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Gustavsen S, Olsson A, Søndergaard HB, Andresen SR, Sørensen PS, Sellebjerg F, Oturai A. The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey. BMC Neurol 2021; 21:317. [PMID: 34399707 PMCID: PMC8365982 DOI: 10.1186/s12883-021-02344-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background People with multiple sclerosis (MS) experience a wide range of unpredictable and variable symptoms. The symptomatology of MS has previously been reported in large sample registry studies; however, some symptoms may be underreported in registries based on clinician-reported outcomes and how the symptoms are associated with quality of life (QoL) are often not addressed. The aim of this study was to comprehensively evaluate the frequency of selected MS related symptoms and their associations with disability and QoL in a large self-report study. Methods We conducted a cross-sectional questionnaire survey among all patients at the Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark. The questionnaire included information on clinical and sociodemographic characteristics, descriptors of QoL and disability, as well as prevalence and severity of the following MS symptoms: impaired ambulation, spasticity, chronic pain, fatigue, bowel and bladder dysfunction, and sleep disturbances. Results Questionnaires were returned by 2244/3606 (62%). Participants without MS diagnosis or incomplete questionnaires were excluded, n = 235. A total of 2009 questionnaires were included for analysis (mean age 49.4 years; mean disease duration 11.7 years; and 69% were women). The most frequently reported symptoms were bowel and bladder dysfunction (74%), fatigue (66%), sleep disturbances (59%), spasticity (51%) and impaired ambulation (38%). With exception of fatigue and sleep disturbances, all other symptoms increased in severity with higher disability level. Invisible symptoms (also referred to as hidden symptoms) such as fatigue, pain and sleep disturbances had the strongest associations with the overall QoL. Conclusion We found invisible symptoms highly prevalent, even at mild disability levels. Fatigue, pain and sleep disturbances had the strongest associations with the overall QoL and were more frequently reported in our study compared with previous registry-based studies. These symptoms may be underreported in registries based on clinician reported outcomes, which emphasizes the importance of including standardized patient reported outcomes in nationwide registries to better understand the impact of the symptom burden in MS.
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Affiliation(s)
- S Gustavsen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.
| | - A Olsson
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - H B Søndergaard
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - S R Andresen
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - P S Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
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Mehta D, Rex-Haffner M, Søndergaard HB, Pinborg A, Binder EB, Frokjaer VG. Genome-wide gene expression in a pharmacological hormonal transition model and its relation to depressive symptoms. Acta Psychiatr Scand 2019; 140:77-84. [PMID: 31099405 DOI: 10.1111/acps.13038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Sensitivity to sex-steroid hormone fluctuations may increase risk for perinatal depression. We aimed to identify genome-wide biological profiles in women demonstrating sensitivity to pharmacological sex-hormone manipulation with gonadotrophin-releasing hormone agonist (GnRHa). METHODS Longitudinal gene expression (Illumina Human HT12.v4) and DNA methylation data (Infinium HumanMethylation450K BeadChip) from 60 women (30 GnRHa, 30 placebo) were generated (Trial ID: NCT02661789). Differences between baseline and two follow-up points (initial stimulation- and subsequent early suppression phase) in the biphasic ovarian hormone response to GnRHa were assessed using linear mixed effects models. RESULTS Genome-wide analysis revealed 588 probes differentially expressed from GnRHa intervention to first stimulatory phase follow-up (intervention group × time) after 10% fdr multiple testing correction. Of these, 54% genes were also significantly associated with estradiol changes over time (proxy for GnRHa response magnitude), 9.5% were associated with changes in depressive symptoms, and 38% were associated with changes in neocortical serotonin transporter binding. The genes were implicated in TGF beta signaling, adipogenesis, regulation of actin cytoskeleton, and focal adhesion pathways and enriched for DNA methylation changes (P = 0.006). CONCLUSIONS These findings point toward an altered peripheral blood transcriptomic landscape in a pharmacological model of sex-hormone-induced depressive symptoms.
