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Nasello M, Zancan V, Reniè R, Romano S, Buscarinu MC, Ristori G, Salvetti M, Bellucci G. Co-existence of Myelin Oligodendrocyte Glycoprotien Antibody-associated Disease (MOGAD) and Spinocerebellar Ataxia type 1 (SCA1): A case report. Neurol Sci 2024:10.1007/s10072-024-07479-8. [PMID: 38512530 DOI: 10.1007/s10072-024-07479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Martina Nasello
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Valeria Zancan
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Roberta Reniè
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy.
- Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
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Bellucci G, Buscarinu MC, Reniè R, Rinaldi V, Bigi R, Mechelli R, Romano S, Salvetti M, Ristori G. Disentangling multiple sclerosis phenotypes through Mendelian disorders: A network approach. Mult Scler 2024; 30:325-335. [PMID: 38333907 DOI: 10.1177/13524585241227119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND The increasing knowledge about multiple sclerosis (MS) pathophysiology has reinforced the need for an improved description of disease phenotypes, connected to disease biology. Growing evidence indicates that complex diseases constitute phenotypical and genetic continuums with "simple," monogenic disorders, suggesting shared pathomechanisms. OBJECTIVES The objective of this study was to depict a novel MS phenotypical framework leveraging shared physiopathology with Mendelian diseases and to identify phenotype-specific candidate drugs. METHODS We performed an enrichment testing of MS-associated variants with Mendelian disorders genes. We defined a "MS-Mendelian network," further analyzed to define enriched phenotypic subnetworks and biological processes. Finally, a network-based drug screening was implemented. RESULTS Starting from 617 MS-associated loci, we showed a significant enrichment of monogenic diseases (p < 0.001). We defined an MS-Mendelian molecular network based on 331 genes and 486 related disorders, enriched in four phenotypic classes: neurologic, immunologic, metabolic, and visual. We prioritized a total of 503 drugs, of which 27 molecules active in 3/4 phenotypical subnetworks and 140 in subnetwork pairs. CONCLUSION The genetic architecture of MS contains the seeds of pathobiological multiplicities shared with immune, neurologic, metabolic and visual monogenic disorders. This result may inform future classifications of MS endophenotypes and support the development of new therapies in both MS and rare diseases.
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Affiliation(s)
- Gianmarco Bellucci
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Virginia Rinaldi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rachele Bigi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy San Raffaele Roma Open University, Rome, Italy
| | - Silvia Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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Altieri M, Capuano R, Bisecco A, d'Ambrosio A, Risi M, Cavalla P, Vercellino M, Annovazzi P, Zaffaroni M, De Stefano N, Stromillo ML, D'Amico E, Zanghì A, Buscarinu MC, Lanzillo R, De Luca G, Calabrese M, Lorefice L, Di Filippo M, Valentino P, Gajofatto A, Marfia GA, Fuiani A, Nociti V, Tedeschi G, Gallo A. Quality of care provided by Multiple Sclerosis Centers during Covid-19 pandemic: Results of an Italian multicenter patient-centered survey. Mult Scler Relat Disord 2023; 77:104870. [PMID: 37454568 DOI: 10.1016/j.msard.2023.104870] [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] [Received: 11/16/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Covid-19 pandemic impacted on management of people with Multiple Sclerosis (pwMS). Level of satisfaction of pwMS regarding the care received by the staff of Multiple Sclerosis Centers (MSCs) during the pandemic was not fully investigated. In a large patient-centered multicenter study, the therapeutic adherence and quality of care of MSCs was assessed. METHODS In April-May 2021, an online survey was widespread by 16 Italian MSCs. Frequencies, percentages and/or means and standard deviations were calculated to describe the sample. ANOVAs were performed to evaluate the effect of sociodemographic and clinical variables on overall pwMS' rating of MSC assistance. RESULTS 1670 pwMS completed the survey (67.3% women). During the pandemic, 88% did not change their disease modifying therapy schedule, and 89.1% reached their MSCs with no or little difficulties. Even if only 1.3% of participants underwent a tele-health follow-up visit with their MSC staff, the 80.1% believed that tele-health services should be improved regardless of pandemic. 92% of participants were satisfied of how their MSC took charge of their needs; ANOVAs revealed an effect of disease duration on pwMS' level of satisfaction on MSCs management during the pandemic. CONCLUSIONS The results revealed an efficient MSCs response to Covid-19 pandemic and provided the basis for the implementing of tele-health services that would further improve the taking charge of patients, particularly those with longer disease, higher disability, and/or living far from their MSC.
