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Singhal T, Cicero S, Rissanen E, Ficke J, Kukreja P, Vaquerano S, Glanz B, Dubey S, Sticka W, Seaver K, Kijewski M, Callen AM, Chu R, Carter K, Silbersweig D, Chitnis T, Bakshi R, Weiner HL. Glial Activity Load on PET Reveals Persistent "Smoldering" Inflammation in MS Despite Disease-Modifying Treatment: 18 F-PBR06 Study. Clin Nucl Med 2024; 49:491-499. [PMID: 38630948 DOI: 10.1097/rlu.0000000000005201] [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] [Indexed: 04/19/2024]
Abstract
PURPOSE OF THE REPORT 18 F-PBR06-PET targeting 18-kDa translocator protein can detect abnormal microglial activation (MA) in multiple sclerosis (MS). The objectives of this study are to develop individualized mapping of MA using 18 F-PBR06, to determine the effect of disease-modifying treatment (DMT) efficacy on reducing MA, and to determine its clinical, radiological, and serological correlates in MS patients. PATIENTS AND METHODS Thirty 18 F-PBR06-PET scans were performed in 22 MS patients (mean age, 46 ± 13 years; 16 females) and 8 healthy controls (HCs). Logarithmically transformed "glial activity load on PET" scores (calculated as the sum of voxel-by-voxel z -scores ≥4), "lnGALP," were compared between MS and HC and between MS subjects on high-efficacy DMTs (H-DMT, n = 13) and those on no or lower-efficacy treatment, and correlated with clinical measures, serum biomarkers, and cortical thickness. RESULTS Cortical gray matter (CoGM) and white matter (WM) lnGALP scores were higher in MS versus HC (+33% and +48%, P < 0.001). In H-DMT group, CoGM and WM lnGALP scores were significantly lower than lower-efficacy treatment ( P < 0.01) but remained abnormally higher than in HC group ( P = 0.006). Within H-DMT patients, CoGM lnGALP scores correlated positively with physical disability, fatigue and serum glial fibrillary acid protein levels ( r = 0.65-0.79, all P 's < 0.05), and inversely with cortical thickness ( r = -0.66, P < 0.05). CONCLUSIONS High-efficacy DMTs decrease, but do not normalize, CoGM and WM MA in MS patients. Such "residual" MA in CoGM is associated with clinical disability, serum biomarkers, and cortical degeneration. Individualized mapping of translocator protein PET using 18 F-PBR06 is clinically feasible and can potentially serve as an imaging biomarker for evaluating "smoldering" inflammation in MS patients.
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Affiliation(s)
| | - Steven Cicero
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Eero Rissanen
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - John Ficke
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Preksha Kukreja
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Steven Vaquerano
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Shipra Dubey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - William Sticka
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Kyle Seaver
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Marie Kijewski
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology
| | - Alexis M Callen
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Renxin Chu
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Kelsey Carter
- From the Department of Neurology, PET Imaging Program in Neurologic Diseases
| | - David Silbersweig
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Rohit Bakshi
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
| | - Howard L Weiner
- Department of Neurology, Brigham Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases
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Conway S, Saxena S, Baecher-Allan C, Krishnan R, Houtchens M, Glanz B, Saraceno TJ, Polgar-Turcsanyi M, Bose G, Bakshi R, Bhattacharyya S, Galetta K, Kaplan T, Severson C, Singhal T, Stazzone L, Zurawski J, Paul A, Weiner HL, Healy BC, Chitnis T. Preserved T cell but attenuated antibody response in MS patients on fingolimod and ocrelizumab following 2nd and 3rd SARS-CoV-2 mRNA vaccine. Mult Scler J Exp Transl Clin 2023; 9:20552173231165196. [PMID: 37057191 PMCID: PMC10086198 DOI: 10.1177/20552173231165196] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/06/2023] [Indexed: 04/15/2023] Open
Abstract
Background There is limited knowledge about T cell responses in patients with multiple sclerosis (MS) after 3 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. Objectives Assess the SARS-CoV-2 spike antibody and T cell responses in MS patients and healthy controls (HCs) after 2 doses (2-vax) and 3 doses (3-vax) of SARS-CoV-2 mRNA vaccination. Methods We studied seroconversion rates and T cell responses by flow cytometry in HC and MS patients on fingolimod or ocrelizumab. Results After 2-vax, 8/33 (24.2%) patients in ocrelizumab group, 5/7 (71.4%) in fingolimod group, and 29/29 (100%) in HC group (P = 5.7 × 10-11) seroconverted. After 3-vax, 9/22 (40.9%) patients in ocrelizumab group, 19/21 (90.5%) in fingolimod group, and 7/7 (100%) in HC group seroconverted (P = 0.0003). The percentage of SARS-CoV-2 peptide reactive total CD4+ T cells increased in HC and ocrelizumab group but not in fingolimod group after 2-vax and 3-vax (P < 0.0001). The percentage of IFNγ and TNFα producing total CD4+ and CD8+ T cells increased in fingolimod group as compared to HC and ocrelizumab group after 2-vax and 3-vax (P < 0.0001). Conclusions MS patients on ocrelizumab and fingolimod had attenuated humoral responses, but preserved cytokine producing T cell responses compared to HCs after SARS-CoV-2 mRNA vaccination. Clinical Trials Registration NCT05060354.
