1
|
Tahara M, Tomoko O, Okada K, Ochi K, Maruyama H, Fukaura H, Nomura K, Shimizu Y, Nakashima I, Misu T, Umemura A, Yamamoto K, Sawada H. Compassionate open-label use of rituximab following a randomised clinical trial against neuromyelitis optica (RIN-2 study): B cell monitoring-based administration. Mult Scler Relat Disord 2022; 60:103730. [DOI: 10.1016/j.msard.2022.103730] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/24/2022]
|
2
|
Kojima M, Oji S, Tanaka S, Izaki S, Hashimoto B, Fukaura H, Nomura K. Tacrolimus is effective for neuromyelitis optica spectrum disorders with or without anti-AQP4 antibody. Mult Scler Relat Disord 2020; 39:101907. [PMID: 31931404 DOI: 10.1016/j.msard.2019.101907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory central nervous system disorders characterized by optic neuritis, transverse myelitis, and anti-aquaporin 4 (AQP4) antibody production. However, it has recently been shown that some cases of typical NMOSD can be anti-AQP4 antibody-negative as well. In this study, we retrospectively investigated the disorder relapse-suppressing effect of tacrolimus (TAC) when combined with prednisolone (PSL) in anti-AQP4 antibody-positive and -negative NMOSD cases. METHODS Subjects were NMOSD outpatients treated at our hospital in August 2016 who fulfilled the 2015 International Panel for NMO Diagnosis criteria and whose medical history before visiting our department was known; anti-myelin oligodendrocyte glycoprotein antibody-positive cases were excluded. We retrospectively investigated the annualized relapse rate (ARR) before and after combined TAC and PSL treatment in 50 NMOSD cases who had been using TAC with PSL for at least 1 year and whom we were also able to observe. RESULTS There were 42 anti-AQP4 antibody-positive cases and 8 negative cases. Observation periods of the anti-AQP4 antibody-positive cases were 1.1 years before TAC and 5.1 years after TAC. ARR before TAC was 1.0 and 0.08 after TAC, indicating a relapse-suppression rate of 92% (p < 0.001) and clear improvement. In the anti-AQP4 antibody-negative group, the observation period was 5.6 years before and 4.1 years after TAC. ARR before TAC was 0.5 and 0.07 after TAC. The relapse-suppression rate was 86% (p < 0.05), which was obviously as effective as in the anti-AQP4 antibody-positive group. PSL dose in the anti-AQP4 antibody-positive group was 15.0 mg/day at the start of TAC and was reduced to 6.3 mg/day after 2 years (p < 0.001). The Expanded Disability Status Scale (EDSS) score decreased from 4.5 at the start of TAC to 2.0 after 2 years in the anti-AQP4 antibody-positive group (p < 0.05), which was a clear improvement. CONCLUSION Combined use of TAC with PSL clearly suppressed relapse of both anti-AQP4 antibody-positive and -negative NMOSD. In the anti-AQP4 antibody-positive group, both PSL dose and EDSS score decreased compared with the dose at the start of the study.
Collapse
|
3
|
Oji S, Yamaga T, Suzuki M, Tanaka S, Fukaura H, Nomura K. [Anti-myelin oligodendrocyte glycoprotein antibody-positive neurologic disease, manifested as clinical course of classical Devic's disease: A case report]. Rinsho Shinkeigaku 2020; 60:219-222. [PMID: 32101847 DOI: 10.5692/clinicalneurol.cn-001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 33-year-old male was admitted to our hospital due to bilateral optic neuritis (ON) and transverse myelitis (TM), which occurred almost simultaneously. Spinal MRI showed the longitudinally extensive TM, located from C2 to conus. Serum anti-aquaporin 4 antibody was negative. He was tentatively diagnosed as seronegative neuromyelitis optica spectrum disorders (NMOSD). During the clinical course, serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody was detected, and finally he was diagnosed as anti-MOG antibody positive neurologic disease (MOG-ND). Our case highlighted that early detection of MOG antibody should be considered in male cases with clinical manifestation of classical Devic's disease, such as simultaneous disease onset of bilateral ON or ON + TM.
Collapse
Affiliation(s)
- Satoru Oji
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Tetsuo Yamaga
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Masato Suzuki
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Satoru Tanaka
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Hikoaki Fukaura
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| |
Collapse
|
4
|
Tahara M, Oeda T, Okada K, Kiriyama T, Ochi K, Maruyama H, Fukaura H, Nomura K, Shimizu Y, Mori M, Nakashima I, Misu T, Umemura A, Yamamoto K, Sawada H. Safety and efficacy of rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet Neurol 2020; 19:298-306. [PMID: 32199095 DOI: 10.1016/s1474-4422(20)30066-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacological prevention against relapses in patients with neuromyelitis optica spectrum disorder (NMOSD) is developing rapidly. We aimed to investigate the safety and efficacy of rituximab, an anti-CD20 monoclonal antibody, against relapses in patients with NMOSD. METHODS We did a multicentre, randomised, double-blind, placebo-controlled clinical trial at eight hospitals in Japan. Patients aged 16-80 years with NMOSD who were seropositive for aquaporin 4 (AQP4) antibody, were taking 5-30 mg/day oral steroids, and had an Expanded Disability Status Scale (EDSS) score of 7·0 or less were eligible for the study. Individuals taking any other immunosuppressants were excluded. Participants were randomly allocated (1:1) either rituximab or placebo by a computer-aided dynamic random allocation system. The doses of concomitant steroid (converted to equivalent doses of prednisolone) and relapses in previous 2 years were set as stratification factors. Participants and those assessing outcomes were unaware of group assignments. Rituximab (375 mg/m2) was administered intravenously every week for 4 weeks, then 6-month interval dosing was done (1000 mg every 2 weeks, at 24 weeks and 48 weeks after randomisation). A matching placebo was administered intravenously. Concomitant oral prednisolone was gradually reduced to 2-5 mg/day, according to the protocol. The primary outcome was time to first relapse within 72 weeks. Relapses were defined as patient-reported symptoms or any new signs consistent with CNS lesions and attributable objective changes in MRI or visual evoked potential. The primary analysis was done in the full analysis set (all randomly assigned patients) and safety analyses were done in the safety analysis set (all patients who received at least one infusion of assigned treatment). The primary analysis was by intention-to-treat principles. This trial is registered with the UMIN clinical trial registry, UMIN000013453. FINDINGS Between May 10, 2014, and Aug 15, 2017, 38 participants were recruited and randomly allocated either rituximab (n=19) or placebo (n=19). Three (16%) patients assigned rituximab discontinued the study and were analysed as censored cases. Seven (37%) relapses occurred in patients allocated placebo and none were recorded in patients assigned rituximab (group difference 36·8%, 95% CI 12·3-65·5; log-rank p=0·0058). Eight serious adverse events were recorded, four events in three (16%) patients assigned rituximab (lumbar compression fracture and infection around nail of right foot [n=1], diplopia [n=1], and uterine cancer [n=1]) and four events in two (11%) people allocated to placebo (exacerbation of glaucoma and bleeding in the right eye chamber after surgery [n=1], and visual impairment and asymptomatic white matter brain lesion on MRI [n=1]); all patients recovered. No deaths were reported. INTERPRETATION Rituximab prevented relapses for 72 weeks in patients with NMOSD who were AQP4 antibody-positive. This study is limited by its small sample size and inclusion of participants with mild disease activity. However, our results suggest that rituximab could be useful maintenance therapy for individuals with NMOSD who are AQP4 antibody-positive. FUNDING Japanese Ministry of Health, Labour and Welfare, Japan Agency for Medical Research and Development, and Zenyaku Kogyo.