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Affiliation(s)
- Manuela Altieri
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Capuano
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alvino Bisecco
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro d'Ambrosio
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Risi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Marco Vercellino
- Dept. of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Turin, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Study Center, ASST Valle Olona, Gallarate, VA, Italy
| | - Nicola De Stefano
- Dept. of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emanuele D'Amico
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, G.F. Ingrassia, University of Catania, Catania, Italy
| | - Maria Chiara Buscarinu
- Dept. of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital-site, Rome, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Dept. of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, Policlinico SS. Annunziata, Chieti, Italy
| | - Massimiliano Calabrese
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Center, Dept. of Medical Sciences and Public Health, Binaghi Hospital, ASL Cagliari, University of Cagliari, Cagliari, Italy
| | | | - Paola Valentino
- Institute of Neurology, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alberto Gajofatto
- Multiple Sclerosis Center, Dept. of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | | | - Aurora Fuiani
- Dept. of Neuroscience, Riuniti Hospital of Foggia, Foggia, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gioacchino Tedeschi
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Gallo
- Multiple Sclerosis Center, Dept. of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Severa M, Rizzo F, Sinigaglia A, Ricci D, Etna MP, Cola G, Landi D, Buscarinu MC, Valdarchi C, Ristori G, Riccetti S, Piubelli C, Palmerini P, Rosato A, Gobbi F, Balducci S, Marfia GA, Salvetti M, Barzon L, Coccia EM. A specific anti‐COVID‐19 BNT162b2 vaccine‐induced early innate immune signature positively correlates with the humoral protective response in healthy and multiple sclerosis vaccine recipients. Clin Transl Immunology 2023; 12:e1434. [PMID: 36969367 PMCID: PMC10036198 DOI: 10.1002/cti2.1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 03/25/2023] Open
Abstract
Objectives The very rapidly approved mRNA‐based vaccines against SARS‐CoV‐2 spike glycoprotein, including Pfizer‐BioNTech BNT162b2, are effective in protecting from severe coronavirus disease 2019 (COVID‐19) in immunocompetent population. However, establishing the duration and identifying correlates of vaccine‐induced protection will be crucial to optimise future immunisation strategies. Here, we studied in healthy vaccine recipients and people with multiple sclerosis (pwMS), undergoing different therapies, the regulation of innate immune response by mRNA vaccination in order to correlate it with the magnitude of vaccine‐induced protective humoral responses. Methods Healthy subjects (n = 20) and matched pwMS (n = 22) were longitudinally sampled before and after mRNA vaccination. Peripheral blood mononuclear cell (PBMC)‐associated type I and II interferon (IFN)‐inducible gene expression, serum innate cytokine/chemokine profile as well as binding and neutralising anti‐SARS‐COV‐2 antibodies (Abs) were measured. Results We identified an early immune module composed of the IFN‐inducible genes Mx1, OAS1 and IRF1, the serum cytokines IL‐15, IL‐6, TNF‐α and IFN‐γ and the chemokines IP‐10, MCP‐1 and MIG, induced 1 day post second and third BNT162b2 vaccine doses, strongly correlating with magnitude of humoral response to vaccination in healthy and MS vaccinees. Moreover, induction of the early immune module was dramatically affected in pwMS treated with fingolimod and ocrelizumab, both groups unable to induce a protective humoral response to COVID‐19 vaccine. Conclusion Overall, this study suggests that the vaccine‐induced early regulation of innate immunity is mediated by IFN signalling, impacts on the magnitude of adaptive responses and it might be indicative of vaccine‐induced humoral protection.
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Affiliation(s)
- Martina Severa
- Department of Infectious DiseaseIstituto Superiore di SanitàRomeItaly
| | - Fabiana Rizzo
- Department of Infectious DiseaseIstituto Superiore di SanitàRomeItaly
| | | | - Daniela Ricci
- Department of Infectious DiseaseIstituto Superiore di SanitàRomeItaly
| | | | - Gaia Cola
- Department of Systems MedicineMS center Tor Vergata UniversityRomeItaly
| | - Doriana Landi
- Department of Systems MedicineMS center Tor Vergata UniversityRomeItaly
| | | | - Catia Valdarchi
- Department of Infectious DiseaseIstituto Superiore di SanitàRomeItaly
| | - Giovanni Ristori
- Center for Experimental Neurological TherapiesSant'Andrea HospitalRomeItaly
- Neuroimmunology UnitIRCCS Fondazione Santa LuciaRomeItaly
| | - Silvia Riccetti
- Department of Molecular MedicineUniversity of PadovaPaduaItaly
| | - Chiara Piubelli
- Department of Infectious‐Tropical Diseases and MicrobiologyIRCCS Sacro Cuore Don Calabria HospitalNegrar di ValpolicellaItaly
| | - Pierangela Palmerini
- Department of Surgery, Oncology and Gastroenterology, Immunology and Oncology SectionUniversity of PadovaPaduaItaly
| | - Antonio Rosato
- Department of Surgery, Oncology and Gastroenterology, Immunology and Oncology SectionUniversity of PadovaPaduaItaly
- Veneto Institute of Oncology IOV – IRCCSPaduaItaly
| | - Federico Gobbi
- Department of Infectious‐Tropical Diseases and MicrobiologyIRCCS Sacro Cuore Don Calabria HospitalNegrar di ValpolicellaItaly
| | | | | | - Marco Salvetti
- Center for Experimental Neurological TherapiesSant'Andrea HospitalRomeItaly
- IRCCS Istituto Neurologico Mediterraneo NeuromedPozzilliItaly
| | - Luisa Barzon
- Department of Molecular MedicineUniversity of PadovaPaduaItaly
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Morena E, Romano C, Marconi M, Diamant S, Buscarinu MC, Bellucci G, Romano S, Scarabino D, Salvetti M, Ristori G. Peripheral Biomarkers in Manifest and Premanifest Huntington's Disease. Int J Mol Sci 2023; 24:ijms24076051. [PMID: 37047023 PMCID: PMC10094222 DOI: 10.3390/ijms24076051] [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: 02/01/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Huntington's disease (HD) is characterized by clinical motor impairment (e.g., involuntary movements, poor coordination, parkinsonism), cognitive deficits, and psychiatric symptoms. An inhered expansion of the CAG triplet in the huntingtin gene causing a pathogenic gain-of-function of the mutant huntingtin (mHTT) protein has been identified. In this review, we focus on known biomarkers (e.g., mHTT, neurofilament light chains) and on new biofluid biomarkers that can be quantified in plasma or peripheral blood mononuclear cells from mHTT carriers. Circulating biomarkers may fill current unmet needs in HD management: better stratification of patients amenable to etiologic treatment; the initiation of preventive treatment in premanifest HD; and the identification of peripheral pathogenic central nervous system cascades.