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Affiliation(s)
- Sarah Conway
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Clare Baecher-Allan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rajesh Krishnan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria Houtchens
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Taylor J Saraceno
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariann Polgar-Turcsanyi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Gauruv Bose
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Galetta
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tamara Kaplan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Severson
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tarun Singhal
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lynn Stazzone
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan Zurawski
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anu Paul
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Palotai M, Pintye D, Glanz B, Chitnis T, Guttmann CRG. Fronto-striatal damage may contribute to resistance to fatigue-lowering medications in multiple sclerosis. J Neuroimaging 2023; 33:269-278. [PMID: 36746670 DOI: 10.1111/jon.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Commonly used fatigue-lowering medications have not been proven effective in treating multiple sclerosis (MS)-related fatigue. A neuroanatomical basis for treatment-resistant fatigue in MS has not been explored. The aim of this study was to investigate the association between brain diffusion abnormality patterns and resistance to fatigue-lowering treatment. METHODS Retrospective patient stratification: 1. treatment-resistant (n = 22) received anti-fatigue and/or anti-depressant and/or anxiolytic medication and the latest two Modified Fatigue Impact Scale (MFIS) score≥38; 2. responder (n = 16): received anti-fatigue and/or antidepressant and/or anxiolytic medication while the latest MFIS was <38, and minimum one previous MFIS was ≥38; 3. non-treated never-fatigued (n = 26): received none of the above-mentioned medications and MFIS was always<38 (over minimum four years assessed with MFIS every 1-2 years). 3T brain MRI was used to perform a cross-sectional voxel-wise comparison of fractional anisotropy (FA) between the groups. RESULTS Treatment-resistant versus responder patients showed more extensive brain damage (ie, lower FA) favoring the fronto-striatal pathways. Both groups showed more widespread brain damage than non-treated never-fatigued patients. A mean fronto-striatal FA value of 0.26 could perfectly predict response to modafinil/armodafinil. CONCLUSION Fronto-striatal damage may play a role in the development of resistance to fatigue-lowering treatment. Fronto-striatal FA may serve as a biomarker to predict response to fatigue-lowering medications in MS.
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Affiliation(s)
- Miklos Palotai
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Pintye
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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4
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Kaplan T, Feldman T, Healey B, Behn M, Glanz B, Chitnis T. Sexual Problems in MS: Sex Differences and Their Impact on Quality of Life. Mult Scler Relat Disord 2023; 74:104672. [PMID: 37031553 DOI: 10.1016/j.msard.2023.104672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/04/2023] [Accepted: 03/25/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Low sexual function and satisfaction are common problems among people with multiple sclerosis (PwMS), but the literature on which patient variables are associated with these issues is inconsistent. OBJECTIVE To investigate the associations between sexual function and satisfaction in PwMS with clinical, demographic, and patient-reported quality of life (QOL) measures and determine if sex differences exist. METHODS This analysis includes PwMS enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB), who completed patient-reported outcome measures: Multiple Sclerosis Quality of Life-54 (MSQOL-54), Modified Fatigue Impact Scale (MFIS), and Center for Epidemiologic Studies Depression Scale (CES-D). Regression models were used to analyze associations between patient variables and function and satisfaction. Results were stratified by sex. Cross-sectional and longitudinal data were used. RESULTS 702 PwMS (526 females,176 males, mean age 42.2 +/-11.1, median EDSS 1.5) were included in the cross-sectional analysis. Data from 341 PwMS were used in the three-year longitudinal analysis. Increasing age, disease duration, and disability were associated with reduced sexual function and satisfaction to the same degree in males and females. However, sex differences existed in the strength of associations with QOL variables. There was no significant longitudinal change in females or males. CONCLUSIONS Age and disease duration were associated with reduced sexual function and satisfaction in males and females. In females, function was significantly associated with disability and satisfaction with fatigue. Males had stronger associations with sexual function in domains related to emotional well-being, health perceptions, and overall QOL. Males had stronger associations with satisfaction in emotional and social functioning and physical health domains. These findings can help better understand the multidimensional problems of sexual function and satisfaction in PwMS and better guide patient care.
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Pol-Patil J, Glanz B, Safar L, Misasi E, Manieri MC, Shanahan R, Healy B, Houtchens M. MeTooMS: Sexual, physical, and emotional abuse experience among women with multiple sclerosis. Mult Scler 2023; 29:287-294. [PMID: 36154526 DOI: 10.1177/13524585221122169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sexual and physical violence against disabled individuals is widespread and linked to negative public health and social outcomes. The real-world prevalence of abuse in women with multiple sclerosis (MS) has not been well studied. OBJECTIVES To explore abuse prevalence in a real-world cohort of females with MS attending an academic MS Center. METHODS Prospective and retrospective abuse data were confidentially collected during neurology clinic visits and extracted from medical records for women attending an academic MS Center. Self-reported and provider-documented prevalence of abuse experiences were correlated with socio-economic and disease-specific factors. RESULTS In total, 200 women completed prospective questionnaires, and 121 non-overlapping independent health records were retrospectively reviewed. Mean age (SD) was 49.055 (11.39). Seventy-six (38%) reported lifetime abuse incidents; 15% were abused within the previous year. Intimate partners were the most likely verbal (p ⩽ 0.01)) and physical (p = 0.04) abuse perpetrators. Neurologic disability correlated with greater likelihood of verbal abuse (p = 0.021) in prospective cohort. There was no billing or encounter documentation for any form of abuse. CONCLUSION Intimate partner violence is common in women with MS, correlates with neurologic disability, and is underreported by the health system. Future research needs to focus on abuse detection and mitigation strategies.
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Affiliation(s)
- Jeta Pol-Patil
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Safar
- Department of Psychiatry & Behavioral Medicine, Lahey Hospital & Medical Center (LHMC), Harvard Medical School, Burlington, MA, USA
| | - Elizabeth Misasi
- Department of Social Work, Brigham and Women's Health Care Center, Westwood, MA, USA
| | | | | | - Brian Healy
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Houtchens
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Drew W, Bakshi R, Cavallari M, Chitnis T, Glanz B, Guttmann C, Palotai M, Fox M, Siddiqi S. TMS targets for multiple sclerosis related depression derived using a precomputed functional connectome. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.814] [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: 02/17/2023] Open
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7
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Cadden M, Barker L, Healy B, Chitnis T, Weiner H, Glanz B. A-69 Baseline Predictors of Longitudinal SDMT Performance in Individuals with Multiple Sclerosis. Arch Clin Neuropsychol 2021. [DOI: 10.1093/arclin/acab062.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
More than half of persons with MS (PwMS) experience cognitive difficulties during the course of their illness. However, not everyone develops cognitive problems suggesting a role for important moderating factors. The object of the current study was to identify baseline predictors of cognitive trajectories in PwMS.