Collapse
Affiliation(s)
- Masayuki Tahara
- Clinical Research Centre and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan.
| | - Tomoko Oeda
- Clinical Research Centre and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Kazumasa Okada
- Department of Neurology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takao Kiriyama
- Department of Neurology, Nara Medical University School of Medicine, Nara, Japan
| | - Kazuhide Ochi
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hikoaki Fukaura
- Department of Neurology, Saitama Medical University, Kawagoe, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical University, Kawagoe, Japan
| | - Yuko Shimizu
- Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Umemura
- Clinical Research Centre and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Kenji Yamamoto
- Clinical Research Centre and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| | - Hideyuki Sawada
- Clinical Research Centre and Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
| |
Collapse
|
5
|
Tanaka S, Hashimoto B, Izaki S, Oji S, Fukaura H, Nomura K. Clinical and immunological differences between MOG associated disease and anti AQP4 antibody-positive neuromyelitis optica spectrum disorders: Blood-brain barrier breakdown and peripheral plasmablasts. Mult Scler Relat Disord 2020; 41:102005. [PMID: 32114369 DOI: 10.1016/j.msard.2020.102005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with anti-aquaporin-4 (AQP4) water channel antibody-positive neuromyelitis optica spectrum disorders (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein (MOG) associated disease (MOGAD) often present with similar clinical symptoms, and some cases are hard to differentiate at the time of onset. In this study, we compared the clinical characteristics, cerebrospinal fluid (CSF) analysis parameters, and peripheral T/B lymphocyte subsets during the active and chronic phases in AQP4-NMOSD and MOGAD. METHODS A total of 17 MOGAD cases and 24 AQP4-NMOSD cases were studied. The clinical characteristics in both groups were summarized, including disease duration, total number of attacks, lesions, prevention of relapse during remission, and CSF analysis results during the active phase. T/B lymphocyte subsets were further investigated in the active and chronic phases. RESULTS In the comparative study on clinical symptoms, a large proportion of optic neuritis was unilateral in MOGAD. In the comparative study on CSF analysis, protein level was significantly lower in MOGAD compared with AQP4-NMOSD (p = 0.006); myelin basic protein was significantly lower in MOGAD compared with AQP4-NMOSD (p = 0.04); albumin quotient was significantly lower in MOGAD compared with AQP4-NMOSD (p = 0.02); and IgG Quotient was significantly lower in MOGAD compared with AQP4-NMOSD (p = 0.05). In the analysis of T/B lymphocyte subsets, plasmablasts of the B cell subset in the active phase were significantly lower in MOGAD (2.1 ± 2.4) compared to AQP4-NMOSD (7.8 ± 7.2) (p < 0.05). In the chronic phase, transitional B cells were significantly higher in MOGAD (2.1 ± 1.8) compared to AQP4-NMOSD (0.6 ± 0.4) (p < 0.01). CONCLUSION Clinical characteristics of MOGAD were similar to those of AQP4-NMOSD, but increased blood brain barrier permeability was suggested to be less severe in MOGAD compared to AQP4-NMOSD from CSF analysis. Furthermore, the pathogenesis of the two diseases was clearly distinct as plasmablasts in the active phase were not elevated in MOGAD, but were increased in AQP4-NMOSD.
Collapse
Affiliation(s)
- Satoru Tanaka
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
| | - Baku Hashimoto
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Shoko Izaki
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Satoru Oji
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hikoaki Fukaura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| |
Collapse
|
6
|
Izaki S, Hashimoto B, Yamaga T, Furuya M, Miyauchi A, Tanaka S, Ishizuka K, Suzuki M, Saito A, Kubota A, Tajima T, Narukawa S, Hara W, Yoshida N, Oji S, Dembo T, Fukaura H, Nomura K. Current status of MG-QOL 15-J score in Saitama prefecture 2017. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3528] [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: 11/16/2022]
|
7
|
Matsushita T, Nakamura Y, Niino M, Fukaura H, Tanaka M, Ochi H, Kanda T, Yokota T, Matsui M, Kusunoki S, Terayama Y, Kawachi I, Ohashi T, Shimohama S, Nishiyama K, Nakatsuji Y, Suzumura A, Ochi K, Yamamoto K, Yamasaki R, Kawano Y, Tsuji S, Hinomura A, Tada M, Matsuyama A, Shimizu Y, Nagaishi A, Okada K, Shinoda K, Isobe N, Kira J. Clinical and genetic features of Japanese patients with multiple sclerosis and neuromyelitis optica spectrum disorder based on Japan multiple sclerosis biobank. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2219] [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: 11/28/2022]
|
8
|
Oji S, Narukawa S, Ishizuka K, Hashimoto B, Yamaga T, Furuya M, Miyauchi A, Tanaka S, Suzuki M, Saito A, Tajima T, Hara W, Kubota A, Izaki S, Yoshida N, Dembo T, Fukaura H, Kaida K, Nomura K. Serum potassium level and short-term prognosis in patients with anti-GM1 antibody positive Guillan-Barre syndrome - preliminary study -. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1854] [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: 11/16/2022]
|
9
|
Kubota A, Fukaura H, Tanaka S, Miyauchi A, Furuya M, Ishizuka K, Suzuki M, Saito A, Narukawa S, Hara W, Tajima T, Izaki S, Yoshida N, Ohji S, Dembo T, Nomura K. Influence of fingolimod on CD4 T cell subsets in the peripheral blood of patients with multiple sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
Yamasaki R, Matsushita T, Fukazawa T, Yokoyama K, Fujihara K, Ogino M, Yokota T, Miyamoto K, Niino M, Nomura K, Tomioka R, Tanaka M, Kawachi I, Ohashi T, Kaida KI, Matsui M, Nakatsuji Y, Ochi H, Fukaura H, Kanda T, Nagaishi A, Togo K, Mizusawa H, Murai H, Kira JI. Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica. Mult Scler 2016; 22:1337-48. [DOI: 10.1177/1352458515617248] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/21/2015] [Indexed: 01/21/2023]
Abstract
Background: No large-scale studies have compared the efficacy of intravenous methylprednisolone pulse therapy (IVMP) for multiple sclerosis (MS) and neuromyelitis optica (NMO). Objective: To explain differences in treatment responses of MS and NMO patients to IVMP. Methods: Changes in neurological symptoms/signs and Expanded Disability Status Scale (EDSS) scores before and within 1 week of IVMP completion were obtained in 2010 at 28 institutions, and retrospectively collated from 271 MS (478 courses) and 73 NMO (118 courses) cases. Results: In MS patients, decreased EDSS score was significant after the first (−0.8 ± 0.9), second (−0.7 ± 0.9), and third (−0.7 ± 0.8) courses ( p < 0.05), but not after the fourth (−0.3 ± 0.7) and fifth (−0.5 ± 0.6). However, decreased EDSS score was only significant after the first course (−0.5 ± 1.5, p < 0.05) in NMO patients. EDSS score was significantly decreased in MS compared with NMO patients at the first course ( p < 0.05), but not thereafter. Model analysis for EDSS score improvement at the first course, adjusting for covariates, showed significantly greater decreases in MS compared with NMO patients ( p < 0.05). Conclusion: IVMP is effective in MS from the first to third courses, and in NMO at the first course. Additionally, IVMP is more efficacious in MS than NMO patients, even at the first course.