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Affiliation(s)
- Emanuele Morena
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Carmela Romano
- Department of Human Neurosciences, Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Martina Marconi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Selene Diamant
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Daniela Scarabino
- Institute of Molecular Biology and Pathology, National Research Council, 00185 Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, Italy
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
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Baione V, Canevelli M, Belvisi D, Buscarinu MC, Bellucci G, Fantozzi R, Nicoletti CG, Malatuni G, Cortese A, De Giglio L, Tartaglia M, Ferrazzano G, Malimpensa L, Leodori G, Bruno G, Ferraro E, Marfia GA, Centonze D, Salvetti M, Conte A. Frailty and relapse activity in multiple sclerosis: A longitudinal observation. Mult Scler Relat Disord 2023; 72:104603. [PMID: 36905818 DOI: 10.1016/j.msard.2023.104603] [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] [Received: 01/04/2023] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
Recent cross-sectional investigations suggest a relationship between frailty, as measured by Frailty Index (FI), and multiple sclerosis (MS). However, if and how frailty is associated with relapse activity in MS is still unknown. To explore this issue, a one-year follow-up study involving 471 patients was conducted. A univariate regression model showed an inverse association between baseline FI score and the presence of relapse, which was also confirmed in the multivariate model. These results suggest that frailty may reflect pathophysiological mechanisms involved in MS disease activity and that the FI may be used as an enrichment criterion in clinical trials.
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Affiliation(s)
- Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | | | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giorgia Malatuni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | | | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giuseppe Bruno
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Girolama Alessandra Marfia
- IRCCS Neuromed, Pozzilli, IS, Italy; Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, IS, Italy; Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza, University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
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Rinaldi V, Bellucci G, Buscarinu MC, Reniè R, Marrone A, Nasello M, Zancan V, Nistri R, Palumbo R, Salerno A, Salvetti M, Ristori G. CNS inflammatory demyelinating events after COVID-19 vaccines: A case series and systematic review. Front Neurol 2022; 13:1018785. [PMID: 36530641 PMCID: PMC9752005 DOI: 10.3389/fneur.2022.1018785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/31/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Vaccinations provided the most effective tool to fight the SARS-CoV-2 pandemic. It is now well established that COVID-19 vaccines are safe for the general population; however, some cases of rare adverse events following immunization have been described, including CNS Inflammatory Demyelinating Events (CIDEs). Although observational studies are showing that these events are rare and vaccines' benefits highly outweigh the risks, collecting and characterizing post-COVID-19 vaccine CIDEs might be relevant to single out potential risk factors and suggest possible underlying mechanisms. METHODS Here we describe six CIDEs, including two acute transverse myelitis (ATM), three multiple sclerosis (MS), and one neuromyelitis optica spectrum disorder (NMOSD), occurring between 8 and 35 days from a COVID-19 vaccine. Moreover, we performed a systematic literature search of post-COVID-19 vaccines CIDEs, including ATM, ADEM, MS, and NMOSD/MOGAD, published worldwide between December 2020 and December 2021, during 1 year of the vaccination campaign. Clinical/MRI and CSF/serum characteristics were extracted from reviewed studies and pooled-analyzed. RESULTS Forty-nine studies were included in the systematic review, reporting a total amount of 85 CIDEs. Considering our additional six cases, 91 CIDEs were summarized, including 24 ATM, 11 ADEM, 47 MS, and nine NMOSD/MOGAD. Overall, CIDEs occurred after both mRNA (n = 46), adenoviral-vectored (n = 37), and inactivated vaccines (n = 8). Adenoviral-vectored vaccines accounted for the majority of ADEM (55%) and NMOSD/MOGAD (56%), while mRNA vaccines were more frequent in MS new diagnoses (87%) and relapses (56%). Age was heterogeneous (19-88) and the female sex was prevalent. Time from vaccine to symptoms onset was notably variable: ADEM and NMOSD/MOGAD had a longer median time of onset (12.5 and 10 days) compared to ATM and MS (6 and 7 days) and further timing differences were observed between events following different vaccine types, with ATM and MS after mRNA-vaccines occurring earlier than those following adenoviral-vectored ones. CONCLUSION Both the prevalence of vaccine types for certain CIDEs and the heterogeneity in time of onset suggest that different mechanisms-with distinct dynamic/kinetic-might underly these events. While epidemiological studies have assessed the safety of COVID-19 vaccines, descriptions and pooled analyses of sporadic cases may still be valuable to gain insights into CIDE's pathophysiology.