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Affiliation(s)
- D Mehta
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia
| | | | - H B Søndergaard
- Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A Pinborg
- Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre, Denmark
| | - E B Binder
- Max Planck Institute of Psychiatry, Munich, Germany.,Emory University, Atlanta, GA, USA
| | - V G Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Mental Health Services Copenhagen, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Hasselbalch IC, Søndergaard HB, Koch-Henriksen N, Olsson A, Ullum H, Sellebjerg F, Oturai AB. The neutrophil-to-lymphocyte ratio is associated with multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217318813183. [PMID: 30515298 PMCID: PMC6262498 DOI: 10.1177/2055217318813183] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background Subtypes of white blood cell counts are known biomarkers of systemic inflammation and a high neutrophil-to-lymphocyte ratio (NLR) has been associated with several autoimmune diseases. Few studies have investigated the NLR in multiple sclerosis (MS). Objective To examine the association between NLR, MS and disability measured by the MS severity score (MSSS). Methods Patients were included from the Danish Multiple Sclerosis Biobank. Information on patient NLR was obtained just before their first treatment and clinical information was provided by the Danish Multiple Sclerosis Treatment Register. Information on NLR from controls was collected from the Danish Blood Donor Study. Patients and controls were 1:2 propensity score matched by baseline confounders. Results Propensity score matching left 740 of 743 MS patients and 1420 of 4691 controls for further analyses. Odds-ratio (OR) was 3.64 (95% confidence interval 2.87–4.60, p < 0.001) for MS disease per unit increase of logarithmically transformed NLR (ln-NLR), corresponding to an OR of 2.68 for each doubling of NLR. Mean NLR was 2.12 for patients and 1.72 for controls (p < 0.001). Ln-NLR correlated weakly with patient MSSS (R2 = 0.019, p = 0.008). Conclusion Patients with early MS had increased levels of NLR compared to healthy controls and NLR was weakly correlated with MSSS.
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Affiliation(s)
- I C Hasselbalch
- Danish Multiple Sclerosis Center, University of Copenhagen, Denmark
| | - H B Søndergaard
- Danish Multiple Sclerosis Center, University of Copenhagen, Denmark
| | - N Koch-Henriksen
- The Danish Multiple Sclerosis Registry, University of Copenhagen, Denmark.,Department of Clinical Epidemiology, University of Aarhus, Denmark
| | - A Olsson
- Danish Multiple Sclerosis Center, University of Copenhagen, Denmark
| | - H Ullum
- Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, University of Copenhagen, Denmark
| | - A B Oturai
- Danish Multiple Sclerosis Center, University of Copenhagen, Denmark
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Olsson A, Oturai AB, Søndergaard HB, Sellebjerg F, Oturai PS. Bone microarchitecture and bone mineral density in multiple sclerosis. Acta Neurol Scand 2018; 137:363-369. [PMID: 29270986 DOI: 10.1111/ane.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients are at increased risk of reduced bone mineral density (BMD) and fractures. The aetiology of bone loss in MS is unclear. Trabecular bone score (TBS) is a novel analytical tool that provides a measurement of the bone microarchitecture. Decreased TBS predicts increased fracture risk independently of BMD. To date, no studies have investigated TBS in MS patients. OBJECTIVES To assess bone quality in MS patients by TBS and to evaluate potential risk factors that may affect BMD and TBS in patients with MS. METHODS Two hundred sixty MS patients were included. TBS was calculated using TBS iNsight software (MediMaps® ). Multivariable regression analyses were performed with information on smoking, alcohol, glucocorticoid (GC) treatment, sun exposure, physical activity, vitamin D and BMI. RESULTS Trabecular bone score was not significantly different from an age-matched reference population. Low TBS was associated with high age (P = .014) and smoking (P = .03). Smoking and physical inactivity were associated with low BMD in spine (P = .034, P = .032). GC treatment was not associated with TBS. CONCLUSION We could not find altered TBS values among MS patients, suggesting that BMD alone, and not the bone microarchitecture, is affected in MS. However, larger studies are needed to verify these findings and to establish the role of TBS in MS. As in the background population, physical activity and non-smoking habits are associated with better bone health in MS.