Methods
680 PwMS completed the Symbol Digit Modalities Test (SDMT) and a battery of patient-reported outcome (PRO) measures as part their participation in The Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital (CLIMB). Each participant had at least 2 SDMT measurements as well as demographic (age, sex), clinical (EDSS, disease duration, course type), and PRO (fatigue, depression, and quality of life) data. Participants had a concurrent brain MRI scan at the time of the baseline SDMT measurement; intracranial cavity (ICC) was calculated for each participant as a proxy of brain reserve. The association between each baseline measure and the longitudinal change in the SDMT over the course of the follow-up period was calculated using a linear mixed effects model.
Results
Increased baseline age (95% CI: −0.29, −0.06; p = 0.002), increased baseline EDSS (95% CI: −0.24, −0.01; p = 0.037), and decreased baseline ICC (95% CI: 0.02, 0.25; p = 0.023) were each associated with a greater decline in the SDMT score longitudinally. Although most PRO measures were cross-sectionally correlated with SDMT performance, none were associated with longitudinal change.
Discussion
Older individuals and those with more clinical disability are likely to experience declines in SDMT performance over time. Individuals with high baseline brain reserve tend to have more favorable SDMT trajectories.
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Galetta K, Deshpande C, Healy BC, Glanz B, Ziehn M, Saxena S, Paul A, Saleh F, Collins M, Gaitan-Walsh P, Castro-Mendoza P, Weiner HL, Chitnis T. Serum neurofilament levels and patient-reported outcomes in multiple sclerosis. Ann Clin Transl Neurol 2021; 8:631-638. [PMID: 33492760 PMCID: PMC7951092 DOI: 10.1002/acn3.51305] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/08/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Serum neurofilament light (sNfL) is a promising new biomarker in multiple sclerosis (MS). We explored the relationship between sNfL and health outcomes and resource use in MS patients. METHODS MS patients with serum samples and health-outcome measurements collected longitudinally between 2011 and 2016 were analyzed. sNfL values were evaluated across age and gender. Data were analyzed using correlation with log-transformed sNfL values. RESULTS A total of 304 MS patients with a mean age of 32.9 years, average EDSS of 1.6 (SD = 1.5) and baseline sNfL of 8.8 (range 1.23-78.3) pg/mL were studied. Baseline sNFL values increased with age and were higher in females. Baseline sNfL correlated with baseline Multiple Sclerosis Quality of Life physical composite (mean = 49.4 (9.1), P = 0.035) and baseline EDSS (P = 0.002). Other PRO measures at baseline did not show a significant relationship with baseline sNfL. Average of baseline and follow-up sNfL correlated with MSQoL physical-role limitations (mean = 48.9 (10.8), P = 0.043) and social-functioning (mean = 52.3 (7), P = 0.034) at 24-month follow-up. We found a trend for numerically higher sNfL levels in nonpersistent patients compared to those who were persistent to treatment (11.13 vs. 8.53 pg/mL, P = 0.093) measured as average of baseline and 24-month values. Baseline NfL was associated with number of intravenous steroid infusions (mean = 0.2; SD = 3.0, P = 0.013), whereas the average of baseline and 12 months NfL values related to inpatient stays at 12 months (mean = 0.2; SD = 3.0 P = 0.053). CONCLUSION Serum NfL is a patient-centric biomarker that correlated with MS patient health-outcomes and healthcare utilization measures in a real-world cohort.
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Affiliation(s)
- Kristin Galetta
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bonnie Glanz
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marina Ziehn
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Shrishti Saxena
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anu Paul
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fermisk Saleh
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mikaela Collins
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patricia Gaitan-Walsh
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paola Castro-Mendoza
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Howard L Weiner
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Singhal T, Cicero S, Pan H, Carter K, Dubey S, Chu R, Glanz B, Hurwitz S, Tauhid S, Park MA, Kijewski M, Stern E, Bakshi R, Silbersweig D, Weiner HL. Regional microglial activation in the substantia nigra is linked with fatigue in MS. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/5/e854. [PMID: 32769103 PMCID: PMC7643614 DOI: 10.1212/nxi.0000000000000854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of our study is to assess the role of microglial activation in MS-associated fatigue (MSAF) using [F-18]PBR06-PET. METHODS Fatigue severity was measured using the Modified Fatigue Impact Scale (MFIS) in 12 subjects with MS (7 relapsing-remitting and 5 secondary progressive) and 10 healthy control participants who underwent [F-18]PBR06-PET. The MFIS provides a total fatigue score as well as physical, cognitive, and psychosocial fatigue subscale scores. Standardized Uptake Value (SUV) 60-90 minute frame PET maps were coregistered to 3T MRI. Voxel-by-voxel analysis using Statistical Parametric Mapping and atlas-based regional analyses were performed. SUV ratios (SUVRs) were global brain normalized. RESULTS Peak voxel-based level of significance for correlation between total fatigue score and PET uptake was localized to the right substantia nigra (T-score 4.67, p = 0.001). Similarly, SUVRs derived from atlas-based segmentation of the substantia nigra showed significant correlation with MFIS (r = 0.76, p = 0.004). On multiple regression, the right substantia nigra was an independent predictor of total MFIS (p = 0.02) and cognitive MFIS subscale values (p = 0.007), after adjustment for age, disability, and depression. Several additional areas of significant correlations with fatigue scores were identified, including the right parahippocampal gyrus, right precuneus, and juxtacortical white matter (all p < 0.05). There was no correlation between fatigue scores and brain atrophy and lesion load in patients with MS. CONCLUSION Substantia nigra microglial activation is linked to fatigue in MS. Microglial activation across key brain regions may represent a unifying mechanism for MSAF, and further evaluation of neuroimmunologic basis of MSAF is warranted.