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Affiliation(s)
- Virginia Rinaldi
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Gianmarco Bellucci
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Roberta Reniè
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Antonio Marrone
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Martina Nasello
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Valeria Zancan
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Riccardo Nistri
- Department of Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Palumbo
- Neurology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Antonio Salerno
- Neurology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Marco Salvetti
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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Landi D, Bovis F, Grimaldi A, Annovazzi PO, Bertolotto A, Bianchi A, Borriello G, Brescia Morra V, Bucello S, Buscarinu MC, Caleri F, Capobianco M, Capra R, Cellerino M, Centonze D, Cerqua R, Chisari CG, Clerico M, Cocco E, Cola G, Cordioli C, Curti E, d'Ambrosio A, D'Amico E, De Luca G, Di Filippo M, Di Lemme S, Fantozzi R, Ferraro D, Ferraro E, Gallo A, Gasperini C, Granella F, Inglese M, Lanzillo R, Lorefice L, Lus G, Malucchi S, Margoni M, Mataluni G, Mirabella M, Moiola L, Nicoletti CG, Nociti V, Patti F, Pinardi F, Portaccio E, Pozzilli C, Ragonese P, Rasia S, Salemi G, Signoriello E, Vitetta F, Totaro R, Sormani MP, Amato MP, Marfia GA. Exposure to natalizumab throughout pregnancy: effectiveness and safety in an Italian cohort of women with multiple sclerosis. J Neurol Neurosurg Psychiatry 2022:jnnp-2022-329657. [PMID: 36180219 DOI: 10.1136/jnnp-2022-329657] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/23/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Assessing the risk of clinical and radiological reactivation during pregnancy and post partum in women with multiple sclerosis (MS) treated with natalizumab (NTZ) throughout pregnancy (LONG_EXP) compared with women interrupting treatment before (NO_EXP) and within >-30 days and ≤90 days from conception (SHORT_EXP), and describing newborns' outcomes. METHODS Maternal clinical and radiological outcomes and obstetric and fetal outcomes were retrospectively collected and compared among groups (NO_EXP, SHORT_EXP, LONG_EXP). Predictors of clinical and radiological reactivation were investigated through univariable and multivariable analysis. RESULTS 170 eligible pregnancies from 163 women referring to 29 Italian MS centres were included. Annualised relapse rate (ARR) was significantly lower in LONG_EXP (n=66, 0.02 (0.001-0.09)) compared with NO_EXP (n=31, 0.43 (0.21-0.75), p=0.002) and SHORT_EXP (n=73, 0.46 (0.30-0.66), p=0.0004) during pregnancy, and in LONG_EXP (0.12 (0.05-0.24)) compared with SHORT_EXP (0.30 (0.17-0.50), p=0.008) during post partum. Gadolinium-enhancing (Gd+) lesions were less frequent in LONG_EXP (n=6/50, 2.00%) compared with NO_EXP (n=9/21, 42.86%) and SHORT_EXP after delivery (n=17/49, 34.69%, p=0.010).Delaying NTZ resumption after delivery significantly increased the risk of relapses (OR=1.29 (95% CI 1.07 to 1.57), p=0.009) and Gd+ lesions (OR=1.49 (95% CI 1.17 to 1.89, p=0.001). Newborns' weight, length, head circumference and gestational age did not differ among groups after adjusting for confounders. Anaemia was tracked in 4/69 LONG_EXP newborns. Congenital anomaly rate was within the expected range for the untreated MS population. CONCLUSIONS Our findings indicate that in women with MS treated with NTZ before conception, continuation of NTZ throughout pregnancy and its early resumption after delivery mitigate the risk of clinical and radiological reactivation. This approach has no major impact on newborns' outcomes.
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Affiliation(s)
- Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Francesca Bovis
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Alfonso Grimaldi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Pietro Osvaldo Annovazzi
- Multiple Sclerosis Center, Neurology II Unit, ASST Valle Olona, Gallarate Hospital, Gallarate, Italy
| | - Antonio Bertolotto
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Alessia Bianchi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Giovanna Borriello
- Multiple Sclerosis Center, 'S. Andrea' Hospital, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Sebastiano Bucello
- Multiple Sclerosis Center, "E. Muscatello" Hospital - ASP8, Augusta (SR), Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesca Caleri
- Multiple Sclerosis Center, Department of Neurology, 'F. Tappeiner' Hospital, Merano (BZ), Italy
| | - Marco Capobianco
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Diego Centonze
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Raffaella Cerqua
- Neurological Clinic, Department of Experimental and Clinical Medicine, Ospedali Riuniti, Ancona, Italy
| | - Clara Grazia Chisari
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Marinella Clerico
- Clinical and Biological Sciences Department, Neurology Unit, University of Torino, 'San Luigi Gonzaga' Hospital, Orbassano, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gaia Cola
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Erica Curti
- Unit of Neurology, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Alessandro d'Ambrosio
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Center, 'SS Annunziata' Hospital, 'Gabriele d'Annunzio' University Chieti-Pesacara, Chieti, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | | | - Diana Ferraro
- Department of Biomedical Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonio Gallo
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Claudio Gasperini
- Department of Neurosciences, 'San Camillo Forlanini' Hospital, Rome, Italy
| | - Franco Granella
- Unit of Neurology, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
- Department of Neurology, Policlinico 'San Martino Hospital'-Sistema Sanitario Regione, Genoa, Italy
| | - Roberta Lanzillo
- Department of Neurosciences Reproductive Sciences and Odontostomatology, Multiple Sclerosis Center, Federico II University, Naples, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Centre, Binaghi Hospital, ATS Sardegna-Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Simona Malucchi
- Multiple Sclerosis Center (CRESM), Department of Neurology, 'San Luigi Gonzaga' University Hospital, Orbassano, Italy
| | - Monica Margoni
- Multiple Sclerosis Center of the Veneto Region, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Massimiliano Mirabella
- Department of Neurosciences, Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy, 'A.Gemelli' University Hospital, Rome, Italy
| | - Lucia Moiola
- Multiple Sclerosis Center, Neurology Department, San Raffaele Hospital IRCCS, Milan, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - Viviana Nociti
- Department of Neurosciences, Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy, 'A.Gemelli' University Hospital, Rome, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy
| | - Federica Pinardi
- UOSI Multiple Sclerosis Rehabilitation, IRCCS Istituto delle scienze neurologiche, Bologna, Italy
| | - Emilio Portaccio
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Human Neurosciences, 'S.Andrea' Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Ragonese
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, Spedali Civili of Brescia, Montichiari (BS), Italy
| | - Giuseppe Salemi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Elisabetta Signoriello
