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Bajrami A, Tamanti A, Peloso A, Ziccardi S, Guandalini M, Calderone M, Castellaro M, Pizzini FB, Montemezzi S, Marastoni D, Calabrese M. Ocrelizumab reduces cortical and deep grey matter loss compared to the S1P-receptor modulator in multiple sclerosis. J Neurol 2024; 271:2149-2158. [PMID: 38289534 PMCID: PMC11055717 DOI: 10.1007/s00415-023-12179-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration. AIM To compare the effect of OCR and FGL on clinical and MRI endpoints. METHODS 95 relapsing-remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated. RESULTS OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (- 0.12% vs - 0.66%; p = 0.002, Cohen's d = 0.54), lower global cortical thickness change (- 0.45% vs - 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus (d-range = 0.65-0.71), frontal gyrus (d-range = 0.47-0.60), cingulate (d-range = 0.41-0.72), insula (d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen (d = 0.35) and thalamus (d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions. CONCLUSIONS When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss.
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Affiliation(s)
- Albulena Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
- Neurology Unit, Ospedale S. Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Largo Medaglie d'oro, 9, 38122, Trento, Italy
| | - Agnese Tamanti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Angela Peloso
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Stefano Ziccardi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Maddalena Guandalini
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Milena Calderone
- Radiology Unit, Cmsr Veneto Medica S.R.L., Altavilla Vicentina, via Vicenza, 204, 36077, Vicenza, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Via Giovanni Gradenigo, 6b , 35131, Padua, Italy
| | - Francesca B Pizzini
- Department of Diagnostics and Public Health, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Stefania Montemezzi
- Department of Diagnostics and Public Health, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Policlinico "G.B. Rossi" Borgo Roma Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
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Marastoni D, Foschi M, Eccher C, Crescenzo F, Mazziotti V, Tamanti A, Bajrami A, Camera V, Ziccardi S, Guandalini M, Bosello F, Anni D, Virla F, Turano E, Romoli M, Mariotti R, Pizzini FB, Bonetti B, Calabrese M. CSF levels of Chitinase3like1 correlate with early response to cladribine in multiple sclerosis. Front Immunol 2024; 15:1343892. [PMID: 38404586 PMCID: PMC10885800 DOI: 10.3389/fimmu.2024.1343892] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cladribine has been introduced as a high-efficacy drug for treating relapsing-remitting multiple sclerosis (RRMS). Initial cohort studies showed early disease activity in the first year after drug initiation. Biomarkers that can predict early disease activity are needed. Aim To estimate cerebrospinal fluid (CSF) markers of clinical and radiological responses after initiation of cladribine. Methods Forty-two RRMS patients (30F/12M) treated with cladribine were included in a longitudinal prospective study. All patients underwent a CSF examination at treatment initiation, clinical follow-up including Expanded Disability Status Scale (EDSS) assessment, and a 3T MRI scan after 6,12 and 24 months, including the evaluation of white matter (WM) and cortical lesions (CLs). CSF levels of 67 inflammatory markers were assessed with immune-assay multiplex techniques. The 'no evidence of disease activity' (NEDA-3) status was assessed after two years and defined by no relapses, no disability worsening measured by EDSS and no MRI activity, including CLs. Results Three patients were lost at follow-up. At the end of follow-up, 19 (48%) patients remained free from disease activity. IFNgamma, Chitinase3like1, IL32, Osteopontin, IL12(p40), IL34, IL28A, sTNFR2, IL20 and CCL2 showed the best association with disease activity. When added in a multivariate regression model including age, sex, and baseline EDSS, Chitinase 3 like1 (p = 0.049) significantly increased in those patients with disease activity. Finally, ROC analysis with Chitinase3like1 added to a model with EDSS, sex, age previous relapses, WM lesion number, CLs, number of Gad enhancing lesions and spinal cord lesions provided an AUC of 0.76 (95%CI 0.60-0.91). Conclusions CSF Chitinase 3 like1 might provide prognostic information for predicting disease activity in the first years after initiation of cladribine. The drug's effect on chronic macrophage and microglia activation deserves further evaluation.