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Affiliation(s)
- A. Olsson
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. B. Oturai
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - H. B. Søndergaard
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - F. Sellebjerg
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - P. S. Oturai
- Department of Clinical Physiology; Nuclear Medicine and PET; Rigshospitalet; Copenhagen Denmark
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Petersen ER, Søndergaard HB, Oturai AB, Jensen P, Sorensen PS, Sellebjerg F, Börnsen L. Soluble serum VCAM-1, whole blood mRNA expression and treatment response in natalizumab-treated multiple sclerosis. Mult Scler Relat Disord 2016; 10:66-72. [PMID: 27919501 DOI: 10.1016/j.msard.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/12/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Natalizumab reduces disease activity in multiple sclerosis (MS). Natalizumab binds to the very late antigen-4 and inhibits vascular cell adhesion molecule-1 (VCAM-1)-mediated transmigration of immune cells across the blood-brain-barrier. This is associated with decreased serum concentrations of soluble (s)VCAM-1 and an altered composition of immune cell-subsets in the blood. OBJECTIVE We aimed to examine if sVCAM-1 serum concentrations and whole blood mRNA expression levels of immune activation biomarkers is associated with disease activity in natalizumab-treated MS-patients. METHODS sVCAM-1 serum concentrations and whole blood mRNA expression were measured in blood samples from untreated RRMS-patients and from two independent groups of natalizumab-treated patients. RESULTS sVCAM-1 serum concentrations and whole blood expression of HLX1 and IL1B mRNA were lower, whereas expression of EBI3 mRNA was higher in natalizumab-treated MS-patients. Five genes were differentially expressed in clinically unstable natalizumab-treated MS-patients in the discovery but not in the validation group. CONCLUSION Decreased serum concentrations of sVCAM-1 and altered whole blood mRNA expression levels of a panel of immunomarkers, associated with natalizumab-treatment, are not sensitive markers of MS disease activity. However, decreased expression of pro-inflammatory HLX1 and IL1B and increased expression of immunoregulatory EBI3 may indicate a less pathogenic immune activation status in natalizumab-treated MS.
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Affiliation(s)
- E R Petersen
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - H B Søndergaard
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A B Oturai
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peh Jensen
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P S Sorensen
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Börnsen
- Danish Multiple Sclerosis Center, Department of neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Gustavsen S, Søndergaard HB, Oturai DB, Laursen B, Laursen JH, Magyari M, Ullum H, Larsen MH, Sellebjerg F, Oturai AB. Shift work at young age is associated with increased risk of multiple sclerosis in a Danish population. Mult Scler Relat Disord 2016; 9:104-9. [PMID: 27645354 DOI: 10.1016/j.msard.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Epidemiological studies suggest an important role for environmental factors in developing multiple sclerosis (MS). Furthermore several studies have indicated that the effect of environmental factors may be especially pronounced in adolescents. Recently only one study investigated and found that shift work at young age is associated with an increased risk of developing MS. In this study we focused on the effect of shift work in the vulnerable period between 15-19 years. OBJECTIVE The aim of this study was to investigate the association between shift work at young age and the risk of developing MS. METHODS We performed a large case-control study including 1723 patients diagnosed with MS and 4067 controls. MS patients were recruited from the Danish Multiple Sclerosis Biobank and controls from The Danish Blood Donor Study. Information on working patterns and lifestyle factors was obtained using a comprehensive lifestyle-environmental factor questionnaire with participants enrolled between 2009 and 2014. Logistic regression models were used to investigate the association between shift work at age 15-19 years and the subsequent risk of MS and were controlled for effects due to established MS risk factors. RESULTS We found a statistically significant association when total numbers of night shifts were compared with non-shift workers. For every additional 100 night shifts the odds ratio (OR) for MS was 1.20 (95% confidence interval (CI), 1.08-1.34, p=0.001). Increasing intensity of shift work also increased MS risk. For every additional night per month the OR was 1.04 (95% CI, 1.01-1.06, p=0.002). Duration of shift work in years was not associated with risk of MS. CONCLUSION This study supports a statistically significant association between shift work at age 15-19 years and MS risk.
