. Information on lifestyles, environmental exposures, and past medical history was obtained from medical charts and phone interviews. RESULTS In multivariable analysis, sunlight exposure was associated with a lower risk of MS: the odds ratio (OR) and 95% confidence interval (CI) of MS associated with a 1-h increment in daily sunlight was 0.62 (0.53-0.73). Smoking was associated with MS risk in women (OR: 6.48, 95% CI: 1.46-28.78), but not in men (OR: 0.72, 95% CI: 0.31-1.68) (p=0.002 for interaction). Finally, past history of common surgical procedures, infectious disorders, or exposure to pets and farm animals was not associated with MS risk. CONCLUSIONS Different modifiable lifestyles, including sunlight exposure and smoking, were associated with lower MS risk in Iran. Interventions aimed at promoting smoking cessation and, more importantly, at increasing exposure to sunlight might contribute to the prevention of MS.
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Affiliation(s)
- Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
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Maghzi AH, Marta M, Bosca I, Etemadifar M, Dobson R, Maggiore C, Giovannoni G, Meier UC. Viral pathophysiology of multiple sclerosis: A role for Epstein-Barr virus infection? Pathophysiology 2011; 18:13-20. [PMID: 20538440 PMCID: PMC7135674 DOI: 10.1016/j.pathophys.2010.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/05/2009] [Revised: 03/19/2010] [Accepted: 04/12/2010] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is the most common inflammatory demyelinating and degenerative disease of the CNS. The cause of MS is unknown but environmental risk factors are implicated in MS. Several viruses have been proposed as a trigger for MS, and lately Epstein-Barr virus (EBV) has become the leading candidate. An infectious aetiology fits with a number of epidemiological observations in addition to the immunopathological features of the disease. In this review we will summarize the emerging evidence, which demonstrates a strong association between EBV infection and MS. The conundrum remains as to whether EBV is directly involved in the pathophysiology of MS, or alternatively if the immunopathology of MS somehow affects the regulation of EBV infection.
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Affiliation(s)
- Amir-Hadi Maghzi
- Neuroimmunology Unit, Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK; Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran; Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Maghzi AH, Etemadifar M, Heshmat-Ghahdarijani K, Moradi V, Nonahal S, Ghorbani A, Minagar A. Cigarette Smoking and the Risk of Multiple Sclerosis: A Sibling Case-Control Study in Isfahan, Iran. Neuroepidemiology 2011; 37:238-42. [DOI: 10.1159/000332765] [Citation(s) in RCA: 17] [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: 08/04/2011] [Accepted: 08/26/2011] [Indexed: 11/19/2022] Open
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Etemadifar M, Hekmatnia A, Tayari N, Kazemi M, Ghazavi A, Akbari M, Maghzi AH. Features of Virchow-Robin spaces in newly diagnosed multiple sclerosis patients. Eur J Radiol 2010; 80:e104-8. [PMID: 20650586 DOI: 10.1016/j.ejrad.2010.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Virchow-Robin spaces (VRSs) are perivascular pia-lined extensions of the subarachnoid space around the arteries and veins as they enter the brain parenchyma. These spaces are responsible for inflammatory processes within the brain. OBJECTIVES This study was designed to shed more light on the location, size and shape of VRSs on 3mm slice thickness, 1.5 Tesla MRI scans of newly diagnosed MS patients in Isfahan, Iran and compare the results with healthy age- and sex-matched controls. METHODS We evaluated MRI scans of 73 MS patients obtained within 3 months of MS onset and compared them with MRI scans from 73 age- and sex-matched healthy volunteers. Three mm section proton density, T2W and FLAIR MR images were obtained for all subjects. The location, size and shape of VRSs were compared between the two groups. RESULTS The total number of VRSs was significantly more in the MS group (p<0.001). The distribution of VRSs were significantly more located in the high convexity areas in the MS group (p<0.001), while there was no significant differences in other regions. The round shaped VRSs were significantly more detected on MRI scans of MS patients, and curvilinear shapes were significantly more frequently observed in healthy volunteers, however there were no significant differences for oval shaped VRSs between the two groups. The number of VRSs with the size over than 2mm were significantly more observed in the MS groups compared to controls. We also observed some differences in the characteristics of VRSs between the genders in the MS group. CONCLUSION The results of this study shed more light on the usefulness of VRSs as an MRI marker for the disease. In addition, according to our results VRSs might also have implication to determine the prognosis of the disease. However, larger studies with more advanced MRI techniques are required to confirm our results.