Collapse
Affiliation(s)
- Ryo Yamasaki
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsushita
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kazumasa Yokoyama
- Department of Neurology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Mieko Ogino
- Department of Neurology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuichi Miyamoto
- Department of Neurology, Kinki University School of Medicine, Osaka, Japan
| | - Masaaki Niino
- Department of Clinical Research, NHO Hokkaido Medical Center, Sapporo, Japan
| | - Kyoichi Nomura
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryo Tomioka
- Department of Neurology, Saitama Medical University, Saitama, Japan
| | - Masami Tanaka
- Multiple Sclerosis Center, NHO Utano National Hospital, Kyoto, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Takashi Ohashi
- Department of Neurology, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan
| | - Ken-ichi Kaida
- Department of Neurology, National Defense Medical College, Tokorozawa, Japan
| | - Makoto Matsui
- Department of Neurology, Kanazawa Medical University, Kanazawa, Japan
| | | | - Hirofumi Ochi
- Department of Neurology, Graduate School of Medicine, Ehime University, Matsuyama, Japan
| | - Hikoaki Fukaura
- Department of Neurology, Iwate Medical University, Morioka, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Akiko Nagaishi
- Department of Neurology, NHO Nagasaki Kawatana Medical Center, Kawatana, Japan
| | - Kanae Togo
- Clinical Statistics, Pfizer Japan Inc., Tokyo, Japan
| | - Hidehiro Mizusawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Murai
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
11
|
Feng J, Misu T, Fujihara K, Sakoda S, Nakatsuji Y, Fukaura H, Kikuchi S, Tashiro K, Suzumura A, Ishii N, Sugamura K, Nakashima I, Itoyama Y. Ibudilast, a nonselective phosphodiesterase inhibitor, regulates Th1/Th2 balance and NKT cell subset in multiple sclerosis. Mult Scler 2016; 10:494-8. [PMID: 15471363 DOI: 10.1191/1352458504ms1070oa] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated the immunoregulatory effects of ibudilast, a nonselective phosphodiesterase inhibitor, at a clinically applicable dose (60 mg/day p.o. for four weeks) in multiple sclerosis (MS) patients. Sensitive real-time PCR for quantifying cytokine mRNA in the blood CD4- cells revealed that the ibudilast monotherapy significantly reduced tumour necrosis factor-a and interferon (IFN)-g mRNA and the IFN-g/interleukin-4 mRNA ratio, suggesting a shift in the cytokine profile from Th1 toward Th2 dominancy. In a flow cytometric analysis, natural killer T cells, which have been reported to relate to Th2 responses in MS and its animal model (experimental autoimmune encephalomyelitis), increased significantly after the therapy. None of the significant immunological changes were seen in healthy subjects or untreated MS patients. Ibudilast may be a promising therapy for MS and its clinical effects warrant further study.
Collapse
Affiliation(s)
- Juan Feng
- Department of Neurology, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Fukaura H. [Diagnostic criteria to patients with multiple sclerosis and clinically isolated syndrome]. Nihon Rinsho 2015; 73 Suppl 7:173-180. [PMID: 26480696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
13
|
Fukaura H. [Disease modifying therapies in multiple sclerosis]. Nihon Rinsho 2014; 72:2015-2022. [PMID: 25518387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this section is to introduce the clinical utility of several disease-modifying agents including natalizumab and immunosuppressive treatments that are currently available in Japan, and glatiramer acetate that will be probably available in Japan within a few years. Immunosuppressive therapy has been used to treat multiple sclerosis(MS) for over 30 years based on the hypothesis that MS is a T cell-mediated autoimmune disease. The most commonly used immunosuppressive agents in MS are azathioprine, cyclophosphamide, methotrexate, and mitoxantrone. Like the interferons and glatiramer acetate, immunosuppressive drugs are most efficacious in stages of MS that have an inflammatory component as evidenced by relapses and/or gadolinium-enhancing lesions on MRI or in patients in earlier stages of disease where inflammation predominates over degenerative processes in the CNS. There is no evidence of efficacy in primary progressive MS or later stages of secondary progressive MS. It is appropriate to consider glatiramer acetate for treatment in any patient who has relapsing remitting MS (RRMS), and glatiramer acetate may be helpful in patients with progressive disease. Because of the possibility that natalizumab therapy may be responsible for the increased risk of primary progressive leukoencephalopathy (PML), it is recommended that natalizumab be reserved for use in selected patients with relapsing remitting disease who have failed other therapies either through continued disease activity or medication intolerance, or who have a particularly aggressive initial disease course.
Collapse
|
14
|
Abstract
Childcare issue and family care issue are critical factors for women doctors to make a career as a neurologist in Japan. To know the actual business conditions of Japanese neurologists an online questioner survey was conducted. Answers were obtained from 737 members of Japanese Society of Neurology and 21 neurological medical facilities. Most of the answers were form members at three major metropolitan areas such as Tokyo, Osaka and Nagoya. Nobody from some prefectures was replied any answer. Almost sixty percent woman doctors had to change their working style from full time to part time at their child raising period and had difficulty with returning to full time job. Some neurologists have answered they used paid vacation to care their families and they felt they could not keep it for a longer period. At 70 percent of medical facilities sick child day care center were not operated. Opinions form members extremely varied from "In the first place woman doctors are unnecessary"to "With the help of the partner I have survived my child raising period".