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Affiliation(s)
- S Gustavsen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - H B Søndergaard
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - D B Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - B Laursen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - J H Laursen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - M Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark; The Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - H Ullum
- Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Denmark
| | - M H Larsen
- Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - A B Oturai
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
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Oturai DB, Søndergaard HB, Börnsen L, Sellebjerg F, Romme Christensen J. Identification of Suitable Reference Genes for Peripheral Blood Mononuclear Cell Subset Studies in Multiple Sclerosis. Scand J Immunol 2015; 83:72-80. [DOI: 10.1111/sji.12391] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/15/2015] [Indexed: 12/19/2022]
Affiliation(s)
- D. B. Oturai
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - H. B. Søndergaard
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - L. Börnsen
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - F. Sellebjerg
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - J. Romme Christensen
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Voldsgaard A, Bager P, Garde E, Åkeson P, Leffers AM, Madsen CG, Kapel C, Roepstorff A, Thamsborg SM, Melbye M, Siebner H, Søndergaard HB, Sellebjerg F, Sørensen PS. Trichuris suis ova therapy in relapsing multiple sclerosis is safe but without signals of beneficial effect. Mult Scler 2015; 21:1723-9. [DOI: 10.1177/1352458514568173] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 12/21/2014] [Indexed: 12/26/2022]
Abstract
Background: An observational study has suggested that relapsing–remitting multiple sclerosis patients with helminth infections have lower disease activity and progression than uninfected multiple sclerosis patients. Objective: To evaluate the safety and efficacy on MRI activity of treatment with TSO in relapsing MS. Methods: The study was an open-label, magnetic resonance imaging assessor-blinded, baseline-to-treatment study including ten patients with relapsing forms of multiple sclerosis. Median (range) age was 41 (24–55) years, disease duration 9 (4–34) years, Expanded Disability Status Scale score 2.5 (1–5.0), and number of relapses within the last two years 3 (2–5). Four patients received no disease modifying therapy, while six patients received IFN-β. After an observational period of 8 weeks, patients received 2500 ova from the helminth Trichuris suis orally every second week for 12 weeks. Patients were followed with serial magnetic resonance imaging, neurological examinations, laboratory safety tests and expression of immunological biomarker genes. Results: Treatment with Trichuris suis orally was well-tolerated apart from some gastrointestinal symptoms. Magnetic resonance imaging revealed 6 new or enlarged T2 lesions in the run-in period, 7 lesions in the early period and 21 lesions in the late treatment period. Two patients suffered a relapse before treatment and two during treatment. Eight patients developed eosinophilia. The expression of cytokines and transcription factors did not change. Conclusions: In a small group of relapsing multiple sclerosis patients, Trichuris suis oral therapy was well tolerated but without beneficial effect.