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Affiliation(s)
- Tarun Singhal
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Steven Cicero
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hong Pan
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kelsey Carter
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shipra Dubey
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Renxin Chu
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bonnie Glanz
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shelley Hurwitz
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shahamat Tauhid
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mi-Ae Park
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marie Kijewski
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Stern
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rohit Bakshi
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Silbersweig
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Howard L Weiner
- From the Partners MS Center (T.S., S.C., K.C., B.G., R.B., H.L.W.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; PET Imaging Program in Neurologic Diseases (T.S., S.C., K.C.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Functional Neuroimaging Laboratory (H.P., R.B., D.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Nuclear Medicine and Molecular Imaging (S.D., M.-A.P., M.K.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Laboratory for Neuroimaging Research (R.C., S.T.), Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Medicine (S.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Ceretype Neuromedicine (E.S.)Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Palotai M, Cavallari M, Koubiyr I, Morales Pinzon A, Nazeri A, Healy BC, Glanz B, Weiner HL, Chitnis T, Guttmann CR. Microstructural fronto-striatal and temporo-insular alterations are associated with fatigue in patients with multiple sclerosis independent of white matter lesion load and depression. Mult Scler 2019; 26:1708-1718. [PMID: 31418637 DOI: 10.1177/1352458519869185] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fatigue in multiple sclerosis (MS) has been inconsistently associated with disruption of specific brain circuitries. Temporal fluctuations of fatigue have not been considered. OBJECTIVE The aim of this study was to investigate the association of fatigue with brain diffusion abnormalities, using robust criteria for patient stratification based on longitudinal patterns of fatigue. METHODS Patient stratification: (1) sustained fatigue (SF, n = 26): latest two Modified Fatigue Impact Scale (MFIS) ⩾ 38; (2) reversible fatigue (RF, n = 25): latest MFIS < 38 and minimum one previous MFIS ⩾ 38; and (3) never fatigued (NF, n = 42): MFIS always < 38 (five assessments minimum). 3T brain magnetic resonance imaging (MRI) was used to perform voxel-wise comparison of fractional anisotropy (FA) between the groups controlling for age, sex, disease duration, physical disability, white matter lesion load (T2LV), and depression. RESULTS SF and, to a lesser extent, RF patients showed lower FA in multiple brain regions compared to NF patients, independent of age, sex, disease duration, and physical disability. In cingulo-postcommissural-striato-thalamic regions, the differences in FA between SF and NF (but not between RF and NF or SF) patients were independent of T2LV, and in ventromedial prefronto-precommissuro-striatal and temporo-insular areas, independent of T2LV and depression. CONCLUSION Damage to ventromedial prefronto-precommissuro-striatal and temporo-insular pathways appears to be a specific substrate of SF in MS.
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Affiliation(s)
- Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ismail Koubiyr
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA/INSERM U1215, Neurocentre Magendie, Bordeaux, France
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aria Nazeri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C Healy
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charles Rg Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Tankou SK, Regev K, Healy BC, Tjon E, Laghi L, Cox LM, Kivisäkk P, Pierre IV, Hrishikesh L, Gandhi R, Cook S, Glanz B, Stankiewicz J, Weiner HL. A probiotic modulates the microbiome and immunity in multiple sclerosis. Ann Neurol 2018; 83:1147-1161. [PMID: 29679417 PMCID: PMC6181139 DOI: 10.1002/ana.25244] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Effect of a probiotic on the gut microbiome and peripheral immune function in healthy controls and relapsing-remitting multiple sclerosis (MS) patients. METHODS MS patients (N = 9) and controls (N = 13) were orally administered a probiotic containing Lactobacillus, Bifidobacterium, and Streptococcus twice-daily for two months. Blood and stool specimens were collected at baseline, after completion of the 2-month treatment, and 3 months after discontinuation of therapy. Frozen peripheral blood mononuclear cells (PBMCs) were used for immune cell profiling. Stool samples were used for 16S rRNA profiling and metabolomics. RESULTS Probiotic administration increased the abundance of several taxa known to be depleted in MS such as Lactobacillus. We found that probiotic use decreased the abundance of taxa previously associated with dysbiosis in MS, including Akkermansia and Blautia. Predictive metagenomic analysis revealed a decrease in the abundance of several KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways associated with altered gut microbiota function in MS patients, such as methane metabolism, following probiotic supplementation. At the immune level, probiotic administration induced an anti-inflammatory peripheral immune response characterized by decreased frequency of inflammatory monocytes, decreased mean fluorescence intensity (MFI) of CD80 on classical monocytes, as well as decreased human leukocyte antigen (HLA) D related MFI on dendritic cells. Probiotic administration was also associated with decreased expression of MS risk allele HLA-DQA1 in controls. Probiotic-induced increase in abundance of Lactobacillus and Bifidobacterium was associated with decreased expression of MS risk allele HLA.DPB1 in controls. INTERPRETATION Our results suggest that probiotics could have a synergistic effect with current MS therapies. Ann Neurol 2018.