Collapse
Affiliation(s)
- Hikoaki Fukaura
- Neurology, Saitama Medical University, Saitama Medical Center
| |
Collapse
|
15
|
Niino M, Mifune N, Kohriyama T, Mori M, Ohashi T, Kawachi I, Shimizu Y, Fukaura H, Nakashima I, Kusunoki S, Miyamoto K, Yoshida K, Kanda T, Nomura K, Yamamura T, Yoshii F, Kira JI, Nakane S, Yokoyama K, Matsui M, Miyazaki Y, Kikuchi S. Association of cognitive impairment with magnetic resonance imaging findings and social activities in patients with multiple sclerosis. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/cen3.12133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Masaaki Niino
- Department of Clinical Research; Hokkaido Medical Center; Sapporo Japan
| | - Nobuhiro Mifune
- School of Management; Kochi University of Technology; Kochi Japan
| | - Tatsuo Kohriyama
- Department of Neurology; Hiroshima City Hospital; Hiroshima Japan
| | - Masahiro Mori
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Takashi Ohashi
- Department of Neurology; Tokyo Women's Medical University Yachiyo Medical Center; Chiba Japan
| | - Izumi Kawachi
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
| | - Yuko Shimizu
- Department of Neurology; Tokyo Women's Medical University School of Medicine; Tokyo Japan
| | - Hikoaki Fukaura
- Department of Neurology; Iwate Medical School; Morioka Japan
- Department of Neurology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Ichiro Nakashima
- Department of Neurology; Tohoku University School of Medicine; Sendai Japan
| | - Susumu Kusunoki
- Department of Neurology; Kinki University School of Medicine; Osaka Japan
| | - Katsuichi Miyamoto
- Department of Neurology; Kinki University School of Medicine; Osaka Japan
| | - Kazuto Yoshida
- Department of Neurology; Asahikawa Red Cross Hospital; Asahikawa Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience; Yamaguchi University Graduate School of Medicine; Yamaguchi Japan
| | - Kyoichi Nomura
- Department of Neurology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Takashi Yamamura
- Department of Immunology; National Institute of Neuroscience; National Center of Neurology and Psychiatry; Tokyo Japan
| | - Fumihito Yoshii
- Department of Neurology; Tokai University School of Medicine; Kanagawa Japan
| | - Jun-ichi Kira
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Shunya Nakane
- Department of Clinical Research; Nagasaki Kawatana Medical Center; Nagasaki Japan
| | - Kazumasa Yokoyama
- Department of Neurology; Juntendo University School of Medicine; Tokyo Japan
| | - Makoto Matsui
- Department of Neurology; Kanazawa Medical University; Ishikawa Japan
| | - Yusei Miyazaki
- Department of Neurology; Hokkaido Medical Center; Sapporo Japan
| | - Seiji Kikuchi
- Department of Neurology; Hokkaido Medical Center; Sapporo Japan
| |
Collapse
|
16
|
Izaki S, Narukawa S, Kubota A, Mitsui T, Fukaura H, Nomura K. [A case of neuromyelitis optica spectrum disorder developing a fulminant course with multiple white-matter lesions following fingolimod treatment]. Rinsho Shinkeigaku 2014; 53:513-7. [PMID: 23892961 DOI: 10.5692/clinicalneurol.53.513] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 49-year-old female neuromyelitis optica spectrum disorder (NMOSD) patient with positive anti-aquaporin 4 (AQP4) antibody was treated with fingolimod (FTY720). Ten days later, she developed acute disturbance of consciousness, aphasia, right hemi-spatial neglect, and right hemiparesis. Brain MRI showed multiple white-matter lesions with slight Gadolinium enhancement. She was diagnosed of acute exacerbation of NMOSD. Thus, fingolimod may be associated with the development of a fulminant course in NMOSD patients with positive anti-AQP4 antibody.
Collapse
Affiliation(s)
- Shoko Izaki
- Department of Neurology, Saitama Medical Center
| | | | | | | | | | | |
Collapse
|
17
|
Niino M, Mifune N, Kohriyama T, Mori M, Ohashi T, Kawachi I, Shimizu Y, Fukaura H, Nakashima I, Kusunoki S, Miyamoto K, Yoshida K, Kanda T, Nomura K, Yamamura T, Yoshii F, Kira JI, Nakane S, Yokoyama K, Matsui M, Miyazaki Y, Kikuchi S. Apathy/depression, but not subjective fatigue, is related with cognitive dysfunction in patients with multiple sclerosis. BMC Neurol 2014; 14:3. [PMID: 24393373 PMCID: PMC3884018 DOI: 10.1186/1471-2377-14-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 09/07/2013] [Accepted: 01/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment could affect quality of life for patients with multiple sclerosis (MS), and cognitive function may be correlated with several factors such as depression and fatigue. This study aimed to evaluate cognitive function in Japanese patients with MS and the association between cognitive function and apathy, fatigue, and depression. METHODS The Brief Repeatable Battery of Neuropsychological tests (BRB-N) was performed in 184 Japanese patients with MS and 163 healthy controls matched for age, gender, and education. The Apathy Scale (AS), Fatigue Questionnaire (FQ), and Beck Depression Inventory Second Edition (BDI-II) were used to evaluate apathy, fatigue, and depression, respectively. Student's t-test was used to compare MS patients and healthy controls. Correlations between two factors were assessed using the Pearson correlation test, and multiple regression analysis was used to evaluate how much each factor affected the BRB-N score. RESULTS In all BRB-N tests, patients with MS scored significantly lower than controls, and the effect size of symbol digit modalities test was the highest among the 9 tests of the BRB-N. Patients with MS had higher AS (p < 0.001), FQ (p < 0.0001), and BDI-II (p < 0.0001) scores than controls. In patients with MS, scores on most of the BRB-N tests correlated with scores on the AS and BDI-II; however, there was little correlation between scores on the BRB-N tests and those on the FQ. CONCLUSIONS Cognitive function was impaired, particularly information-processing speed, and decreased cognitive function was correlated with apathy and depression in Japanese patients with MS. Despite the association between cognitive variables and depression/apathy, cognitive function was impaired beyond the effect of depression and apathy. However, subjective fatigue is not related with cognitive impairment. Taken together, this suggests that different therapeutic approaches are needed to improve subjective fatigue and cognition, and thereby quality of life, in patients with MS.