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Affiliation(s)
- A Voldsgaard
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark
| | - P Bager
- Department of Epidemiology Research, Statens Serum Institut, Denmark
| | - E Garde
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Denmark
| | - P Åkeson
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Denmark
| | - AM Leffers
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Denmark
| | - CG Madsen
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Denmark
| | - C Kapel
- Faculty of Life Sciences, University of Copenhagen, Denmark
| | - A Roepstorff
- Faculty of Life Sciences, University of Copenhagen, Denmark/Deceased
| | - SM Thamsborg
- Faculty of Life Sciences, University of Copenhagen, Denmark
| | - M Melbye
- Department of Epidemiology Research, Statens Serum Institut, Denmark
| | - H Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Denmark
| | - HB Søndergaard
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark
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Sellebjerg F, Søndergaard HB, Koch-Henriksen N, Sørensen PS, Oturai AB. Prediction of response to interferon therapy in multiple sclerosis. Acta Neurol Scand 2014; 130:268-75. [PMID: 24943672 DOI: 10.1111/ane.12269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Single nucleotide polymorphisms (SNPs) in the genes encoding interferon response factor (IRF)-5, IRF-8 and glypican-5 (GPC5) have been associated with disease activity in multiple sclerosis (MS) patients treated with interferon (IFN)-β. We analysed whether SNPs in the IRF5, IRF8 and GPC5 genes are associated with clinical disease activity in MS patients beginning de novo treatment with IFN-β. METHODS The SNPs rs2004640, rs3807306 and rs4728142 in IRF5, rs13333054 and rs17445836 in IRF8 and rs10492503 in GPC5 were genotyped in 575 patients with relapsing-remitting MS followed prospectively after the initiation of their first treatment with IFN-β. RESULTS 62% of patients experienced relapses during the first 2 years of treatment, and 32% had disability progression during the first 5 years of treatment. Patients with a pretreatment annualized relapse rate >1 had an increased risk of relapse (hazard ratio 1.53, 95% confidence interval 1.24-1.90) and progression (hazard ratio 1.48, 95% confidence interval 1.10-1.99) on treatment and patients with breakthrough relapses in the form of relapses during the first 2 years of treatment had an increased risk of progression during the first 5 years of treatment (hazard ratio 2.04, 95% confidence interval 1.47-2.85).The gene variants in IRF5, IRF8 and GPC5 were not associated with risk of relapse or disease progression. CONCLUSIONS Pretreatment relapse rate and clinical disease activity during the first 2 years of treatment may be associated with disease progression in MS patients treated with IFN-β. Genetic analysis of the studied gene variants do not provide additional information.
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Affiliation(s)
- F. Sellebjerg
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - H. B. Søndergaard
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - N. Koch-Henriksen
- The Danish MS Registry under the Danish MS Center; Rigshospitalet; University of Copenhagen and Clinical Institute; Copenhagen Denmark
- Department of Clinical Epidemiology; Aarhus University; Aarhus Denmark
| | - P. S. Sørensen
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - A. B. Oturai
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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Møller M, Søndergaard HB, Koch-Henriksen N, Sorensen PS, Sellebjerg F, Oturai AB. The chemokine receptor CCR5 Δ32 allele in natalizumab-treated multiple sclerosis. Acta Neurol Scand 2014; 129:27-31. [PMID: 23668375 DOI: 10.1111/ane.12145] [Citation(s) in RCA: 6] [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] [Accepted: 04/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The chemokine receptor CCR5 may be important for the recruitment of pathogenic T cells to the CNS in multiple sclerosis (MS). We hypothesized that this chemokine receptor might still be important for T-cell migration during treatment with anti-very late antigen (VLA)-4 antibody. We therefore analysed whether natalizumab-treated MS patients carrying the CCR5 Δ32 deletion allele, which results in reduced expression of CCR5 on the cell surface, had lower disease activity. METHODS CCR5 Δ32 was analysed in 212 natalizumab-treated MS patients. RESULTS CCR5 Δ32 status had no significant impact on the frequency of relapses 1 year prior to natalizumab treatment or during the first 48 weeks of treatment. The multiple sclerosis severity score (MSSS) was significantly lower at baseline in patients carrying CCR5 Δ32 (P = 0.031). CONCLUSIONS CCR5 Δ32 is not associated with lower disease activity in MS patients treated with natalizumab. We found lower MSSS scores in patients carrying CCR5 Δ32 compared with the remaining patients, which is consistent with previous studies reporting an association with a more favourable disease course. Further studies are, however, needed before the relationship between CCR5 Δ32 and disease activity in MS can be definitely established.