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Affiliation(s)
- Damiano Marastoni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Foschi
- Neurology Unit, Department of Neuroscience, Multiple Sclerosis Center, S. Maria delle Croci Hospital, AUSL, Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Chiara Eccher
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Valentina Mazziotti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Albulena Bajrami
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Valentina Camera
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Bosello
- Eye Clinic, Department of Surgery, Dentistry, Maternity, and Infant, University of Verona, Verona, Italy
| | - Daniela Anni
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federica Virla
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ermanna Turano
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Ospedale “Bufalini”, Cesena, Italy
| | - Raffaella Mariotti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Bruno Bonetti
- Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Pitteri M, Vannucci M, Dapor C, Guandalini M, Daffinà A, Marastoni D, Calabrese M. Prominent role of executive functioning on the Phonemic Fluency Test in people with multiple sclerosis. J Int Neuropsychol Soc 2023; 29:902-906. [PMID: 36781412 DOI: 10.1017/s1355617723000139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Executive functioning (EF) can be one of the earliest, despite under-detected, impaired cognitive domains in patients with multiple sclerosis (pwMS). However, it is still not clear the role of EF on verbal fluency tests given the presence of information processing speed (IPS) deficits in pwMS. METHOD Performance of a group of 43 pwMS without IPS impairment as measured with the Symbol Digit Modalities Test (SDMT) and a group of 32 healthy controls (HC) was compared on the Phonemic and Semantic Fluency Tests. For each group, we scored the number of words generated (i) in the early time interval (i.e., first 15 sec, semi-automatic process) and (ii) in the late time interval (i.e., from 15 to 60 sec, controlled process). RESULTS Globally, pwMS produced significantly fewer words than HC on the Phonemic but not on the Semantic Fluency Test. Crucially, in the Phonemic Fluency Test pwMS generated significantly fewer words than HC in the late time interval, whereas no significant difference between the two groups emerged in the early time interval. CONCLUSIONS These findings suggest that executive dysfunction is the core element on the Phonemic Fluency Test also in pwMS and it deserves attention in both research and clinical practice.
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Affiliation(s)
- Marco Pitteri
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Manila Vannucci
- Department of NEUROFARBA, Section of Psychology, University of Florence, Florence, Italy
| | - Caterina Dapor
- Department of General Psychology, University of Padua, Padua, Italy
| | - Maddalena Guandalini
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelica Daffinà
- Psychology Area, Salesian University Institution of Venice and Verona (IUSVE), Venice-Mestre, Italy
| | - Damiano Marastoni
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Ziccardi S, Pisani AI, Schiavi GM, Guandalini M, Crescenzo F, Colombi A, Peloso A, Tamanti A, Bertolazzo M, Marastoni D, Calabrese M. Cortical lesions at diagnosis predict long-term cognitive impairment in multiple sclerosis: A 20-year study. Eur J Neurol 2023; 30:1378-1388. [PMID: 36692863 DOI: 10.1111/ene.15697] [Citation(s) in RCA: 2] [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] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Although cognitive impairment (CI) is frequent in multiple sclerosis (MS) patients, few studies (and with conflicting results) have evaluated early predictors of CI in the long term. We aimed at determining associations between early clinical/neuroradiological variables with reference to CI after 20 years of MS. METHODS We investigated in 170 MS patients the relationship between clinical/magnetic resonance imaging (MRI) data at diagnosis and cognitive status almost 20 years after MS onset. Among others, number and volume of both white matter lesions (WMLs) and cortical lesions (CLs) were evaluated at diagnosis and after 2 years. All MS patients were followed over time and underwent a comprehensive neuropsychological assessment at the end of study. Advanced statistical methods (unsupervised cluster analysis and random forest model) were conducted. RESULTS CI patients showed higher focal cortical pathology at diagnosis compared to cognitively normal subjects (p < 0.001). Volumes of both WMLs and CLs emerged as the MRI metrics most associated with long-term CI. Moreover, number of CLs (especially ≥3) was also strongly associated with long-term CI (≥3 CLs: odds ratio [OR] = 3.7, 95% confidence interval = 1.8-7.5, p < 0.001), more than number of WMLs; the optimal cutoff of three CLs (area under the curve = 0.67, specificity = 75%, sensitivity = 55%) was estimated according to the risk of developing CI. CONCLUSIONS These results highlight the impact of considering both white and gray matter focal damage from early MS stages. Given the low predictive value of WML number and the poor clinical applicability of lesion volume estimation in the daily clinical context, the evaluation of number of CLs could represent a reliable prognostic marker of CI.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Isabella Pisani