Collapse
Affiliation(s)
- Masaaki Niino
- Department of Clinical Research, Hokkaido Medical Center, Yamanote 5jo 7chome, Nishi-ku, Sapporo 063-0005, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kira JI, Yamasaki R, Yoshimura S, Fukazawa T, Yokoyama K, Fujihara K, Ogino M, Yokota T, Miyamoto K, Niino M, Nomura K, Tomioka R, Tanaka M, Kawachi I, Ohashi T, Kaida K, Matsui M, Nakatsuji Y, Ochi H, Fukaura H, Kanda T, Nagaishi A, Togo K, Mizusawa H, Kawano Y. Efficacy of methylprednisolone pulse therapy for acute relapse in Japanese patients with multiple sclerosis and neuromyelitis optica: A multicenter retrospective analysis - 1. Whole group analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cen3.12071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Jun-ichi Kira
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Ryo Yamasaki
- Department of Neurological Therapeutics; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Satoshi Yoshimura
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Kazumasa Yokoyama
- Department of Neurology; Juntendo University School of Medicine; Tokyo Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Mieko Ogino
- Department of Neurology; Kitasato University School of Medicine; Sagamihara Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science; Tokyo Medical and Dental University; Tokyo Japan
| | - Katsuichi Miyamoto
- Department of Neurology; Kinki University School of Medicine; Osaka Japan
| | - Masaaki Niino
- Department of Clinical Research; NHO Hokkaido Medical Center; Sapporo Japan
| | - Kyoichi Nomura
- Department of Neurology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Ryo Tomioka
- Department of Neurology; Saitama Medical University; Saitama Japan
| | - Masami Tanaka
- Multiple Sclerosis Center; NHO Utano National Hospital; Kyoto Japan
| | - Izumi Kawachi
- Department of Neurology; Brain Research Institute; Niigata University; Niigata Japan
| | - Takashi Ohashi
- Department of Neurology; Tokyo Women's Medical University Yachiyo Medical Center; Tokyo Japan
| | - Kenichi Kaida
- Department of Neurology; National Defense Medical College; Tokorozawa Japan
| | - Makoto Matsui
- Department of Geriatric Medicine; Kanazawa Medical University; Kanazawa Japan
| | | | - Hirofumi Ochi
- Department of Neurology; Ehime University Medical School; Matsuyama Japan
| | - Hikoaki Fukaura
- Department of Neurology; Iwate Medical University; Morioka Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience; Yamaguchi University Graduate School of Medicine; Ube Japan
| | - Akiko Nagaishi
- Department of Neurology; NHO Nagasaki Kawatana Medical Center; Kawatana Japan
| | - Kanae Togo
- Clinical Statistics; Pfizer Japan; Tokyo Japan
| | - Hidehiro Mizusawa
- Department of Neurology and Neurological Science; Tokyo Medical and Dental University; Tokyo Japan
| | - Yuji Kawano
- Department of Neurology; Neurological Institute; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| |
Collapse
|
19
|
Kubota A, Tajima T, Narukawa S, Yamazato M, Fukaura H, Takahashi Y, Tanaka K, Shimizu J, Nomura K. [Anti-Ma2, anti-NMDA-receptor and anti-GluRε2 limbic encephalitis with testicular seminoma: short-term memory disturbance]. Rinsho Shinkeigaku 2012; 52:666-71. [PMID: 22989902 DOI: 10.5692/clinicalneurol.52.666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 36-year-old man presented with cognitive impairment and disturbance of short-term memory functions with character change. Cerebrospinal fluid analysis revealed no abnormalities; however, brain MRI revealed high-signal intensity from bilateral hippocampus lesions on fluid attenuated inversion recovery (FLAIR) images and T(2) weighted images. The 18F-fluorodeoxyglucose PET demonstrated high glucose uptake in the bilateral hippocampus lesions. He was diagnosed as limbic encephalitis, and was administered high-dose intravenous methylprednisolone and immune adsorption plasma therapy followed by intravenous immunoglobulin therapy. MRI abnormalities improved after treatment but recent memory disturbance remained. Ma2 antibody, NMDA-receptor antibody, and GluRε2 antibody were positive. Eleven months atter the onset of disease, the tumor was identified in left testicle by ultrasound and removed the tumor. The pathological findings were seminoma. We experienced a case of paraneoplastic limbic encephalitis associated with seminoma with short-term memory disturbance. The occurrence of paraneoplastic limbic encephalitis with antibodies against cell membrane (NMDA-receptor antibody and GluRε2 antibody) and intracellular (Ma2 antibody) is rare even in the literature.
Collapse
Affiliation(s)
- Akihiro Kubota
- Department of Neurology, Saitama Medical Center, Saitama Medical University
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Fukaura H. [How do we cure the medical divide between northern Tohoku district and Tokyo?]. Rinsho Shinkeigaku 2010; 50:1069-1072. [PMID: 21921567] [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: 05/31/2023]
Abstract
What is required to provide high quality medical service to anybody, anytime and anywhere? We have investigated health care in neurology as provided by national health insurance in Aomori, Akita and Iwate prefectures compared to health care in Tokyo. We have conducted hearing surveillance to patients and doctors. Most of the patients have to drive to hospital for more than 100 kms as there is no licensed neurologist in their neighborhood and public transportation is poor. There are only a few medical facilities that can satisfy their needs even in prefectural cities. Neurologists who work alone at general hospitals face difficulties as they cannot consult with other neurologist about diagnosis and treatment and have rare opportunity to attend academic conferences. A licensed neurologist at northern Tohoku district has to be in charge of a half of Tokyo 23 districts area and twice as many people as Tokyo. We have concluded that medical divide due to the more or less of quantity of selection exists between northern Tohoku and Tokyo. How do we cure this medical divide? Creating a new framework of patients transporting system, increasing the number of doctors who work at general hospitals and opening satellite clinics at regional towns should be considered.
Collapse
|
21
|
Fukaura H. [Manpower in neurological care in rural and urban Japan]. Rinsho Shinkeigaku 2010; 50:1058. [PMID: 22937562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
22
|
Fukaura H. [Myelin oligodendrocyte glycoprotein (MOG) antibody and demyelination]. Nihon Rinsho 2010; 68 Suppl 6:637-640. [PMID: 20942151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
23
|
O'Connor KC, McLaughlin KA, De Jager PL, Chitnis T, Bettelli E, Xu C, Robinson WH, Cherry SV, Bar-Or A, Banwell B, Fukaura H, Fukazawa T, Tenembaum S, Wong SJ, Tavakoli NP, Idrissova Z, Viglietta V, Rostasy K, Pohl D, Dale RC, Freedman M, Steinman L, Buckle GJ, Kuchroo VK, Hafler DA, Wucherpfennig KW. Self-antigen tetramers discriminate between myelin autoantibodies to native or denatured protein. Nat Med 2007; 13:211-7. [PMID: 17237795 PMCID: PMC3429369 DOI: 10.1038/nm1488] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [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: 07/24/2006] [Accepted: 09/04/2006] [Indexed: 11/08/2022]
Abstract
The role of autoantibodies in the pathogenesis of multiple sclerosis (MS) and other demyelinating diseases is controversial, in part because widely used western blotting and ELISA methods either do not permit the detection of conformation-sensitive antibodies or do not distinguish them from conformation-independent antibodies. We developed a sensitive assay based on self-assembling radiolabeled tetramers that allows discrimination of antibodies against folded or denatured myelin oligodendrocyte glycoprotein (MOG) by selective unfolding of the antigen domain. The tetramer radioimmunoassay (RIA) was more sensitive for MOG autoantibody detection than other methodologies, including monomer-based RIA, ELISA or fluorescent-activated cell sorting (FACS). Autoantibodies from individuals with acute disseminated encephalomyelitis (ADEM) selectively bound the folded MOG tetramer, whereas sera from mice with experimental autoimmune encephalomyelitis induced with MOG peptide immunoprecipitated only the unfolded tetramer. MOG-specific autoantibodies were identified in a subset of ADEM but only rarely in adult-onset MS cases, indicating that MOG is a more prominent target antigen in ADEM than MS.