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Affiliation(s)
- Masoud Etemadifar
- Department of Clinical and Biological Sciences, Division of Neurology, San Luigi Gonzaga School of Medicine, Orbassano, Torino, Turin, Italy
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Abstract
Swallowing disorders are commonly observed in multiple sclerosis (MS) patients. The complications of dysphagia are common causes of morbidity and death in late stages of MS. However, dysphagia in MS usually receives limited attention. The purpose of this study was to determine the prevalence of different kinds of swallowing disorders in MS patients with mild to moderate disability; and to identify possible associations between clinical and demographic features of patients and the presence of dysphagia. The swallowing functions of 101 consecutive MS patients were screened by the Northwestern Dysphagia Patient Check Sheet. This is a screening test which identifies patients with pharyngeal stage disorders, aspiration, oral stage disorders and/or pharyngeal delay. 'Dysphagia' was defined as having at least one of the above mentioned four disorders. Among 101 MS patients, 32 (31.7%) were classified as having dysphagia. Pharyngeal stage disorders were the most common observed impairment (28.7%) and aspiration, oral stage disorders, and pharyngeal delay were observed in 6.9%, 5%, and 1% of patients, respectively. Dysphagic patients had a significantly longer disease duration (p = 0.031) and more neurological impairment in cerebellar functional system (p = 0.04) when compared with non-dysphagic patients. Moreover, dysphagia was significantly more prevalent in patients with more neurological disability as measured by Expanded Disability Status Scale (EDSS) scores (p = 0.04). These results emphasize the importance of assessment and management of swallowing function in MS patients, particularly in patients with a high EDSS score; more severe cerebellar dysfunction, and long disease duration.
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Affiliation(s)
- Marziyeh Poorjavad
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran
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Maghzi AH, Ghazavi H, Ahsan M, Etemadifar M, Mousavi SA, Khorvash F, Minagar A. Increasing female preponderance of multiple sclerosis in Isfahan, Iran: a population-based study. Mult Scler 2010; 16:359-61. [DOI: 10.1177/1352458509358092] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an overall increase in the worldwide prevalence and incidence of multiple sclerosis (MS). Studies from several countries also demonstrated an increase of female/male ratio over time denoting an increase in the incidence of MS particularly in women. In this study we sought to assess the trends in MS incidence and prevalence in males and females over recent decades in Isfahan, Iran, which differs from other regions in terms of environmental and lifestyle changes. We determined female/male ratio by year of birth (YOB) in 1584 patients with MS registered with Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to August 2007. A comparison of sex ratio of MS patients by YOB showed a significant, progressive, gradual increase, with an apparent interruption in the late 1960s. In this study year of birth is a significant predictor for sex ratio ( p < 0.001, χ2 = 17.130, Spearman’s rank correlation r = 0.893). Our findings show that there is a significant increase in the incidence of MS among females for the the last decades in the Isfahan province of Iran. This rapid increase may be related to changes in environmental interactions rather than genetic factors, and among them vitamin D insufficiency, enhanced diagnosis, and lifestyle changes appear to be more plausible causative factors.
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Affiliation(s)
- AH Maghzi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran, , Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Neuroimmunology Unit, Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
| | - H. Ghazavi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. Ahsan
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran
| | - M. Etemadifar
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - SA Mousavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F. Khorvash
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A. Minagar
- Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Etemadifar M, Fatehi F, Sahraian MA, Borhanihaghighi A, Ardestani PM, Kaji-Esfahani M, Maghzi AH. Multiple sclerosis and neurofibromatosis type 1: report of seven patients from Iran. Mult Scler 2009; 15:1126-30. [DOI: 10.1177/1352458509106612] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Introduction Co-occurrence of multiple sclerosis (MS) and neurofibromatosis type 1 (NF1) is rare. Case reports In this study, we describe the clinical and neuroimaging features of seven patients with NF1 and MS. In our patients, six patients with MS were women, in all of them history of NF1 existed. Three of our patients had primary progressive, one had secondary progressive MS, and three relapsing–remitting MS. Optic neuritis as presenting symptoms was seen in three patients, and motor manifestation as presenting symptom was observed in three patients. The risk of having both NF1 and MS seemed to be higher than would be expected based on the prevalence rates of the two diseases in the general population. Conclusion The findings of this study suggest a possible casual relationship between MS and NF1, indicating higher risk of MS among patients with NF1.