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Marco Schiavi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Annalisa Colombi
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Peloso
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Bertolazzo
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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Ziccardi S, Pizzini FB, Guandalini M, Tamanti A, Cristofori C, Calabrese M. Making Visible the Invisible: Automatically Measured Global and Regional Brain Volume Is Associated with Cognitive Impairment and Fatigue in Multiple Sclerosis. Bioengineering (Basel) 2022; 10:bioengineering10010041. [PMID: 36671613 PMCID: PMC9855175 DOI: 10.3390/bioengineering10010041] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/30/2022]
Abstract
In multiple sclerosis (MS), the transition from relapsing-remitting to the secondary-progressive phase is characterized by a progression independent of relapse activity (PIRA), resulting in physical disability accumulation and invisible symptoms, i.e., fatigue and cognitive impairment (CI). These symptoms are related to neurodegenerative processes and have been correlated with MRI measures of brain atrophy only at a group level; however, the application in clinical practice of atrophy-based measurements for single-patient evaluation is yet to be fully investigated. In the present study, we aimed to evaluate the association between brain atrophy, measured with easy-to-use automatic software, and the "invisible" MS symptoms of cognition and fatigue. A total of 69 MS patients were included in the study; cognitive impairment and fatigue (FSS) (in addition to neurological disability, EDSS) were assessed and correlated with brain volumes calculated using the automated software QyScore® which is validated for single-patient use in the clinical setting. Results showed that the cognitive status was accurately reflected by measures of atrophy, with a sensitivity of up to 90%. CI patients showed a lower volume compared to cognitively normal patients in the whole brain (p = 0.017), gray matter (p = 0.042), insula (p = 0.035), cerebellum (p = 0.008), and limbic lobe (p = 0.049). FSS was associated with temporal lobe (r = -0.37, p = 0.013) and insular (r = -0.36, p = 0.019) volumes. The volumes of the same regions were also associated with EDSS. The global/regional atrophy results, assessed with automatic and easy-to-use software, correlated with cognitive and fatigue symptoms, thus supporting the clinical application in routine patient management.
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Affiliation(s)
- Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Francesca Benedetta Pizzini
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
- Correspondence: (F.B.P.); (M.C.)
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Cecilia Cristofori
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Correspondence: (F.B.P.); (M.C.)
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Mazziotti V, Crescenzo F, Tamanti A, Dapor C, Ziccardi S, Guandalini M, Colombi A, Camera V, Peloso A, Pezzini F, Turano E, Marastoni D, Calabrese M. Immune Response after COVID-19 mRNA Vaccination in Multiple Sclerosis Patients Treated with DMTs. Biomedicines 2022; 10:biomedicines10123034. [PMID: 36551795 PMCID: PMC9775192 DOI: 10.3390/biomedicines10123034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
The impact of disease-modifying therapies (DMTs) on the immune response to coronavirus disease-2019 (COVID-19) vaccines in persons with multiple sclerosis (pwMS) needs further elucidation. We investigated BNT162b2 mRNA COVID-19 vaccine effects concerning antibody seroconversion, inflammatory mediators' level and immunophenotype assessment in pwMS treated with cladribine (c-pwMS, n = 29), fingolimod (f-pwMS, n = 15) and ocrelizumab (o-pwMS, n = 54). Anti-spike immunoglobulin (Ig)-G detection was performed by an enzyme immunoassay; molecular mediators (GrB, IFN-γ and TNF-α) were quantified using the ELLA platform, and immunophenotype was assessed by flow cytometry. ANCOVA, Student's t-test and Pearson correlation analyses were applied. Only one o-pwMS showed a mild COVID-19 infection despite most o-pwMS lacking seroconversion and showing lower anti-spike IgG titers than c-pwMS and f-pwMS. No significant difference in cytokine production and lymphocyte count was observed in c-pwMS and f-pwMS. In contrast, in o-pwMS, a significant increase in GrB levels was detected after vaccination. Considering non-seroconverted o-pwMS, a significant increase in GrB serum levels and CD4+ T lymphocyte count was found after vaccination, and a negative correlation was observed between anti-spike IgG production and CD4+ T cells count. Differences in inflammatory mediators' production after BNT162b2 vaccination in o-pwMS, specifically in those lacking anti-spike IgG, suggest a protective cellular immune response.
