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Huang YT, Giacomini PS, Massie R, Venkateswaran S, Trudelle AM, Fadda G, Sharifian-Dorche M, Boudjani H, Poliquin-Lasnier L, Airas L, Saveriano AW, Ziller MG, Miller E, Martinez-Rios C, Wilson N, Davila J, Rush C, Longbrake EE, Longoni G, Macaron G, Bernard G, Tampieri D, Antel J, Brais B, La Piana R. The White Matter Rounds experience: The importance of a multidisciplinary network to accelerate the diagnostic process for adult patients with rare white matter disorders. Front Neurol 2022; 13:928493. [PMID: 35959404 PMCID: PMC9359417 DOI: 10.3389/fneur.2022.928493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Adult genetic leukoencephalopathies are rare neurological disorders that present unique diagnostic challenges due to their clinical and radiological overlap with more common white matter diseases, notably multiple sclerosis (MS). In this context, a strong collaborative multidisciplinary network is beneficial for shortening the diagnostic odyssey of these patients and preventing misdiagnosis. The White Matter Rounds (WM Rounds) are multidisciplinary international online meetings attended by more than 30 physicians and scientists from 15 participating sites that gather every month to discuss patients with atypical white matter disorders. We aim to present the experience of the WM Rounds Network and demonstrate the value of collaborative multidisciplinary international case discussion meetings in differentiating and preventing misdiagnoses between genetic white matter diseases and atypical MS. Methods We retrospectively reviewed the demographic, clinical and radiological data of all the subjects presented at the WM Rounds since their creation in 2013. Results Seventy-four patients (mean age 44.3) have been referred and discussed at the WM Rounds since 2013. Twenty-five (33.8%) of these patients were referred by an MS specialist for having an atypical presentation of MS, while in most of the remaining cases, the referring physician was a geneticist (23; 31.1%). Based on the WM Rounds recommendations, a definite diagnosis was made in 36/69 (52.2%) patients for which information was available for retrospective review. Of these diagnosed patients, 20 (55.6%) had a genetic disease, 8 (22.2%) had MS, 3 (8.3%) had both MS and a genetic disorder and 5 (13.9%) had other non-genetic conditions. Interestingly, among the patients initially referred by an MS specialist, 7/25 were definitively diagnosed with MS, 5/25 had a genetic condition (e.g., X-linked adrenoleukodystrophy and hereditary small vessel diseases like Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and COL4A1-related disorder), and one had both MS and a genetic demyelinating neuropathy. Thanks to the WM Rounds collaborative efforts, the subjects who currently remain without a definite diagnosis, despite extensive investigations performed in the clinical setting, have been recruited in research studies aimed at identifying novel forms of genetic MS mimickers. Conclusions The experience of the WM Rounds Network demonstrates the benefit of collective discussions on complex cases to increase the diagnostic rate and decrease misdiagnosis in patients with rare or atypical white matter diseases. Networks of this nature allow physicians and scientists to compare and share information on challenging cases from across the world, provide a basis for future multicenter research studies, and serve as model for other rare diseases.
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Affiliation(s)
- Yu Tong Huang
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Paul S. Giacomini
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Rami Massie
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Sunita Venkateswaran
- Department of Pediatrics, Division of Neurology, CHEO, University of Ottawa, Ottawa, ON, Canada
| | | | - Giulia Fadda
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Maryam Sharifian-Dorche
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Hayet Boudjani
- Department of Neurology, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | | | - Laura Airas
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Alexander W. Saveriano
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Matthias Georg Ziller
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Neurology, St. Mary's Hospital, Montreal, QC, Canada
| | - Elka Miller
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | | | - Nagwa Wilson
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Jorge Davila
- Department of Medical Imaging, CHEO, University of Ottawa, Ottawa, ON, Canada
| | - Carolina Rush
- Division of Neurology, Neuroscience Department, University of Ottawa, Ottawa, ON, Canada
| | - Erin E. Longbrake
- Department of Neurology, Yale MS Center, Yale School of Medicine, North Haven, CT, United States
| | - Giulia Longoni
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Gabrielle Macaron
- Department of Neurology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Geneviève Bernard
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Center, Montreal, QC, Canada,Child Health and Human Development Program, Research Institute of the McGill University Health Center, Montreal, QC, Canada,Departments of Pediatrics and Human Genetics, McGill University, Montreal, QC, Canada
| | - Donatella Tampieri
- Department of Diagnostic Radiology, Kingston Health Science Centre, Queen's University, Kingston, ON, Canada
| | - Jack Antel
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Roberta La Piana
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada,Department of Diagnostic Radiology, McGill University, Montreal, QC, Canada,*Correspondence: Roberta La Piana
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Nyirenda MH, Fadda G, Healy LM, Mexhitaj I, Poliquin-Lasnier L, Hanwell H, Saveriano AW, Rozenberg A, Li R, Moore CS, Belabani C, Johnson T, O'Mahony J, Arnold DL, Yeh EA, Marrie RA, Dunn S, Banwell B, Bar-Or A. Pro-inflammatory adiponectin in pediatric-onset multiple sclerosis. Mult Scler 2021; 27:1948-1959. [PMID: 33522403 DOI: 10.1177/1352458521989090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Being obese is associated with both increased risk of developing multiple sclerosis (MS) and greater MS disease activity. OBJECTIVES The objective of this study is to investigate levels and potential pathophysiologic contribution of serum adipose-hormones (adipokines) in pediatric-onset MS. METHODS Following a Luminex adipokine screen, adiponectin (APN) and its isoforms were quantified by enzyme-linked immunosorbent assay (ELISA) in 169 children with incident acquired demyelinating syndromes (ADS), prospectively ascertained as having either MS or other forms of inflammatory central nervous system (CNS) demyelination. The effect of recombinant APN and APN-containing sera was assessed on functional responses of normal human peripheral blood myeloid and T cells and on human CNS-derived microglia. RESULTS Compared to other cohorts, children with MS harbored higher serum APN levels, principally driven by higher levels of the low-molecular-weight isoform. Recombinant APN and pediatric MS serum-induced APN-dependent pro-inflammatory activation of CD14+ monocytes and of activated CD4+ and CD8+ T cells (both directly and indirectly through myeloid cells). APN induced human microglia activation while inhibiting their expression of molecules associated with quiescence. CONCLUSIONS Elevated APN levels in children with MS may contribute to enhanced pro-inflammatory states of innate and adaptive peripheral immune responses and breach CNS-resident microglia quiescence, providing a plausible and potentially targetable mechanism by which APN contributes to MS disease activity.