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Affiliation(s)
- Stephanie K Tankou
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Keren Regev
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Emily Tjon
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Luca Laghi
- University of Bologna, Department of Agricultural and Food Sciences, Cesena 47521, Italy
| | - Laura M Cox
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Pia Kivisäkk
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Isabelle V Pierre
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Lokhande Hrishikesh
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Roopali Gandhi
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
| | - Sandra Cook
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Bonnie Glanz
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - James Stankiewicz
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts 02115, USA
- Evergrande Center for Immunologic Diseases
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12
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Tankou SK, Regev K, Healy BC, Cox LM, Tjon E, Kivisakk P, Vanande IP, Cook S, Gandhi R, Glanz B, Stankiewicz J, Weiner HL. Investigation of probiotics in multiple sclerosis. Mult Scler 2018; 24:58-63. [DOI: 10.1177/1352458517737390] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
None of the disease-modifying therapies (DMTs) currently being used for the management of multiple sclerosis (MS) are 100% effective. In addition, side effects associated with the use of these DMTs have limited the practice of combination therapy. Hence, there is a need for safe immunomodulatory agents to fine-tune the management of MS. The gut microbiome plays an important role in autoimmunity, and several studies have reported alterations in the gut microbiome of MS patients. Studies in animal model of MS have identified members of the gut commensal microflora that exacerbate or ameliorate neuroinflammation. Probiotics represent an oral, non-toxic immunomodulatory agent that could be used in combination with current MS therapy. We designed a pilot study to investigate the effect of VSL3 on the gut microbiome and peripheral immune system function in healthy controls and MS patients. VSL3 administration was associated with increased abundance of many taxa with enriched taxa predominated by Lactobacillus, Streptococcus, and Bifidobacterium species. At the immune level, VSL3 administration induced an anti-inflammatory peripheral immune response characterized by decreased frequency of intermediate monocytes (CD14highCD16low), decreased mean fluorescence intensity (MFI) of CD80 on classical monocytes as well as decreased human leukocyte antigen–antigen D related (HLA-DR) MFI on dendritic cells.
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Affiliation(s)
- Stephanie K Tankou
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Keren Regev
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Laura M Cox
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Emily Tjon
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Pia Kivisakk
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Isabelle P Vanande
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Sandra Cook
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Roopali Gandhi
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - James Stankiewicz
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Evergrande Center for Immunologic Diseases, Partners Multiple Sclerosis Center, Brigham and Women’s Hospital and Department of Neurology, Harvard Medical School, Boston, MA, USA
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Cavallari M, Egorova S, Healy BC, Palotai M, Prieto JC, Polgar‐Turcsanyi M, Tauhid S, Anderson M, Glanz B, Chitnis T, Guttmann CR. Evaluating the Association between Enlarged Perivascular Spaces and Disease Worsening in Multiple Sclerosis. J Neuroimaging 2017; 28:273-277. [DOI: 10.1111/jon.12490] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/23/2017] [Accepted: 11/12/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Michele Cavallari
- Center for Neurological ImagingDepartment of RadiologyBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Svetlana Egorova
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Brian C. Healy
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Miklos Palotai
- Center for Neurological ImagingDepartment of RadiologyBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Juan Carlos Prieto
- Center for Neurological ImagingDepartment of RadiologyBrigham and Women's HospitalHarvard Medical School Boston MA
| | | | - Shahamat Tauhid
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Mark Anderson
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Bonnie Glanz
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis CenterBrigham and Women's HospitalHarvard Medical School Boston MA
| | - Charles R.G. Guttmann
- Center for Neurological ImagingDepartment of RadiologyBrigham and Women's HospitalHarvard Medical School Boston MA
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Sattarnezhad N, Farrow S, Kimbrough D, Glanz B, Healy B, Chitnis T. Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients. Mult Scler 2017; 24:1126-1130. [PMID: 28585909 DOI: 10.1177/1352458517713667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. OBJECTIVES To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. METHODS A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women's hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland-Altman analysis and paired t-test. RESULTS For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were -7.9 to +8.5 letters for the right eye and -10.9 to +11.2 letters for the left eye. CONCLUSION An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.
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Affiliation(s)
- Neda Sattarnezhad
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Samantha Farrow
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorlan Kimbrough
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
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15
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Gandhi R, Mazzola M, Raheja R, Gopal M, Rajabi H, Kumar D, Pertel T, Regev K, Griffin R, Aly L, Kivisakk P, Nejad P, Patel B, Gwanyalla NG, Hey H, Glanz B, Chitnis T, Weiner HL, Gandhi R. TCF-1 regulates effector T cell responses upon FTY720 treatment in multiple sclerosis. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.54.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Background
Cytokine producing effector T helper cells are the prime mediators of inflammation during multiple sclerosis (MS) and other autoimmune diseases. The basic immune mechanisms associated with increased pro-inflammatory effector T cell function in MS are not understood. TCF-1 (T cell factor 1, also known, as TCF-7) is a transcription factor that plays an important role in T cell biology in mice.
Methods
T cells from MS patients and healthy controls were isolated to measure gene expression profiles using nanostring and qPCR. Cytokine protein expression was measured using luminex assay and flow cytometry analysis. Lentivirus vector carrying shRNA was used to knock down the expression of specific genes in CD4+ T cells. Chromatin immunoprecipitation was performed to assess TCF-1 binding to promoter regions. Luciferase assays were performed to test the regulation of IFN-γ and granzyme B by TCF-1. Western blot analysis was used to assess the phosphorylation status of Akt and GSK3β.
Results
We found that TCF-1 expression is decreased in MS T cells, and FTY720 increased the expression of TCF-1 in treated T cells. We found that FTY720 treated T cell have decreased effector phenotype as measured by decreased T cell proliferation, decreased cytokine and granzyme B production. The decreased effector phenotype of the T cells is dependent upon regulatory transcription factor, TCF-1. TCF-1 blocked T cell effector function by directly binding and negatively regulating the expression of cytokines and granzyme B. Thus, our study for the first time showed that TCF-1 regulates human effector T cell function and its decreased expression could be related to altered T cell function in MS.