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Affiliation(s)
- M. Møller
- Department of Neurology; The Danish Multiple Sclerosis Center; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - H. B. Søndergaard
- Department of Neurology; The Danish Multiple Sclerosis Center; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - N. Koch-Henriksen
- Danish Multiple Sclerosis Treatment Registry; Rigshospitalet; Copenhagen Denmark
- Department of Neurology; University Hospital in Aalborg; Aalborg Denmark
| | - P. S. Sorensen
- Department of Neurology; The Danish Multiple Sclerosis Center; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - F. Sellebjerg
- Department of Neurology; The Danish Multiple Sclerosis Center; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - A. B. Oturai
- Department of Neurology; The Danish Multiple Sclerosis Center; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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Ratzer R, Søndergaard HB, Christensen JR, Börnsen L, Borup R, Sørensen PS, Sellebjerg F. Gene expression analysis of relapsing-remitting, primary progressive and secondary progressive multiple sclerosis. Mult Scler 2013; 19:1841-8. [PMID: 24085340 DOI: 10.1177/1352458513500553] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 11/15/2022]
Abstract
BACKGROUND Previous studies of multiple sclerosis (MS) have indicated differences in the pathogenesis in relapsing-remitting (RRMS), secondary progressive (SPMS) and primary progressive (PPMS) disease. OBJECTIVE We hypothesized that different MS subtypes would show differences in gene expression that could be traced to specific subsets of peripheral blood mononuclear cells (PBMCs). METHODS Gene expression in RRMS, SPMS, PPMS and healthy control (HC) PBMCs was analyzed on Affymetrix arrays. In addition, we studied gene expression in pools of purified PBMC subsets. RESULTS We found 380 genes that were differentially expressed in RRMS, PPMS, SPMS and HCs (false discovery rate < 5%). There were no major differences between the subtypes of MS. The genes showing most prominent expression changes in RRMS were associated with adaptive immune pathways, while genes in PPMS were associated with innate immune system pathways. SPMS patients shared pathways with RRMS and PPMS patients. Gene expression changes were most prominent in B cells, CD8+ T cells and monocytes. CONCLUSION Differences in gene expression, which could be traced to B cells, CD8+ T cells and monocytes, were found between MS patients and HCs but only minor differences were observed between MS subgroups.
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Affiliation(s)
- R Ratzer
- Danish Multiple Sclerosis Center, Denmark
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Sellebjerg F, Hesse D, Limborg S, Lund H, Søndergaard HB, Krakauer M, Sørensen PS. Dendritic cell, monocyte and T cell activation and response to glatiramer acetate in multiple sclerosis. Mult Scler 2012; 19:179-87. [PMID: 22653658 DOI: 10.1177/1352458512450353] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment with glatiramer acetate (GA) modestly decreases disease activity in multiple sclerosis (MS). The mechanism of action is incompletely understood and differences in the response to treatment between individuals may exist. OBJECTIVE To study the activation of CD4+ T cells, monocytes and dendritic cells (DC) in relation to disease activity in MS patients treated with GA. METHODS Flow cytometry was used to study the activation of CD4+ T cells and T cell subsets (CD25(high) and CD26(high) cells), monocytes and DCs in a cross-sectional study of 39 untreated and 29 GA-treated MS patients, the latter followed prospectively for one year. Gd-enhanced magnetic resonance imaging (MRI) studies were conducted in all patients. Disease activity was assessed as relapses. RESULTS The median percentage of DCs expressing CD40 was 10% in untreated MS patients and 5.9% in GA-treated patients (Bonferroni-corrected p=0.0005). The hazard ratio of relapse was 1.32 (95% confidence interval 1.05-1.64) per 1% increase in CD40+ DCs. Patients treated with GA had fewer CD4+ T cells expressing surface markers associated with T helper type 1 effector responses and more CD4+ T cells expressing surface markers associated with regulatory, naïve or central memory T cell populations, but CD4+ T cell activation was not related with relapse risk. CONCLUSIONS MS patients treated with GA show prominent changes in circulating antigen-presenting cells and CD4+ T cells. Expression of CD40 on DCs is significantly lower and associated with relapse risk in MS patients treated with GA.
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Affiliation(s)
- F Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, Denmark.