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Affiliation(s)
- Valentina Mazziotti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Francesco Crescenzo
- Neurology Unit, “Mater Salutis” Hospital, ULSS 9 Scaligera, 37045 Legnago, Italy
| | - Agnese Tamanti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Caterina Dapor
- Department of General Psychology, University of Padova, 35131 Padua, Italy
| | - Stefano Ziccardi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Maddalena Guandalini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Annalisa Colombi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Valentina Camera
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Angela Peloso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Francesco Pezzini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37134 Verona, Italy
| | - Ermanna Turano
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Correspondence:
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Pitteri M, Dapor C, Ziccardi S, Guandalini M, Meggiato R, Calabrese M. A Videogame-Based Approach to Measuring Information Processing Speed in Multiple Sclerosis Patients. Games Health J 2021; 10:115-120. [PMID: 33818136 DOI: 10.1089/g4h.2020.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Objective: Slowing information processing speed (IPS) is a biomarker of neuronal damage in patients with multiple sclerosis (pwMS). A focus on IPS might be the ideal solution in the perspective of promptly detecting cognitive changes over time. We developed a tablet-based home-made videogame to test the sensitivity of this device in measuring subclinical IPS in pwMS. Materials and Methods: Forty-three pwMS without cognitive impairment and 20 healthy controls (HCs) were administered the videogame task with a tablet. Response times (RTs) and accuracy were recorded. Results: PwMS (mean RTs = 505.5 ± 73.9 ms) were significantly slower than HCs (mean RTs = 462.3 ± 40.3 ms, P = 0.014) on the videogame task. A moderate but significant correlation (r = -0.35, P = 0.03) between mean RTs and the Symbol Digit Modalities Test was observed. Conclusion: Our videogame showed good sensitivity in measuring IPS in apparently cognitive normal pwMS. Computerized testing might be useful in screening initial cognitive dysfunction that should be monitored as a marker of underlying disease progression. IRB approval Number is 2332CESC.
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Affiliation(s)
- Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Caterina Dapor
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Riccardo Meggiato
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Magliozzi R, Pitteri M, Ziccardi S, Pisani AI, Montibeller L, Marastoni D, Rossi S, Mazziotti V, Guandalini M, Dapor C, Schiavi G, Tamanti A, Nicholas R, Reynolds R, Calabrese M. CSF parvalbumin levels reflect interneuron loss linked with cortical pathology in multiple sclerosis. Ann Clin Transl Neurol 2021; 8:534-547. [PMID: 33484486 PMCID: PMC7951111 DOI: 10.1002/acn3.51298] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction and methods In order to verify whether parvalbumin (PVALB), a protein specifically expressed by GABAergic interneurons, could be a MS‐specific marker of grey matter neurodegeneration, we performed neuropathology/molecular analysis of PVALB expression in motor cortex of 40 post‐mortem progressive MS cases, with/without meningeal inflammation, and 10 control cases, in combination with cerebrospinal fluid (CSF) assessment. Analysis of CSF PVALB and neurofilaments (Nf‐L) levels combined with physical/cognitive/3TMRI assessment was performed in 110 naïve MS patients and in 32 controls at time of diagnosis. Results PVALB gene expression was downregulated in MS (fold change = 3.7 ± 1.2, P < 0.001 compared to controls) reflecting the significant reduction of PVALB+ cell density in cortical lesions, to a greater extent in MS patients with high meningeal inflammation (51.8, P < 0.001). Likewise, post‐mortem CSF‐PVALB levels were higher in MS compared to controls (fold change = 196 ± 36, P < 0.001) and correlated with decreased PVALB+ cell density (r = −0.64, P < 0.001) and increased MHC‐II+ microglia density (r = 0.74, P < 0.01), as well as with early age of onset (r = −0.69, P < 0.05), shorter time to wheelchair (r = −0.49, P < 0.05) and early age of death (r = −0.65, P < 0.01). Increased CSF‐PVALB levels were detected in MS patients at diagnosis compared to controls (P = 0.002). Significant correlation was found between CSF‐PVALB levels and cortical lesion number on MRI (R = 0.28, P = 0.006) and global cortical thickness (R = −0.46, P < 0.001), better than Nf‐L levels. CSF‐PVALB levels increased in MS patients with severe cognitive impairment (mean ± SEM:25.2 ± 7.5 ng/mL) compared to both cognitively normal (10.9 ± 2.4, P = 0.049) and mild cognitive impaired (10.1 ± 2.9, P = 0.024) patients. Conclusions CSF‐PVALB levels reflect loss of cortical interneurons in MS patients with more severe disease course and might represent an early, new MS‐specific biomarker of cortical neurodegeneration, atrophy, and cognitive decline.