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Francesca Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Neurology Unit, University of L'Aquila, L'Aquila, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics, University of Genova, Genoa, Italy
| | - Maria Pia Amato
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
- IRCCS, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
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9
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Gargano F, Guerrera G, Piras E, Serafini B, Di Paola M, Rizzetto L, Buscarinu MC, Annibali V, Vuotto C, De Bardi M, D’Orso S, Ruggieri S, Gasperini C, Pavarini L, Ristori G, Picozza M, Rosicarelli B, Ballerini C, Mechelli R, Vitali F, Cavalieri D, Salvetti M, Angelini DF, Borsellino G, De Filippo C, Battistini L. Proinflammatory mucosal-associated invariant CD8+ T cells react to gut flora yeasts and infiltrate multiple sclerosis brain. Front Immunol 2022; 13:890298. [PMID: 35979352 PMCID: PMC9376942 DOI: 10.3389/fimmu.2022.890298] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
The composition of the intestinal microbiota plays a critical role in shaping the immune system. Modern lifestyle, the inappropriate use of antibiotics, and exposure to pollution have significantly affected the composition of commensal microorganisms. The intestinal microbiota has been shown to sustain inappropriate autoimmune responses at distant sites in animal models of disease, and may also have a role in immune-mediated central nervous system (CNS) diseases such as multiple sclerosis (MS). We studied the composition of the gut mycobiota in fecal samples from 27 persons with MS (pwMS) and in 18 healthy donors (HD), including 5 pairs of homozygous twins discordant for MS. We found a tendency towards higher fungal abundance and richness in the MS group, and we observed that MS twins showed a higher rate of food-associated strains, such as Saccharomyces cerevisiae. We then found that in pwMS, a distinct population of cells with antibacterial and antifungal activity is expanded during the remitting phase and markedly decreases during clinically and/or radiologically active disease. These cells, named MAIT (mucosal-associated invariant T cells) lymphocytes, were significantly more activated in pwMS compared to HD in response to S. cerevisiae and Candida albicans strains isolated from fecal samples. This activation was also mediated by fungal-induced IL-23 secretion by innate immune cells. Finally, immunofluorescent stainings of MS post-mortem brain tissues from persons with the secondary progressive form of the disease showed that MAIT cells cross the blood–brain barrier (BBB) and produce pro-inflammatory cytokines in the brain. These results were in agreement with the hypothesis that dysbiosis of the gut microbiota might determine the inappropriate response of a subset of pathogenic mucosal T cells and favor the development of systemic inflammatory and autoimmune diseases.
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Affiliation(s)
- Francesca Gargano
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Gisella Guerrera
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Eleonora Piras
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Barbara Serafini
- Istituto Superiore di Sanità, Department of Neuroscience, Rome, Italy
| | - Monica Di Paola
- University of Florence, Department of Biology, Florence, Italy
| | - Lisa Rizzetto
- Research and Innovation Centre – Fondazione Edmund Mach, S. Michele all’Adige (TN), Italy
| | - Maria Chiara Buscarinu
- Neurology and Centre for Experimental Neurological therapies (CENTERS), S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Viviana Annibali
- Neurology and Centre for Experimental Neurological therapies (CENTERS), S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Claudia Vuotto
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Marco De Bardi
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Silvia D’Orso
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Serena Ruggieri
- Department of Neuroscience “Lancisi”, S. Camillo Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neuroscience “Lancisi”, S. Camillo Hospital, Rome, Italy
| | - Lorenzo Pavarini
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- University of Florence, Department of Biology, Florence, Italy
| | - Giovanni Ristori
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Neurology and Centre for Experimental Neurological therapies (CENTERS), S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Mario Picozza
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | | | - Clara Ballerini
- University of Florence, Clinical and Experimental Medicine, Florence, Italy
| | - Rosella Mechelli
- Neurology and Centre for Experimental Neurological therapies (CENTERS), S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Vitali
- National Research Council, Institute of Agricultural Biology and Biotechnology, Pisa, Italy
| | | | - Marco Salvetti
- Neurology and Centre for Experimental Neurological therapies (CENTERS), S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Daniela F. Angelini
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giovanna Borsellino
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- *Correspondence: Giovanna Borsellino, ; Luca Battistini,
| | - Carlotta De Filippo
- National Research Council, Institute of Agricultural Biology and Biotechnology, Pisa, Italy
| | - Luca Battistini
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- *Correspondence: Giovanna Borsellino, ; Luca Battistini,
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10
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Guerrera G, Mandelli A, Finardi A, Orrico M, D'Orso S, Picozza M, Noviello M, Beretta V, Bonetti B, Calabrese M, Marastoni D, De Rossi N, Capra R, Salvetti M, Buscarinu MC, Inglese M, Uccelli A, Moiola L, Raposo C, Muros-Le Rouzic E, Pedotti R, Filippi M, Bonini C, Battistini L, Borsellino G, Furlan R. Anti-SARS-CoV-2 T-stem cell memory persists in ocrelizumab-treated MS patients. Mult Scler 2022; 28:1937-1943. [PMID: 35723265 DOI: 10.1177/13524585221102158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Development of long-lasting anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) T-cell responses in persons with multiple sclerosis (pwMS) treated with ocrelizumab is questioned. OBJECTIVE Investigate antiviral T-cell responses after infection with SARS-CoV-2 in ocrelizumab-treated pwMS. Control groups included ocrelizumab-treated pwMS without SARS-CoV-2 infection, and non-MS individuals with and without SARS-CoV-2 infection. METHODS Peripheral blood mononuclear cells were stimulated with SARS-CoV-2 peptide pools and T-cell reactivity was assessed by ELISPOT for interferon (IFN)-γ detection, and by multiparametric fluorescence-activated cell sorting (FACS) analyses for assessment and characterization of T-cell activation. RESULTS ELISPOT assay against the spike and the N protein of SARS-CoV-2 displayed specific T-cell reactivity in 28/29 (96%) pwMS treated with ocrelizumab and infected by SARS-CoV-2, similar to infected persons without MS. This reactivity was present 1 year after infection and independent from the time of ocrelizumab infusion. FACS analysis following stimulation with SARS-CoV-2 peptide pools showed the presence of activation-induced markers (AIMs) in both CD4+ and CD8+ T-cell subsets in 96% and 92% of these individuals, respectively. Within naïve AIM+ CD4+ and CD8+ T-cells, we detected T memory stem cells, suggesting the acquisition of long-term memory. CONCLUSIONS B-cell depletion using ocrelizumab does not impair the development of long-lasting anti-SARS-CoV-2 T-cell responses.