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Affiliation(s)
- M Etemadifar
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - F Fatehi
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - MA Sahraian
- Department of Neurology and Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - A Borhanihaghighi
- Department of Neurology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - PM Ardestani
- Department of Anatomy, Neuroscience lab II, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - M Kaji-Esfahani
- Department of Radiology, Islamic Azad University of Najafabad, Isfahan, Iran
| | - AH Maghzi
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Neuroimmunology unit, Neuroscience Center, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
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Abstract
This study was designed to evaluate the efficacy of gabapentin (GBP) in the treatment of SUNCT syndrome on a relatively large sample of Persian patients. Eight patients with SUNCT syndrome underwent a 4-week, open-label, daily treatment of 600-900 mg GBP. The frequency, intensity and duration of attacks were compared before and after the trial. After 4 weeks of treatment, intensity, duration and frequency of headaches were significantly ( P< 0.05) reduced. In addition, five patients (62.5±) were completely relieved from headaches, and in the other three patients the mean intensity, frequency and duration of headaches were decreased notably. In this study, GBP was well tolerated and no unfavourable side-effects were reported. After the end of the trial all patients continued the medication, and after 3 months none reported undesired side-effects or return of the headaches to the pre-treatment status. Our patients had a significant response to GBP, and considering other case reports on the effectiveness of GBP in the treatment of SUNCT syndrome, we propose that, taking into account the good side-effect profile and lack of interactions of GBP, this drug could be considered as an option for the treatment of SUNCT.
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Affiliation(s)
| | - AH Maghzi
- Medical School, Isfahan University of Medical Sciences, Isfahan
| | | | | | - M Kaji Esfahani
- Department of Radiology, Islamic Azad University of Najafabad, Najafabad, Iran
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Etemadifar M, Raoufi M, Maghzi AH, Ebrahimi A, Kaji-Esfahani M, Mousavi SA. Television-provoked epilepsy in children: a follow-up survey from Isfahan, Iran. Arch Iran Med 2008; 11:649-653. [PMID: 18976036] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Television as an external stimulation can precipitate epileptic seizures. Today this kind of epilepsy is known as television epilepsy. As children spend much of their time watching television, it is important to study this type of epilepsy in this age group. This study was designed to describe the clinical and some demographic characteristics of television epilepsy in Iranian children. METHODS Patients who were diagnosed as having television epilepsy with an age less than 12 years were recruited from outpatient neurology clinics in Isfahan, Iran, from September 2002 through September 2006. We collected the case-related information including electroencephalograms, radiologic findings, and patients' history. RESULTS Thirty patients with television epilepsy with the age less than 12 years were identified. Of whom 17 (56.7%) were females and 13 (43.3%) were males. The mean age at the onset of seizure was 9.9+/-2.1 years. Children had absence (3.3%), myoclonic (3.3%), and generalized tonic-clonic (93.3+/-) seizures in response to intermittent photic stimulations. Interictal epileptiform discharges in electroencephalograms were detected in 83.3%. In addition, neuroimaging findings were normal in 96.7% of the patients. In our study, 56.7% of the children had pure television epilepsy and 43.3% experienced other types of generalized seizure. During the follow-up period after initiation of variable drug treatments including valproic acid, carbamazepine, phenobarbital, clonazepam, ethosuximide, and lamotrigine all the patients had complete seizure remission. CONCLUSION The clinical and demographic differences of our patients compared with other reports are probably due to genetic differences. In our study, it was demonstrated that carbamazepine could be used in children with television epilepsy because it had successfully terminated seizures in 43.3% of the patients.