Collapse
Affiliation(s)
- Kevin C O'Connor
- Center for Neurologic Diseases, Brigham and Women's Hospital, 77 Avenue Louis Pasteur, Boston, Massachusetts 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Fukazawa T, Kikuchi S, Miyagishi R, Miyazaki Y, Fukaura H, Yabe I, Hamada T, Tashiro K, Sasaki H. CSF pleocytosis and expansion of spinal lesions in Japanese Multiple sclerosis with special reference to the new diagnostic criteria. J Neurol 2005; 252:824-9. [PMID: 15750702 DOI: 10.1007/s00415-005-0753-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Revised: 10/19/2004] [Accepted: 10/20/2004] [Indexed: 10/25/2022]
Abstract
New diagnostic criteria for multiple sclerosis (MS) were recently proposed from the international panel on the diagnosis of MS, and they include exclusion criteria, such as lesions extending over more than two vertebral segments on spinal MRI and CSF pleocytosis of more than 50/mm3. We reviewed the clinical features of 158 patients who satisfied the diagnostic criteria for MS except for having the above atypical paraclinical findings. All patients exhibited two or more clinical attacks and objective clinical evidence of multiple lesions without any evidence of other disorders. Thirty-three (20.9%) patients had one or both atypical paraclinical findings. Twenty-one out of the 33 patients were classified as having optico-spinal MS (OSMS), and the other 12 as non-OSMS patients with atypical large expanding or destructive cerebral, cerebellar or brainstem lesions on MRI as well as one or both atypical paraclinical findings. Based on this heterogeneity in clinical findings in MS, there is an urgent need to develop a common general concept of the "MS" syndromes, and the ethnic-related heterogeneity should be considered in the revised criteria for the diagnosis of MS.
Collapse
Affiliation(s)
- Toshiyuki Fukazawa
- Hokuyukai Neurology Hospital, Niju-Yon-Ken 2-2-4-30, Nishi-ku, Sapporo 063-0802, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Fukazawa T, Kikuchi S, Niino M, Yabe I, Miyagishi R, Fukaura H, Hamada T, Tashiro K, Sasaki H. Attack-related severity: a key factor in understanding the spectrum of idiopathic inflammatory demyelinating disorders. J Neurol Sci 2004; 225:71-8. [PMID: 15465088 DOI: 10.1016/j.jns.2004.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 06/22/2004] [Accepted: 07/02/2004] [Indexed: 11/19/2022]
Abstract
Understanding the spectrum of idiopathic inflammatory demyelinating disorders (IIDD) is a fundamental issue for the diagnosis and treatment of these disorders as well as for the approach to their pathogenesis. The spectrum of IIDD is usually classified according to clinical course and lesion distribution. We compared the demographic features, clinical characteristics, laboratory findings, and genetic backgrounds between 193 Japanese patients with and without clinically or radiographically fulminant attacks who all satisfied the diagnostic criteria for multiple sclerosis (MS). "Fulminant attacks" in the current study represent attack-related clinically or radiologically severe relapses but do not necessarily mean severe disability. Patients with fulminant attacks were clinically and immunogenetically distinct from those free of such attacks, and the previously described characteristics of the opticospinal form of MS (OSMS) or neuromyelitis optica (NMO) were mostly shared by patients with fulminant attacks. HLA profiles were similar among patients with fulminant attacks irrespective of the lesion distributions. The GG homozygous and G alleles of the CTLA4 gene A/G coding SNP at position 49 in exon 1 were significantly more common in patients with fulminant attacks than in those without. Attack-related severity may be an important factor if validated by prospective studies defining criteria and establishing relationships to disease course and treatment regimens.
Collapse
Affiliation(s)
- Toshiyuki Fukazawa
- Hokuyukai Neurology Hospital, Niju-Yon-Ken 2-2-4-30, Nishi-ku, Sapporo 063-0802, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Fukazawa T, Kikuchi S, Niino M, Yabe I, Miyagishi R, Fukaura H, Hamada T, Tashiro K. [Susceptibility genes for multiple sclerosis]. Nihon Rinsho 2003; 61:1311-6. [PMID: 12962016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Multiple lines of evidence support the role of genetic factors for susceptibility to multiple sclerosis (MS), although unknown environmental factors must play an important role in developing MS. In this paper, we review the reports studied for the possible associations between Japanese MS and candidate genes by using case-control method. As for HLA alleles, HLA-DRB1*1501 and -DPB1*0501 allele have been confirmed to be associated with conventional MS and opticospinal MS, respectively. Some polymorphisms of vitamin D receptor gene, estrogen receptor gene, CTLA-4 gene, and osteopontin gene were reported to be associated with conventional MS. Appropriate case ascertainment and collection as well as proper statistical method are needed to isolate the susceptibility genes for MS.
Collapse
|
27
|
Fukaura H, Kikuchi S. [IL-18 in multiple sclerosis]. Nihon Rinsho 2003; 61:1416-21. [PMID: 12962032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
IL-18, previously named interferon-gamma inducing factor, is produced by monocytes/macropharges, dendritic cells, B cells and other APC cells as well as by astrocytes, microglia. IL-18 is a unique cytokine that stimulates both Th1 and Th2 responses depending on its cytokine milieu. Caspase-1 regulates the cellular export of IL-18. Anti IL-18 antibodies prevent EAE. IL-18 directs autoreactive T cells and promotes autodestruction in CNS via induction of IFN-gamma by NK cells in EAE. IL-18 is expressed in MS plaque. Common IL-18 promoter polymorphisms influence the expression on IL-18. IL-18 is linked to raised IFN-gamma in MS and is induced by activated CD4(+) T cells via CD40-CD40 ligand interaction. IL-18 in MS is suppressed by treatments such as GA and IFN-beta.
Collapse
Affiliation(s)
- Hikoaki Fukaura
- Department of Neurology, Hokkaido University School of Medicine
| | | |
Collapse
|
28
|
Takashima H, Smith DR, Fukaura H, Khoury SJ, Hafler DA, Weiner HL. Pulse cyclophosphamide plus methylprednisolone induces myelin-antigen-specific IL-4-secreting T cells in multiple sclerosis patients. Clin Immunol Immunopathol 1998; 88:28-34. [PMID: 9683547 DOI: 10.1006/clin.1998.4558] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Multiple sclerosis (MS) is a presumed cell-mediated Th1-type autoimmune disease. Thus therapies which decrease T cells secreting IFN-gamma production or increase IL-4 production would be expected to have an ameliorating effect on MS. We have previously reported increased anti-CD3-induced IL-4 secretion by T cells in progressive MS patients treated with cyclophosphamide plus methylprednisolone (CY/MP) which was associated with eosinophilia. To investigate whether the increased IL-4 secretion was myelin antigen specific, we generated 3990 short-term T cell lines to myelin basic protein (MBP), proteolipid protein (PLP), or tetanus toxoid (TT) from 31 progressive MS patients: 11 MS patients treated with CY/MP, 10 MS patients treated with MP alone, and 10 untreated MS patients. We found increased frequencies of both MBP- and PLP-specific IL-4-secreting T cell lines in CY/MP-treated patients compared to untreated MS patients. However, no change in the frequency of TT-specific IL-4-secreting T cells was observed. MP treatment alone did not increase the frequency of antigen-specific IL-4-secreting T cell lines. These results demonstrate immune deviation favoring Th2-type responses specific to autoantigens following pulse cyclophosphamide therapy in MS patients.