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Jensen PEH, Sellebjerg F, Søndergaard HB, Sørensen PS. Correlation between anti-interferon-β binding and neutralizing antibodies in interferon-β-treated multiple sclerosis patients. Eur J Neurol 2012; 19:1311-7. [PMID: 22564111 DOI: 10.1111/j.1468-1331.2012.03721.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 03/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Measurements of binding antibodies (BAbs), neutralizing antibodies (NAbs) and MX1 mRNA expression are used to analyse the immunological reactions in patients with MS treated with IFN-β. The correlations between these are yet not fully understood. METHODS We measured BAbs and NAbs to IFN-β in 110 serum samples from 83 patients with MS treated with IFN-β, and in a subgroup, antibody titre was compared with corresponding expressions of MX1 mRNA. The methods used were capture ELISA assay, luciferase reporter gene assay and mRNA RT-PCR for MX1 gene expression. RESULTS There were significant correlations between binding, neutralizing and MX1 results. Cut-off values are suggested for the definition of samples of BAbs and NAbs as negative, positive and grey zones. Naturally occurring groups of low and high antibody titres were identified by the correlation between BAbs and NAbs, probably as a result of an immunological maturation process of antibodies. The low-titre group had lower correlations between BAbs and NAbs than the high-titre group. CONCLUSIONS High correlation is demonstrated between the results obtained by the three methods, and we suggest the possibility of using ELISA measurements of BAbs to identify patients with high titres of anti-IFN-β antibodies that block the biological response to IFN-β. Ιn patients with low titres, we suggest to supplement ELISA with measurement of MX1 mRNA to establish whether the bioavailability of IFN-β is preserved.
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Affiliation(s)
- P E H Jensen
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Sellebjerg F, Hedegaard CJ, Krakauer M, Hesse D, Lund H, Nielsen CH, Søndergaard HB, Sørensen PS. Glatiramer acetate antibodies, gene expression and disease activity in multiple sclerosis. Mult Scler 2011; 18:305-13. [PMID: 22020419 DOI: 10.1177/1352458511420268] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Glatiramer acetate (GA) treatment suppresses disease activity in multiple sclerosis (MS). The immunological response to treatment may differ in patients who are stable on GA therapy and patients with breakthrough disease activity, but the results of previous studies are inconsistent. OBJECTIVES We studied the immunological response to GA and its relationship with disease activity. METHODS Anti-GA antibodies in plasma and the expression of genes encoding cytokines and T-cell-polarizing transcription factors in blood cells were analysed by flow cytometric bead array and polymerase chain reaction (PCR) analysis in 39 untreated and 29 GA-treated relapsing-remitting MS patients. Definition of breakthrough disease was based on the occurrence of relapses, disability progression, or gadolinium (Gd)-enhanced MRI. RESULTS The expression of T helper type 1 (Th1) and Th17 cytokines and transcription factors was reduced during long-term treatment, but there was no relationship between the expression of cytokines and transcription factors and anti-GA antibodies. High expression of mRNA encoding GATA3 and lymphotoxin-β (LT-β) was associated with low disease activity in Gd-enhanced MRI studies. None of the variables studied were associated with clinical disease activity. GA treatment resulted in the development of IgG and IgG4 anti-GA antibodies during the first months of treatment, persisting during long-term treatment. CONCLUSIONS The observed relationship between the expression of mRNA encoding GATA3 and LT-β expression and MRI disease activity deserves further analysis in future studies. The development of anti-GA antibodies was observed in all patients treated with GA, but this was not related with measures of cellular immunity, clinical or MRI disease activity.
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Affiliation(s)
- F Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark.
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Hesse D, Krakauer M, Lund H, Søndergaard HB, Limborg SJW, Soelberg Sørensen P, Sellebjerg F. Disease protection and interleukin‐10 induction by endogenous interferon‐β in multiple sclerosis? Eur J Neurol 2011; 18:266-272. [DOI: 10.1111/j.1468-1331.2010.03116.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- D. Hesse
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
| | - M. Krakauer
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
| | - H. Lund
- Danish Research Centre for Magnetic Resonance, Section 340, Copenhagen University Hospital, Hvidovre, Denmark
| | - H. B. Søndergaard
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
| | - S. J. W. Limborg
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
| | - P. Soelberg Sørensen
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
| | - F. Sellebjerg
- Department of Neurology, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Rigshospitalet
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