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Etemadifar M, Nasr-Esfahani AH, Khodabandehlou R, Maghzi AH. Childhood-onset multiple sclerosis: report of 82 patients from Isfahan, Iran. Arch Iran Med 2007; 10:152-6. [PMID: 17367215 DOI: 07102/aim.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although multiple sclerosis is considered as an inflammatory demyelinating disease of young adults, nearly 3% of patients manifest it under the age of 16 years. The aim of this study was to highlight the clinical and demographic features of early-onset multiple sclerosis in Isfahan, Iran. METHODS This prospective study concerned multiple sclerosis patients in whom the disease started before the age of 16 years and who were referred to the only clinic of multiple sclerosis in Isfahan from October 1997 through February 2003. All early-onset multiple sclerosis patients underwent magnetic resonance imaging. Magnetic resonance imaging findings were analyzed according to the Barkhof's criteria. All early-onset multiple sclerosis patients were followed for a mean period of 4.7 years. RESULTS Among 1,238 multiple sclerosis patients, 82 early-onset multiple sclerosis patients were identified. The female to male ratio was 4.5:1. The mean age of onset was 14.1 (range: 5 to 16) years. In 53 (65%) patients, the onset was monosymptomatic; in the remaining 29 (35%), it was polysymptomatic. Sixty-four (78%) patients presented a relapsing-remitting course, 14 (17%) had a secondary-progressive and 4 (5%) had a primary-progressive course. At the last evaluation, the expanded disability status scale score was > or =6 in only 8 (10%) patients. According to Barkhof's criteria, the characteristic magnetic resonance imaging findings were observed in 80 (98%) of early-onset multiple sclerosis patients. CONCLUSION In our study, a high rate of childhood multiple sclerosis was observed that may be because of geographical or ethnic differences. Our study also showed that Barkhof's criteria, which is mostly used in adult patients, could be also applied to early-onset multiple sclerosis cases.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
Primary progressive multiple sclerosis (PPMS) is an uncommon form of multiple sclerosis (MS) in which the course of disease is progressive from onset. In a retrospective study amongst 1606 MS patients registered in Isfahan MS Society (IMSS) from April 2003 to 31 December 2005, 92 PPMS cases were identified. That means, the frequency of PPMS amongst all included MS patients would be 5.7% (95% CI: 6.7% and 4.7%). The mean expanded disability status scale (EDSS) for the group was 5.09 +/- 1.3. The commonest mode of presentation was motor disturbance in 55 (59.8%), other modes of presentation were, vertigo in 15 (16.3%), visual problems in 12 (13%), sensory disturbances in six (6.5%), and diplopia in four (4.3%). The current [corrected] existing symptoms were motor problems in all 92 (100%), cerebellar symptoms in 46 (50%), and cognitive impairment in only 6[corrected](6.5%). Interestingly, two (2%) were affected by poliomyelitis during childhood and presenting symptom in both was limb weakness. Primary progressive form of MS is less common in Persian population and some of the rates observed in PPMS patients differ from those in other regions, these differences may be due to different ethnicity of Persian patients or to geographical differences.
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Affiliation(s)
- A H Maghzi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.
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Maghzi AH, Etemadifar M, Shaygannejad V, Saadatnia M, Salehi M, Hassanzadeh A. Conjugal multiple sclerosis in Isfahan, Iran: a population-based study. Mult Scler 2007; 13:673-5. [PMID: 17548450 DOI: 10.1177/1352458506072092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Conjugal multiple sclerosis (MS) is a rare form of MS in which both spouses are affected, and at least one is affected after marriage. Among 1606 definite MS patients, 1076 were in marital relationship, among whom we identified six conjugal pairs, giving the conjugal rate of 0.5%. This rate is 12.5 times higher than the estimated risk of MS for the general population (0.04%). The observed conjugal rate suggests an increased risk of developing MS for MS patients' spouses, this could be due to transmission or, more likely, to the same environmental factors shared in adult life. Multiple Sclerosis 2007; 13: 673-675. http://msj.sagepub.com
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Affiliation(s)
- A H Maghzi
- Medical School, Isfahan University of Medical Sciences, Isfahan, 81744-176, Iran.
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