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Affiliation(s)
- Roberta Magliozzi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Marco Pitteri
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Isabella Pisani
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luigi Montibeller
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefania Rossi
- Department of Oncology and Molecular Oncology, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Mazziotti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Caterina Dapor
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gianmarco Schiavi
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Richard Nicholas
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Massimiliano Calabrese
- Neurology Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Pitteri M, Dapor C, Ziccardi S, Guandalini M, Meggiato R, Calabrese M. Visual-Attentional Load Unveils Slowed Processing Speed in Multiple Sclerosis Patients: A Pilot Study with a Tablet-Based Videogame. Brain Sci 2020; 10:E871. [PMID: 33218213 PMCID: PMC7699274 DOI: 10.3390/brainsci10110871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Abstract
Slowing in information processing speed (IPS) is the key cognitive deficit in multiple sclerosis (MS). Testing IPS in different cognitive load conditions by using computerized tools might reveal initial IPS slowness underestimated by classic paper-and-pencil tests. To investigate the extent to which IPS can be affected by increased task demands, we developed three tasks based on the manipulation of the visual-attentional load, delivered with a home-made, tablet-based videogame. Fifty-one patients with MS (pwMS), classified as having no cognitive impairment in classic paper-and-pencil tests, and 20 healthy controls (HC) underwent the videogame tasks; reaction times (RTs) and accuracy were recorded. A significant reduced performance of pwMS as compared with HC was found on the videogame tasks, with pwMS being on average slower and less accurate than HC. Furthermore, pwMS showed a significantly more pronounced decrement in accuracy as a function of the visual-attentional load, suggesting a higher susceptibility to increased task demands. Significant correlations among the Symbol Digit Modalities Test (SDMT) and the videogame mean RTs and accuracy were found, providing evidence for the concurrent validity of the videogame as a valid tool to test IPS in pwMS. The high potential that might derive from the adoption of computerized assessment tools in clinical practice should be taken into consideration and investigated further.
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Affiliation(s)
- Marco Pitteri
- Correspondence: (M.P.); (M.C.); Tel.: +39-045-8124678 (M.C.)
| | | | | | | | | | - Massimiliano Calabrese
- Neurology Section, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (C.D.); (S.Z.); (M.G.); (R.M.)