Collapse
Affiliation(s)
- H Takashima
- Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | | | | | | | | | | |
Collapse
|
29
|
Hafler DA, Kent SC, Pietrusewicz MJ, Khoury SJ, Weiner HL, Fukaura H. Oral administration of myelin induces antigen-specific TGF-beta 1 secreting T cells in patients with multiple sclerosis. Ann N Y Acad Sci 1997; 835:120-31. [PMID: 9616767 DOI: 10.1111/j.1749-6632.1997.tb48623.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [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] [Indexed: 11/28/2022]
Abstract
Oral administration of antigen is a long-recognized method of inducing systemic immune tolerance. In animals with experimental autoimmune disease, a major mechanism of oral tolerance involves the induction of regulatory T cells that mediate active suppression by secreting the cytokine TGF-beta 1. Multiple sclerosis (MS) is a presumed T cell-mediated Th1 type autoimmune disease. In this paper we investigated, in patients with MS, whether oral myelin treatment (myelin containing both MBP and PLP) induced antigen-specific MBP- or PLP-reactive T cells that were either Th2-like (secreted IL-4 or TGF-beta 1), or alternatively whether Th1 type sensitization occurred as measured by IFN-gamma secretion. Specifically, 4,860 short-term T cell lines were generated to either MBP, PLP or TT from 34 relapsing-remitting patients with MS; 17 were orally treated with bovine myelin daily for a minimum of two years as compared to 17 non-treated patients. We found a marked increase in the relative frequencies of both MBP- and PLP-specific TGF-beta 1 secreting T cell lines in the myelin-treated MS patients as compared to non-treated MS patients (MBP, p < 0.001; PLP, p < 0.003). In contrast, no changes in the frequency of MBP- or PLP-specific IFN-gamma or TT-specific TGF-beta 1 secreting T cells were observed. These results suggest that the oral administration of antigens generates antigen-specific TGF-beta 1 secreting T cells of presumed mucosal origin that may represent a distinct cytokine-secreting lineage of T cells (Th3). Since, in animal models, antigen-specific TGF-beta 1 secreting cells localize to the target organ and then suppress inflammation in the local microenvironment, oral tolerization with self-antigens may provide a therapeutic approach for the treatment of cell-mediated autoimmune disease which does not depend upon knowledge of the antigen specificity of the original T cell clone triggering the autoimmune cascade.
Collapse
Affiliation(s)
- D A Hafler
- Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | |
Collapse
|
30
|
Kent SC, Fukaura H, Pietrusewicz MJ, Khoury SJ, Weiner HL, Hafler DA. Oral administration of myelin induces antigen-specific TGF-beta 1-secreting T cells in multiple sclerosis patients. Ann N Y Acad Sci 1997; 815:412-22. [PMID: 9186687 DOI: 10.1111/j.1749-6632.1997.tb52092.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S C Kent
- Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
31
|
Fukaura H, Kent SC, Pietrusewicz MJ, Khoury SJ, Weiner HL, Hafler DA. Induction of circulating myelin basic protein and proteolipid protein-specific transforming growth factor-beta1-secreting Th3 T cells by oral administration of myelin in multiple sclerosis patients. J Clin Invest 1996; 98:70-7. [PMID: 8690806 PMCID: PMC507402 DOI: 10.1172/jci118779] [Citation(s) in RCA: 374] [Impact Index Per Article: 13.4] [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] [Indexed: 02/01/2023] Open
Abstract
Oral administration of antigen is a long recognized method of inducing systemic immune tolerance. In animals with experimental autoimmune disease, a major mechanism of oral tolerance triggered by oral administration of antigen involves the induction of regulatory T cells that mediate active suppression by secreting the cytokine TGF-beta 1. Multiple sclerosis (MS) is a presumed T cell-mediated Th1 type autoimmune disease. Here, we investigated whether in MS patients oral myelin treatment, containing both myelin basic protein (MBP) and proteolipid protein (PLP), induced antigen specific MBP or PLP reactive T cells that either secreted IL4, TGF-beta1, or alternatively did Th1 type sensitization occur as measured by IFN-gamma secretion. Specifically, 4,860 short-term T cell lines were generated to either MBP, PLP, or tetanus toxoid (TT) from 34 relapsing-remitting MS patients: 17 orally treated with bovine myelin daily for a minimum of 2 yr as compared to 17 nontreated patients. We found a marked increase in the relative frequencies of both MBP and PLP specific TGF-beta1-secreting T cell lines in the myelin treated MS patients as compared to non-treated MS patients (MBP P < 0.001, PLP P < 0.003). In contrast, no change in the frequency of MBP or PLP specific IFN-gamma or TT specific TGF-beta1 secreting T cells were observed. These results suggest that the oral administration of antigens generates antigen specific TGF-beta1 secreting Th3 cells of presumed mucosal origin that represent a distinct lineage of T cells. Since antigen-specific TGF-beta1 secreting cells localize to the target organ and then suppress inflammation in the local microenvironment, oral tolerization with self antigens may provide a therapeutic approach for the treatment of cell-mediated autoimmune disease which does not depend upon knowledge of the antigen specificity of the original T cell clone triggering the autoimmune cascade.
Collapse
Affiliation(s)
- H Fukaura
- Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
32
|
Fukaura H, Kent SC, Pietrusewicz MJ, Khoury SJ, Weiner HL, Hafler DA. Antigen-specific TGF-beta1 secretion with bovine myelin oral tolerization in multiple sclerosis. Ann N Y Acad Sci 1996; 778:251-7. [PMID: 8610978 DOI: 10.1111/j.1749-6632.1996.tb21133.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [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: 01/31/2023]
Abstract
Multiple sclerosis is a presumed autoimmune disease, associated with inflammation in the CNS white matter, mediated by autoreactive T cells. We previously reported that oral myelin tolerization of relapsing-remitting MS patients resulted in fewer attacks, as compared to a placebo-fed group. Here, we examined whether oral tolerization with bovine myelin resulted in altered autoreactive T-cell populations or altered T-cell fraction. We generated 4,620 T-cell lines from 34 relapsing-remitting MS patients (17 were fed bovine myelin daily), and each line was examined for proliferation to MBP, PLP, and TT and for secretion of IL-4, IFN-gamma, and TGF-beta1. The frequency of TGF-beta1-secreting T-cell lines after MBP and PLP stimulation in fed patients was greater than that of nonfed patients. These experiments demonstrate that oral tolerization with autoantigen results in altered cytokine secretion in a human autoimmune disease with the generation of TGF-beta1-secreting T cells that may regulate the inflammatory response at the site of the demyelinating lesions in multiple sclerosis. These data provide the first evidence of antigen-specific modification of cytokine secretion in a human autoimmune disease.