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Affiliation(s)
- Mukanthu H Nyirenda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Giulia Fadda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Luke M Healy
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ina Mexhitaj
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laurence Poliquin-Lasnier
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Department of Neurology, Hull Hospital, Gatineau, QC, Canada
| | - Heather Hanwell
- Neurosciences and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada/ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Ayal Rozenberg
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Neuroimmunology Unit, Rambam Health Care Campus, Haifa, Israel
| | - Rui Li
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig S Moore
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Chahrazed Belabani
- Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Trina Johnson
- Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Julia O'Mahony
- Neurosciences and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Douglas L Arnold
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Shannon Dunn
- Keenan Research Centre for Biomedical Science, Toronto, ON, Canada/Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Brenda Banwell
- Neurosciences and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada/Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada/Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Bar-Or
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/Experimental Therapeutics Program, Montreal Neurological Institute, McGill University, Montreal, QC, Canada/Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Michell-Robinson MA, Moore CS, Healy LM, Osso LA, Zorko N, Grouza V, Touil H, Poliquin-Lasnier L, Trudelle AM, Giacomini PS, Bar-Or A, Antel JP. Effects of fumarates on circulating and CNS myeloid cells in multiple sclerosis. Ann Clin Transl Neurol 2015; 3:27-41. [PMID: 26783548 PMCID: PMC4704479 DOI: 10.1002/acn3.270] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/14/2015] [Accepted: 11/03/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Dimethyl fumarate (DMF), a therapy for relapsing-remitting multiple sclerosis (RRMS), is implicated as acting on inflammatory and antioxidant responses within both systemic immune and/or central nervous system (CNS) compartments. Orally administered DMF is rapidly metabolized to monomethyl fumarate (MMF). Our aim was to analyze the impact of fumarates on antiinflammatory and antioxidant profiles of human myeloid cells found in the systemic compartment (monocytes) and in the inflamed CNS (blood-derived macrophages and brain-derived microglia). METHODS We analyzed cytokine and antioxidant expression in monocytes from untreated or DMF-treated RRMS patients and controls, and in monocyte-derived macrophages (MDMs) and microglia isolated from adult and fetal human brain tissue. RESULTS Monocytes from multiple sclerosis (MS) patients receiving DMF had reduced expression of the proinflammatory micro-RNA miR-155 and of antioxidant genes HMOX1 and OSGIN1 compared to untreated MS patients; similar changes were observed in patients receiving FTY720 and/or natalizumab. In vitro addition of DMF but not MMF to MDMs and microglia inhibited lipopolysaccharide-induced production of inflammatory cytokines and increased expression of the antioxidant gene HMOX1 in the absence of significant cytotoxicity. INTERPRETATION Our in vivo-based observations that effects of DMF therapy on systemic myeloid cell gene expression are also observed with FTY720 and natalizumab therapy suggests that the effect may be indirect, reflecting reduced overall disease activity. Our in vitro results demonstrate significant effects of DMF but not MMF on inflammation and antioxidant responses by MDMs and microglia, questioning the mechanisms whereby DMF therapy would modulate myeloid cell properties within the CNS.
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Affiliation(s)
- Mackenzie A Michell-Robinson
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Craig S Moore
- Division of BioMedical Sciences Faculty of Medicine Memorial University St. John's Newfoundland Canada
| | - Luke M Healy
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Lindsay A Osso
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Nika Zorko
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Vladimir Grouza
- Institute of Biomaterials and Biomedical Engineering University of Toronto Toronto Ontario Canada
| | - Hanane Touil
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Laurence Poliquin-Lasnier
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Anne-Marie Trudelle
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Paul S Giacomini
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Amit Bar-Or
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
| | - Jack P Antel
- Neuroimmunology Unit Department of Neurology and Neurosurgery Montreal Neurological Institute and Hospital McGill University Montreal Quebec Canada
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