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Affiliation(s)
| | - Alessandra Mandelli
- Division of Neuroscience, Clinical Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Division of Neuroscience, Clinical Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Orrico
- Neurology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Silvia D'Orso
- Neuroimmunology Unit, Fondazione Santa Lucia, Rome, Italy
| | - Mario Picozza
- Neuroimmunology Unit, Fondazione Santa Lucia, Rome, Italy
| | - Maddalena Noviello
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Beretta
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Bonetti
- Dipartimento di Scienze Neurologiche e della Visione, Istituto di Neurologia Policlinico Borgo Roma, Universita di Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, Regional Multiple Sclerosis Center, Università degli Studi di Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology B, Regional Multiple Sclerosis Center, Università degli Studi di Verona, Verona, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy/IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Lucia Moiola
- Neurology, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | | | | | - Massimo Filippi
- Vita-Salute San Raffaele University, Milano, Italy/Neuroimaging Research Unit, Division of Neuroscience/Neurology Unit/Neurorehabilitation Unit/Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milano, Italy
| | | | | | - Roberto Furlan
- Division of Neuroscience, Clinical Neuroimmunology Unit, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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11
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Umeton R, Bellucci G, Bigi R, Romano S, Buscarinu MC, Reniè R, Rinaldi V, Pizzolato Umeton R, Morena E, Romano C, Mechelli R, Salvetti M, Ristori G. Multiple sclerosis genetic and non-genetic factors interact through the transient transcriptome. Sci Rep 2022; 12:7536. [PMID: 35534508 PMCID: PMC9085834 DOI: 10.1038/s41598-022-11444-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
A clinically actionable understanding of multiple sclerosis (MS) etiology goes through GWAS interpretation, prompting research on new gene regulatory models. Our previous investigations suggested heterogeneity in etiology components and stochasticity in the interaction between genetic and non-genetic factors. To find a unifying model for this evidence, we focused on the recently mapped transient transcriptome (TT), that is mostly coded by intergenic and intronic regions, with half-life of minutes. Through a colocalization analysis, here we demonstrate that genomic regions coding for the TT are significantly enriched for MS-associated GWAS variants and DNA binding sites for molecular transducers mediating putative, non-genetic, determinants of MS (vitamin D deficiency, Epstein Barr virus latent infection, B cell dysfunction), indicating TT-coding regions as MS etiopathogenetic hotspots. Future research comparing cell-specific transient and stable transcriptomes may clarify the interplay between genetic variability and non-genetic factors causing MS. To this purpose, our colocalization analysis provides a freely available data resource at www.mscoloc.com.
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Affiliation(s)
- Renato Umeton
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Biological Engineering, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Gianmarco Bellucci
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Rachele Bigi
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy.,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy.,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Virginia Rinaldi
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Raffaella Pizzolato Umeton
- Department of Neurology, UMass Memorial Health Care, Worcester, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Emanuele Morena
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Carmela Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele Roma Open University, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy. .,IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy.
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy. .,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.
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12
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Schwartz CE, Rapkin BD, Bonavita S, Bossa M, Buscarinu MC, Grasso MG, Luca M, Nozzolillo A, Nocentini U. The impact of COVID-19 on people with multiple sclerosis: A comparison of Italian and United States cohorts. Mult Scler Relat Disord 2022; 63:103888. [DOI: 10.1016/j.msard.2022.103888] [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] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022]
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13
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Buonomo AR, Viceconte G, Calabrese M, De Luca G, Tomassini V, Cavalla P, Maniscalco GT, Ferraro D, Nociti V, Radaelli M, Buscarinu MC, Paolicelli D, Gajofatto A, Annovazzi P, Pinardi F, Di Filippo M, Cordioli C, Zappulo E, Scotto R, Gentile I, Spiezia AL, Petruzzo M, De Angelis M, Morra VB, Solaro C, Gasperini C, Cocco E, Moccia M, Lanzillo R. Correction to: Management of hepatitis B virus prophylaxis in patients treated with disease-modifying therapies for multiple sclerosis: a multicentric Italian retrospective study. J Neurol 2022; 269:3308-3309. [PMID: 35377015 PMCID: PMC9119876 DOI: 10.1007/s00415-022-11066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy.