Collapse
Affiliation(s)
- H Fukaura
- Center for Neurologic Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | | | | | | | | | | |
Collapse
|
33
|
Markovic-Plese S, Fukaura H, Zhang J, al-Sabbagh A, Southwood S, Sette A, Kuchroo VK, Hafler DA. T cell recognition of immunodominant and cryptic proteolipid protein epitopes in humans. J Immunol 1995; 155:982-92. [PMID: 7541828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the immune response to proteolipid protein (PLP), the most abundant central nervous system myelin protein in humans. A total of 8207 short-term T cell lines were generated from 49 individuals, 39 patients with multiple sclerosis and 10 control subjects. As we have reported previously, the frequency of PLP-reactive T cells did not differ between the two groups. To determine immunodominant PLP epitopes, proliferative responses of 971 PLP-specific lines were tested with 27 overlapping 20-amino acid peptides encompassing the human PLP sequence and the binding affinities of the PLP peptides to DRB5*0101 and DRB1*1501, DR2 MHC class II isotypes associated with multiple sclerosis, were determined. The T cell response after primary PLP stimulation was focused on two immunodominant epitopes comprising residues p30-49 and p180-199. These two fragments were recognized after processing of native protein by APCs and were situated in hydrophilic regions of PLP exhibiting only moderate affinity to DR2 molecules. In contrast, when T cells from DR2+ subjects were stimulated initially by individual synthetic peptides with either high or low affinity to DRB5*0101 and DRB1*1501 isotypes, additional cryptic epitopes were recognized. MHC restriction of lines specific for the cryptic PLP epitopes were related to binding affinity to DR2 isotypes. Our results indicate that protein Ags are recognized in vivo as immunodominant epitopes after Ag processing by APCs and as cryptic epitopes after processing, presumably by extracellular proteolytic enzymes.
Collapse
Affiliation(s)
- S Markovic-Plese
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Markovic-Plese S, Fukaura H, Zhang J, al-Sabbagh A, Southwood S, Sette A, Kuchroo VK, Hafler DA. T cell recognition of immunodominant and cryptic proteolipid protein epitopes in humans. The Journal of Immunology 1995. [DOI: 10.4049/jimmunol.155.2.982] [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: 01/02/2023]
Abstract
Abstract
We investigated the immune response to proteolipid protein (PLP), the most abundant central nervous system myelin protein in humans. A total of 8207 short-term T cell lines were generated from 49 individuals, 39 patients with multiple sclerosis and 10 control subjects. As we have reported previously, the frequency of PLP-reactive T cells did not differ between the two groups. To determine immunodominant PLP epitopes, proliferative responses of 971 PLP-specific lines were tested with 27 overlapping 20-amino acid peptides encompassing the human PLP sequence and the binding affinities of the PLP peptides to DRB5*0101 and DRB1*1501, DR2 MHC class II isotypes associated with multiple sclerosis, were determined. The T cell response after primary PLP stimulation was focused on two immunodominant epitopes comprising residues p30-49 and p180-199. These two fragments were recognized after processing of native protein by APCs and were situated in hydrophilic regions of PLP exhibiting only moderate affinity to DR2 molecules. In contrast, when T cells from DR2+ subjects were stimulated initially by individual synthetic peptides with either high or low affinity to DRB5*0101 and DRB1*1501 isotypes, additional cryptic epitopes were recognized. MHC restriction of lines specific for the cryptic PLP epitopes were related to binding affinity to DR2 isotypes. Our results indicate that protein Ags are recognized in vivo as immunodominant epitopes after Ag processing by APCs and as cryptic epitopes after processing, presumably by extracellular proteolytic enzymes.
Collapse
Affiliation(s)
- S Markovic-Plese
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - H Fukaura
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - J Zhang
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - A al-Sabbagh
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - S Southwood
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - A Sette
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - V K Kuchroo
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - D A Hafler
- Laboratory of Molecular Immunology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
35
|
Windhagen A, Scholz C, Höllsberg P, Fukaura H, Sette A, Hafler DA. Modulation of cytokine patterns of human autoreactive T cell clones by a single amino acid substitution of their peptide ligand. Immunity 1995; 2:373-80. [PMID: 7536622 DOI: 10.1016/1074-7613(95)90145-0] [Citation(s) in RCA: 188] [Impact Index Per Article: 6.5] [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: 01/25/2023]
Abstract
We demonstrate that cognate peptide ligands altered at T cell receptor (TCR) contact residues and bound to class II major histocompatability complex can change the cytokine pattern of mature T cell clones. Myelin basic protein peptide 85-99-reactive Th0 T cell clones were stimulated with altered peptide ligands, which acted both as TCR antagonist and induced new mRNA synthesis and protein secretion of TGF-beta 1, while no longer inducing mRNA synthesis or protein secretion of IL-2, IL-4, IL-10, and IFN gamma. The modified peptides failed to induce a detectable calcium flux, p56lck activation, or thymidine incorporation, yet triggered nearly equal amounts of IL-4 secretion in the presence of ionomycin. Antigen-induced modulation of T cell cytokine secretion may be important in regulating the immune response.
Collapse
Affiliation(s)
- A Windhagen
- Laboratory of Molecular Immunology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
36
|
Windhagen A, Scholz C, Fukaura H, Sette A, Hafler DA. Switch of autoreactive human T cell clones from a TH2 to a TGFβ1 secreting phenotype with low affinity T-cell receptor stimulating peptide/MHC complex. J Neuroimmunol 1994. [DOI: 10.1016/0165-5728(94)90586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
Miyagishi R, Fukaura H, Fukazawa T, Tashiro K. [Immunological aspects of multiple sclerosis]. No To Shinkei 1993; 45:917-24. [PMID: 8268031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- R Miyagishi
- Department of Neurology, Hokkaido University School of Medicine, Sapporo, Japan
| | | | | | | |
Collapse
|
38
|
Hamada K, Sudoh K, Fukaura H, Yanagihara T, Hamada T, Tashiro K, Isu T. [An autopsy case of amyotrophic lateral sclerosis associated with cervical syringomyelia]. No To Shinkei 1990; 42:527-31. [PMID: 2206638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An autopsied case of amyotrophic lateral sclerosis complicated by cervical syringomyelia was reported. The case was a 59-year-old man, who first noticed weakness of both lower extremities at 54-year-old. The weakness spread to both upper extremities within 2 years. Cervical myelography revealed multi-level cervical spondylosis and anterior fusion of C5-C7 was done. But the weakness and atrophy of proximal muscle, diminished deep tendon reflex on upper extremities, hyperreflexia and pathological reflexes on both legs, tongue fasciculation and respiratory muscle weakness developed successively, and the patient died of respiratory distress at 59-year-old. Autopsy revealed multiple independent four syrinxes located at the level between C2-C7. One of these syrinxes had ependymal cell lining and thought to be idiopathic syringomyelia. The other three syrinxes were considered to be the cavitation in association with cervical spondylotic myelopathy. Degeneration and decreasing of spinal anterior horn cells, atrophy of medullary pyramis and Bunina bodies were observed as features of typical amyotrophic lateral sclerosis. Cervical spondylosis as causative lesion of multiple syrinxes was discussed, and relationship between ALS and the syrinxes was not indicated clearly.
Collapse
Affiliation(s)
- K Hamada
- Hokuyukai Neurological Hospital, Sapporo, Japan
| | | | | | | | | | | | | |
Collapse
|