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Mazzola MA, Raheja R, Murugaiyan G, Rajabi H, Kumar D, Pertel T, Regev K, Griffin R, Aly L, Kivisakk P, Nejad P, Patel B, Gwanyalla N, Hei H, Glanz B, Chitnis T, Weiner HL, Gandhi R. Identification of a novel mechanism of action of fingolimod (FTY720) on human effector T cell function through TCF-1 upregulation. J Neuroinflammation 2015; 12:245. [PMID: 26714756 PMCID: PMC4696082 DOI: 10.1186/s12974-015-0460-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 10/26/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022] Open
Abstract
Background Fingolimod (FTY720), the first oral treatment for multiple sclerosis (MS), blocks immune cell trafficking and prevents disease relapses by downregulation of sphingosine-1-phosphate receptor. We determined the effect of FTY720 on human T cell activation and effector function. Methods T cells from MS patients and healthy controls were isolated to measure gene expression profiles in the presence or absence of FTY720 using nanostring and quantitative real-time polymerase chain reaction (qPCR). Cytokine protein expression was measured using luminex assay and flow cytometry analysis. Lentivirus vector carrying short hairpin RNA (shRNA) was used to knock down the expression of specific genes in CD4+ T cells. Chromatin immunoprecipitation was performed to assess T cell factor 1 (TCF-1) binding to promoter regions. Luciferase assays were performed to test the direct regulation of interferon gamma (IFN-γ) and granzyme B (GZMB) by TCF-1. Western blot analysis was used to assess the phosphorylation status of Akt and GSK3β. Results We showed that FTY720 treatment not only affects T cell trafficking but also T cell activation. Patients treated with FTY720 showed a significant reduction in circulating CD4 T cells. Activation of T cells in presence of FTY720 showed a less inflammatory phenotype with reduced production of IFN-γ and GZMB. This decreased effector phenotype of FTY720-treated T cells was dependent on the upregulation of TCF-1. FTY720-induced TCF-1 downregulated the pathogenic cytokines IFN-γ and GZMB by binding to their promoter/enhancer regions and mediating epigenetic modifications. Furthermore, we observed that TCF-1 expression was lower in T cells from multiple sclerosis patients than in those from healthy individuals, and FTY720 treatment increased TCF-1 expression in multiple sclerosis patients. Conclusions These results reveal a previously unknown mechanism of the effect of FTY720 on human CD4+ T cell modulation in multiple sclerosis and demonstrate the role of TCF-1 in human T cell activation and effector function. Electronic supplementary material The online version of this article (doi:10.1186/s12974-015-0460-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Antonietta Mazzola
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Radhika Raheja
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Gopal Murugaiyan
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Hasan Rajabi
- Dana Farber Cancer Institute, Boston, MA, 02115, USA.
| | - Deepak Kumar
- Department of Biochemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, 02115, USA.
| | - Thomas Pertel
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Keren Regev
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Russell Griffin
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Lilian Aly
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Pia Kivisakk
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Parham Nejad
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Bonny Patel
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Nguendab Gwanyalla
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Hillary Hei
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
| | - Bonnie Glanz
- Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Howard L Weiner
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA. .,Partners MS Center, Brigham and Women's Hospital, 1 Brookline Place, Brookline, MA, 02445, USA.
| | - Roopali Gandhi
- Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA.
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Rotstein DL, Healy BC, Malik MT, Carruthers RL, Musallam AJ, Kivisakk P, Weiner HL, Glanz B, Chitnis T. Effect of vitamin D on MS activity by disease-modifying therapy class. Neurol Neuroimmunol Neuroinflamm 2015; 2:e167. [PMID: 26568968 PMCID: PMC4630683 DOI: 10.1212/nxi.0000000000000167] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/11/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether vitamin D status predicts disease activity in patients with multiple sclerosis (MS) taking interferon-β (IFN), glatiramer acetate (GA), and fingolimod (FTY). METHODS Participants (n = 324) with relapsing-remitting MS on IFN (96), GA (151), or FTY (77) were identified from the Comprehensive Longitudinal Investigation of MS at Brigham and Women's Hospital (CLIMB) Study at the Partners MS Center. FTY-treated participants were analyzed separately because of differences in selection. Serum vitamin 25(OH)D concentration was adjusted for season. We evaluated the relationship between 25(OH)D tertile and time to relapse or gadolinium-enhancing lesion using a Cox model adjusted for age, sex, and disease duration. RESULTS Higher 25(OH)D was associated with longer time to the combined endpoint in the overall IFN/GA cohort (p for trend = 0.042; hazard ratio [HR] = 0.77) and in the IFN subgroup (HRIFN = 0.58; p IFN = 0.012), but not in GA-treated participants (p = 0.50; HR = 0.89). For gadolinium-enhancing lesions alone, there was a significant association observed in GA and IFN subgroups, although the effect was more pronounced on IFN (HRGA = 0.57; p GA = 0.039 vs HRIFN = 0.41; p IFN = 0.022). No significant associations were found for relapses. For FTY, higher 25(OH)D was associated with longer survival for the combined endpoint (HRFTY = 0.48; p FTY = 0.016) and for relapses (HRFTY = 0.50; p FTY = 0.046), but not for gadolinium-enhancing lesions. CONCLUSIONS Disease activity generally improved with higher 25(OH)D, but this study raises the question of effect modification by treatment class.