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Magliozzi R, Scalfari A, Pisani AI, Ziccardi S, Marastoni D, Pizzini FB, Bajrami A, Tamanti A, Guandalini M, Bonomi S, Rossi S, Mazziotti V, Castellaro M, Montemezzi S, Rasia S, Capra R, Pitteri M, Romualdi C, Reynolds R, Calabrese M. The CSF Profile Linked to Cortical Damage Predicts Multiple Sclerosis Activity. Ann Neurol 2020; 88:562-573. [PMID: 32418239 DOI: 10.1002/ana.25786] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Intrathecal inflammation correlates with the grey matter damage since the early stages of multiple sclerosis (MS), but whether the cerebrospinal fluid (CSF) profile can help to identify patients at risk of disease activity is still unclear. METHODS We evaluated the association between CSF levels of 18 cytokines, previously found to be associated to grey matter damage, and the disease activity, among 99 patients with relapsing-remitting MS, who underwent blinded clinical and 3 T magnetic resonance imaging (MRI) evaluations for 4 years. Groups with evidence of disease activity (EDA) or no evidence of disease activity (NEDA; occurrence of relapses, new white matter lesions, and Expanded Disability Status Scale [EDSS] change) were identified. Cortical lesions and the annualized cortical thinning were also evaluated. RESULTS Forty-one patients experienced EDA and, compared to the NEDA group, had at diagnosis higher CSF levels of CXCL13, CXCL12, IFNγ, TNF, sCD163, LIGHT, and APRIL (p < 0.001). In the multivariate analysis, CXCL13 (hazard ratio [HR] = 1.35; p = 0.0002), LIGHT (HR = 1.22; p = 0.005) and APRIL (HR = 1.78; p = 0.0001) were the CSF molecules more strongly associated with the risk of EDA. The model, including CSF variables, predicted more accurately the occurrence of disease activity than the model with only clinical/MRI parameters (C-index at 4 years = 71% vs 44%). Finally, higher CSF levels of CXCL13 (β = 4.7*10-4 ; p < 0.001), TNF (β = 3.1*10-3 ; p = 0.004), LIGHT (β = 2.6*10-4 ; p = 0.003), sCD163 (β = 4.3*10-3 ; p = 0.009), and TWEAK (β = 3.4*10-3 ; p = 0.024) were associated with more severe cortical thinning. INTERPRETATION A specific CSF profile, mainly characterized by elevated levels of B-cell related cytokines, distinguishes patients at high risk of disease activity and severe cortical damage. The CSF analysis may allow stratifications of patients at diagnosis for optimizing therapeutic approaches. ANN NEUROL 2020;88:562-573.
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Affiliation(s)
- Roberta Magliozzi
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Antonio Scalfari
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Anna Isabella Pisani
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Ziccardi
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Damiano Marastoni
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesca Benedetta Pizzini
- Neuroradiology & Radiology Units, Department of Diagnostic and Pathology, Integrated University Hospital of Verona, Verona, Italy
| | - Albulena Bajrami
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Agnese Tamanti
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Maddalena Guandalini
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Samuele Bonomi
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefania Rossi
- Department of Oncology and Molecular Medicine, Higher Institute of Health Care, Rome, Italy
| | - Valentina Mazziotti
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Castellaro
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Stefania Montemezzi
- Neuroradiology & Radiology Units, Department of Diagnostic and Pathology, Integrated University Hospital of Verona, Verona, Italy
| | | | | | - Marco Pitteri
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Richard Reynolds
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Massimiliano Calabrese
- Regional Multiple Sclerosis Center, Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Pitteri M, Dapor C, Pisani AI, Castellaro M, DeLuca J, Chiaravalloti N, Guandalini M, Ziccardi S, Calabrese M. Executive functioning affects verbal learning process in multiple sclerosis patients: Behavioural and imaging results. J Neuropsychol 2019; 14:384-398. [DOI: 10.1111/jnp.12198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/08/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Pitteri
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Caterina Dapor
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Anna Isabella Pisani
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Marco Castellaro
- Padova Neuroscience Center University of Padova Italy
- Department of Information Engineering University of Padova Italy
| | - John DeLuca
- Kessler Foundation West Orange New Jersey USA
- Department of Physical Medicine and Rehabilitation Rutgers, New Jersey Medical School Newark New Jersey USA
- Department of Neurology Rutgers, New Jersey Medical School Newark New Jersey USA
| | - Nancy Chiaravalloti
- Department of Physical Medicine and Rehabilitation Rutgers, New Jersey Medical School Newark New Jersey USA
- Neuropsychology and Neuroscience Lab Kessler Foundation East Hanover New Jersey USA
| | - Maddalena Guandalini
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Stefano Ziccardi
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
| | - Massimiliano Calabrese
- Neurology Section Department of Neuroscience, Biomedicine and Movements Sciences University of Verona Italy
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