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Giovanna De Luca
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Paola Cavalla
- Department of Neuroscience and Mental Health-City of Health and Science University, Hospital of Torino, Multiple Sclerosis Center, Turin, Italy
| | | | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, S. Andrea Hospital Site, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona-Gallarate Hospital, Gallarate, VA, Italy
| | | | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Montichiari Hospital, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University of Naples "Federico II", Via Sergio Pansini 5, 80130, Naples, Italy
| | - Antonio Luca Spiezia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Petruzzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Marcello De Angelis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Claudio Gasperini
- Department of Neuroscience, San-Camillo Forlanini Hospital, Rome, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, Azienda Tutela Della Salute (ATS) Sardegna, Cagliari, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Buscarinu MC, Reniè R, Morena E, Romano C, Bellucci G, Marrone A, Bigi R, Salvetti M, Ristori G. Late-Onset MS: Disease Course and Safety-Efficacy of DMTS. Front Neurol 2022; 13:829331. [PMID: 35356454 PMCID: PMC8960027 DOI: 10.3389/fneur.2022.829331] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/05/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS), an inflammatory demyelinating and neurodegenerative disease of the central nervous system, usually begins between the ages of 20 and 49 years, though in rare cases it is diagnosed in childhood and adolescence before the age of 18 years, or at the age of 50 years and later. When the onset of the disease occurs at 50 years or older it is conventionally defined as late onset MS (LOMS). Compared to classical MS, the LOMS is characterized by progressive course, a greater delay in diagnosis and a higher prevalence of motor disability. The older the patients, the greater is the risk of comorbidities that can negatively influence the course of the disease and can limit therapeutic strategies. To date, there is no study focused on the efficacy of Disease Modifying Therapies (DMT) in older patients with MS. The only data available are retrievable from subgroup analysis from phase-3 trials of DMT efficacy. In this work, we discuss how the aging process influences the onset, the clinical course and the therapeutic approach in LOMS.
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Affiliation(s)
- Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Department of Clinical-Experimental Neuroscience and Psychiatry, Sapienza University, Rome, Italy
| | - Emanuele Morena
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Carmela Romano
- Department of Clinical-Experimental Neuroscience and Psychiatry, Sapienza University, Rome, Italy
| | - Gianmarco Bellucci
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Antonio Marrone
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Rachele Bigi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
- *Correspondence: Marco Salvetti
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Giovanni Ristori
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15
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Bellucci G, Umeton R, Bigi R, Romano S, Buscarinu MC, Reniè R, Rinaldi V, Umeton RP, Morena E, Romano C, Mechelli R, Salvetti M, Ristori G. GWAS-associated variants, non-genetic factors, and transient transcriptome in multiple sclerosis etiopathogenesis: A colocalization analysis. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118157] [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: 11/30/2022]
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16
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Bellucci G, Rinaldi V, Buscarinu MC, Reniè R, Bigi R, Pellicciari G, Morena E, Romano C, Marrone A, Mechelli R, Salvetti M, Ristori G. Multiple Sclerosis and SARS-CoV-2: Has the Interplay Started? Front Immunol 2021; 12:755333. [PMID: 34646278 PMCID: PMC8503550 DOI: 10.3389/fimmu.2021.755333] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/11/2022] Open
Abstract
Current knowledge on Multiple Sclerosis (MS) etiopathogenesis encompasses complex interactions between the host's genetic background and several environmental factors that result in dysimmunity against the central nervous system. An old-aged association exists between MS and viral infections, capable of triggering and sustaining neuroinflammation through direct and indirect mechanisms. The novel Coronavirus, SARS-CoV-2, has a remarkable, and still not fully understood, impact on the immune system: the occurrence and severity of both acute COVID-19 and post-infectious chronic illness (long COVID-19) largely depends on the host's response to the infection, that echoes several aspects of MS pathobiology. Furthermore, other MS-associated viruses, such as the Epstein-Barr Virus (EBV) and Human Endogenous Retroviruses (HERVs), may enhance a mechanistic interplay with the novel Coronavirus, with the potential to interfere in MS natural history. Studies on COVID-19 in people with MS have helped clinicians in adjusting therapeutic strategies during the pandemic; similar efforts are being made for SARS-CoV-2 vaccination campaigns. In this Review, we look over 18 months of SARS-CoV-2 pandemic from the perspective of MS: we dissect neuroinflammatory and demyelinating mechanisms associated with COVID-19, summarize pathophysiological crossroads between MS and SARS-CoV-2 infection, and discuss present evidence on COVID-19 and its vaccination in people with MS.
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Affiliation(s)
- Gianmarco Bellucci
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Virginia Rinaldi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
| | - Roberta Reniè
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rachele Bigi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Giulia Pellicciari
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Emanuele Morena
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Carmela Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Antonio Marrone
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy
- San Raffaele Roma Open University, Rome, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy
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17
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Alvino B, Arianna F, Assunta B, Antonio C, Emanuele D, Giorgia M, Leonardo S, Daniele S, Renato D, Buscarinu MC, Massimiliano M, Crisafulli SG, Aurora Z, Gabri Nicoletti C, Marco S, Viola B, Francesco P, Marfia AG, Grazia S, Valentina S, Davide O, Giovanni S, Gioacchino T, Gallo A. Prevalence and predictors of bowel dysfunction in a large multiple sclerosis outpatient population: an Italian multicenter study. J Neurol 2021; 269:1610-1617. [PMID: 34347149 PMCID: PMC8857096 DOI: 10.1007/s00415-021-10737-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/04/2021] [Accepted: 07/27/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bowel dysfunction (BD) is reported as a common and disabling symptom in multiple sclerosis (MS) patients. To date, no studies have explored the prevalence of these symptoms in a large multicenter outpatient setting. The aims of the present study are to assess: (i) the prevalence of BD in a large multicenter Italian MS population, and (ii) the correlation between clinico-demographic variables and the severity of BD. METHODS Each of the nine participating center screened MS patients prospectively: 1100 subjects were enrolled. All patients underwent the Expanded Disability Status Scale (EDSS) and completed the Neurogenic Bowel Dysfunction score (NBDs). Multivariable linear and logistic regression models were used to assess the association between NBDs and several clinico-demographic variables. RESULTS Fourteen percent of MS patients showed a moderate/severe BD (NBDs > 10); this percentage increased in patients with high disability, ranging from 26 to 32%. Moderate/severe BD was more frequent in MS patients with: progressive phenotypes, higher disability, older age, and longer disease duration. NBDs severity was predicted by female sex, ambulation impairment and bladder symptoms. CONCLUSION This study confirms the relatively high prevalence of moderate/severe BD in a large, multicenter, unselected, outpatient MS population. BD appears to be mainly associated to female sex and MS-related disability.