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Affiliation(s)
- Dalia L Rotstein
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Brian C Healy
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Muhammad T Malik
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Robert L Carruthers
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Alexander J Musallam
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Pia Kivisakk
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Howard L Weiner
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston
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18
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Bove R, White CC, Giovannoni G, Glanz B, Golubchikov V, Hujol J, Jennings C, Langdon D, Lee M, Legedza A, Paskavitz J, Prasad S, Richert J, Robbins A, Roberts S, Weiner H, Ramachandran R, Botfield M, De Jager PL. Evaluating more naturalistic outcome measures: A 1-year smartphone study in multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2015; 2:e162. [PMID: 26516627 PMCID: PMC4608760 DOI: 10.1212/nxi.0000000000000162] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/19/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In this cohort of individuals with and without multiple sclerosis (MS), we illustrate some of the novel approaches that smartphones provide to monitor patients with chronic neurologic disorders in their natural setting. METHODS Thirty-eight participant pairs (MS and cohabitant) aged 18-55 years participated in the study. Each participant received an Android HTC Sensation 4G smartphone containing a custom application suite of 19 tests capturing participant performance and patient-reported outcomes (PROs). Over 1 year, participants were prompted daily to complete one assigned test. RESULTS A total of 22 patients with MS and 17 cohabitants completed the entire study. Among patients with MS, low scores on PROs relating to mental and visual function were associated with dropout (p < 0.05). We illustrate several novel features of a smartphone platform. First, fluctuations in MS outcomes (e.g., fatigue) were assessed against an individual's ambient environment by linking responses to meteorological data. Second, both response accuracy and speed for the Ishihara color vision test were captured, highlighting the benefits of both active and passive data collection. Third, a new trait, a person-specific learning curve in neuropsychological testing, was identified using spline analysis. Finally, averaging repeated measures over the study yielded the most robust correlation matrix of the different outcome measures. CONCLUSIONS We report the feasibility of, and barriers to, deploying a smartphone platform to gather useful passive and active performance data at high frequency in an unstructured manner in the field. A smartphone platform may therefore enable large-scale naturalistic studies of patients with MS or other neurologic diseases.
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Affiliation(s)
- Riley Bove
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Charles C White
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Gavin Giovannoni
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Bonnie Glanz
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Victor Golubchikov
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Johnny Hujol
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Charles Jennings
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Dawn Langdon
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Michelle Lee
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Anna Legedza
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - James Paskavitz
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Sashank Prasad
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - John Richert
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Allison Robbins
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Susan Roberts
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Howard Weiner
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Ravi Ramachandran
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Martyn Botfield
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
| | - Philip L De Jager
- Program in Translational Neuropsychiatric Genomics (R.B., C.C.W., B.G., M.L., S.P., A.R., H.W., P.L.D.J.), Ann Romney Center for Neurologic Diseases, and the Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Brookline, MA; Harvard Medical School (R.B., B.G., S.P., H.W., P.L.D.G.), Boston, MA; Blizard Institute (G.G.) and Royal Holloway (D.L.), University College London, London, UK; Vertex Pharmaceuticals Incorporated (V.G., A.L., S.R., R.R., M.B.), Boston MA; Woo Sports (J.H.), Boston, MA; McGovern Institute Neurotechnology Program (C.J.), MIT, Cambridge, MA; and Biogen-Idec (J.P., J.R.), Cambridge, MA
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Ceccarelli A, Neema M, Jackson J, Han X, Arora A, Glanz B, Benedict R, Bakshi R. The Longitudinal Relationship between Cognitive Dysfunction and Global vs. Regional Brain Atrophy in Relapsing Remitting Multiple Sclerosis: A One Year Follow-Up Study (S51.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s51.004] [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: 11/15/2022] Open
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Bove R, Healy B, Houtchens M, Glanz B, Khoury S, Guttmann C, De Jager P, Chitnis T. Menopause May Not Modulate Disease Course in Multiple Sclerosis (P06.183). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.183] [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: 11/15/2022] Open
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Arora A, Delloglio E, Ceccarelli A, Glanz B, Healy B, Tauhid S, Jackson J, Saravanan N, Benedict R, Bakshi R, Neema M. Quantification of Global Cerebral Gray Matter Atrophy in Multiple Sclerosis from 3T MRI (P03.056). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.056] [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: 11/15/2022] Open
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Bove R, Secor E, Vaughan T, Wicks P, Glanz B, Weiner H, Chitnis T, De Jager P. Comparison of Demographic and Disease Characteristics in Patients with Multiple Sclerosis at an MS Clinic and on an Online Research Forum (P01.145). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.145] [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: 11/15/2022] Open
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Healy BC, Liguori M, Tran D, Chitnis T, Glanz B, Wolfish C, Gauthier S, Buckle G, Houtchens M, Stazzone L, Khoury S, Hartzmann R, Fernandez-Vina M, Hafler DA, Weiner HL, Guttmann CRG, De Jager PL. HLA B*44: protective effects in MS susceptibility and MRI outcome measures. Neurology 2010; 75:634-40. [PMID: 20713950 DOI: 10.1212/wnl.0b013e3181ed9c9c] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In addition to the main multiple sclerosis (MS) major histocompatibility complex (MHC) risk allele (HLA DRB1*1501), investigations of the MHC have implicated several class I MHC loci (HLA A, HLA B, and HLA C) as potential independent MS susceptibility loci. Here, we evaluate the role of 3 putative protective alleles in MS: HLA A*02, HLA B*44, and HLA C*05. METHODS Subjects include a clinic-based patient sample with a diagnosis of either MS or a clinically isolated syndrome (n = 532), compared to subjects in a bone marrow donor registry (n = 776). All subjects have 2-digit HLA data. Logistic regression was used to determine the independence of each allele's effect. We used linear regression and an additive model to test for correlation between an allele and MRI and clinical measures of disease course. RESULTS After accounting for the effect of HLA DRB1*1501, both HLA A*02 and HLA B*44 are validated as susceptibility alleles (p(A*02) 0.00039 and p(B*44) 0.00092) and remain significantly associated with MS susceptibility in the presence of the other allele. Although A*02 is not associated with MS outcome measures, HLA B*44 demonstrates association with a better radiologic outcome both in terms of brain parenchymal fraction and T2 hyperintense lesion volume (p = 0.03 for each outcome). CONCLUSION The MHC class I alleles HLA A*02 and HLA B*44 independently reduce susceptibility to MS, but only HLA B*44 appears to influence disease course, preserving brain volume and reducing the burden of T2 hyperintense lesions in subjects with MS.
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Affiliation(s)
- B C Healy
- Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham and Women's Hospital, 77 Avenue Louis Pasteur, NRB 168c, Boston, MA 02115, USA
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Chitnis T, Glanz B, Jaffin S, Healy B. Demographics of pediatric-onset multiple sclerosis in an MS center population from the Northeastern United States. Mult Scler 2009; 15:627-31. [PMID: 19299440 DOI: 10.1177/1352458508101933] [Citation(s) in RCA: 172] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The prevalence of pediatric-onset multiple sclerosis (MS) in the United States is unknown. Objective In a large cohort of MS patients, we sought to identify the proportion with first symptom-onset below the age of 18 years, and to compare their demographic and disease characteristics to a typical adult-onset MS population. Methods Patients seen at the Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, Massachusetts, with clinical histories and characteristics of first symptoms recorded in an electronic database, were included in this study. Results We found that 3.06% of patients with a recorded MS history experienced a first attack under the age of 18 years of age compared to 30.83% of patients who experienced first symptoms between the ages of 25–35 years. Gender proportions were similar in both groups, with the exception of a lower female preponderance in pre-pubertal-onset patients. There was a higher proportion of non-Caucasians in the younger cohort. Localization of first symptoms was similar in the two groups. Conclusion About 3% of MS patients experience their first symptom prior to the age of 18 years. Standardized follow-up is required after a first demyelinating attack in childhood, which may lead to earlier diagnosis and treatment of pediatric-onset MS.
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Affiliation(s)
- T Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - B Glanz
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - S Jaffin
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
| | - B Healy
- Partners Multiple Sclerosis Center, Brigham and Women’s Hospital, Boston, MA, USA
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Bakshi R, Neema M, Healy BC, Liptak Z, Betensky RA, Buckle GJ, Gauthier SA, Stankiewicz J, Meier D, Egorova S, Arora A, Guss ZD, Glanz B, Khoury SJ, Guttmann CRG, Weiner HL. Predicting clinical progression in multiple sclerosis with the magnetic resonance disease severity scale. ACTA ACUST UNITED AC 2008; 65:1449-53. [PMID: 19001162 DOI: 10.1001/archneur.65.11.1449] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Individual magnetic resonance imaging (MRI) disease severity measures, such as atrophy or lesions, show weak relationships to clinical status in patients with multiple sclerosis (MS). OBJECTIVE To combine MS-MRI measures of disease severity into a composite score. DESIGN Retrospective analysis of prospectively collected data. SETTING Community-based and referral subspecialty clinic in an academic hospital. PATIENTS A total of 103 patients with MS, with a mean (SD) Expanded Disability Status Scale (EDSS) score of 3.3 (2.2), of whom 62 (60.2%) had the relapsing-remitting, 33 (32.0%) the secondary progressive, and 8 (7.8%) the primary progressive form. MAIN OUTCOME MEASURES Brain MRI measures included baseline T2 hyperintense (T2LV) and T1 hypointense (T1LV) lesion volume and brain parenchymal fraction (BPF), a marker of global atrophy. The ratio of T1LV to T2LV (T1:T2) assessed lesion severity. A Magnetic Resonance Disease Severity Scale (MRDSS) score, on a continuous scale from 0 to 10, was derived for each patient using T2LV, BPF, and T1:T2. RESULTS The MRDSS score averaged 5.1 (SD, 2.6). Baseline MRI and EDSS correlations were moderate for BPF, T1:T2, and MRDSS and weak for T2LV. The MRDSS showed a larger effect size than the individual MRI components in distinguishing patients with the relapsing-remitting form from those with the secondary progressive form. Models containing either T2LV or MRDSS were significantly associated with disability progression during the mean (SD) 3.2 (0.3)-year observation period, when adjusting for baseline EDSS score. CONCLUSION Combining brain MRI lesion and atrophy measures can predict MS clinical progression and provides the basis for developing an MRI-based continuous scale as a marker of MS disease severity.
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Affiliation(s)
- Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Gladman DD, Urowitz MB, Slonim D, Glanz B, Carlen P, Noldy N, Gough J, Pauzner R, Heslegrave R, Darby P, MacKinnon A. Evaluation of predictive factors for neurocognitive dysfunction in patients with inactive systemic lupus erythematosus. J Rheumatol 2000; 27:2367-71. [PMID: 11036831] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To determine predictive factors associated with the cognitive dysfunction in patients with inactive systemic lupus erythematosus (SLE). METHODS Consecutive patients followed at the Lupus Clinic with inactive SLE (SLE Disease Activity Index, SLEDAI, = 0) underwent a battery of neuropsychological tests; Beck Depression Inventory and psychiatric assessment were also performed. Neurocognitive dysfunction was defined as 3 abnormal scores. Data were analyzed using chi-square tests, ANOVA tests, and logistic regression. RESULTS Twenty-five of the 58 patients with SLE (43%) versus 9 of 47 healthy controls (19%) demonstrated neurocognitive dysfunction (p < 0.01). Neurocognitive dysfunction was not associated with depression or a psychiatric diagnosis, use of steroids, or previous or current evidence for fibromyalgia. SLEDAI > 10 at first presentation to the Lupus Clinic and previous vasculitis were associated with neurocognitive dysfunction, but previous central nervous system disease, renal disease, renal damage, or atherosclerotic complications were not. Neurophysiologic studies at the time of the assessment were not predictive of neurocognitive dysfunction. CONCLUSION Patients with inactive SLE demonstrate neurocognitive dysfunction. This is associated with more disease activity at presentation, but is not associated with specific organ involvement or organ damage.
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Affiliation(s)
- D D Gladman
- The Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Ontario, Canada
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