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Affiliation(s)
- Bisecco Alvino
- MS Center-I Division of Neurology, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italia, piazza Miraglia, 2, 80138, Naples, Italy
| | - Fornasiero Arianna
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Roma, Italy
| | - Bianco Assunta
- Fondazione Policlinico Universitario A. Gemelli IRCCS and, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Cortese Antonio
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | | | - Mataluni Giorgia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Roma, Italy
| | - Sinisi Leonardo
- UOC di Neurologia e Centro Sclerosi Multipla, Ospedale San Paolo, ASL Napoli 1 Centro, Napoli, Italy
| | - Spitaleri Daniele
- UOC di Neurologia e Centro Sclerosi Multipla, Azienda Ospedaliera San Giuseppe Moscati, Avellino, Italy
| | - Docimo Renato
- Centro Sclerosi Multipla, Presidio Ospedaliero "San Giuseppe Moscati", ASL Caserta, Aversa, CE, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Roma, Italy
| | - Mirabella Massimiliano
- Fondazione Policlinico Universitario A. Gemelli IRCCS and, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Zanghì Aurora
- Department GF Ingrassia, University of Catania, Catania, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Roma, Italy
| | - Salvetti Marco
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Roma, Italy
| | - Baione Viola
- Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Patti Francesco
- Department GF Ingrassia, University of Catania, Catania, Italy
| | - Alessandra Girolama Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University and Hospital, Roma, Italy
| | - Sibilia Grazia
- UOC di Neurologia e Centro Sclerosi Multipla, Ospedale San Paolo, ASL Napoli 1 Centro, Napoli, Italy
| | - Scarano Valentina
- UOC di Neurologia e Centro Sclerosi Multipla, Azienda Ospedaliera San Giuseppe Moscati, Avellino, Italy
| | - Orlando Davide
- UOD Endoscopia Digestiva, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Stabile Giovanni
- MS Center-I Division of Neurology, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italia, piazza Miraglia, 2, 80138, Naples, Italy
| | - Tedeschi Gioacchino
- MS Center-I Division of Neurology, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italia, piazza Miraglia, 2, 80138, Naples, Italy
| | - Antonio Gallo
- MS Center-I Division of Neurology, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italia, piazza Miraglia, 2, 80138, Naples, Italy.
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18
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Ferraldeschi M, Romano S, Giglio S, Romano C, Morena E, Mechelli R, Annibali V, Ubaldi M, Buscarinu MC, Umeton R, Sani G, Vecchione A, Salvetti M, Ristori G. Circulating hsa-miR-323b-3p in Huntington's Disease: A Pilot Study. Front Neurol 2021; 12:657973. [PMID: 34025560 PMCID: PMC8131841 DOI: 10.3389/fneur.2021.657973] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The momentum of gene therapy in Huntington's disease (HD) deserves biomarkers from easily accessible fluid. We planned a study to verify whether plasma miRNome may provide useful peripheral “reporter(s)” for the management of HD patients. We performed an exploratory microarray study of whole non-coding RNA profiles in plasma from nine patients with HD and 13 matched controls [eight healthy subjects (HS) and five psychiatric patients (PP) to minimize possible iatrogenic impact on the profile of non-coding RNAs]. We found an HD-specific signature: downregulation of hsa-miR-98 (fold change, −1.5, p = 0.0338 HD vs. HS, and fold change, 1.5, p = 0.0045 HD vs. PP) and upregulation of hsa-miR-323b-3p (fold change, 1.5, p = 0.0007 HD vs. HS, and fold change, 1.5, p = 0.0111 HD vs. PP). To validate this result in an independent cohort, we quantify by digital droplet PCR (ddPCR) the presence of the two microRNA in the plasma of 33 HD patients and 49 matched controls (25 HS and 24 PP patients). We were able to confirm that hsa-miR-323b-3p was upregulated in HD and premanifest HD vs. HS and PP: the median values (first–third quartile) were 4.1 (0.9–10.53) and 5.8 (1.9–10.70) vs. 0.69 (0.3–2.75) and 1.4 (0.78–2.70), respectively, p < 0.05. No significant difference was found for hsa-miR-98. To evaluate the biological plausibility of the hsa-miR-323b-3p as a component of the disease pathophysiology, we performed a bioinformatic analysis based on its targetome and the huntingtin (HTT) interactome. We found a statistically significant overconnectivity between the targetome of hsa-miR-323b-3p and the HTT interactome (p = 1.48e−08). Furthermore, there was a significant transcription regulation of the HTT interactome by the miR-323b-3p targetome (p = 0.02). The availability of handy, reproducible, and minimally invasive biomarkers coming from peripheral miRNome may be valuable to characterize the illness progression, to indicate new therapeutic targets, and to monitor the effect of disease-modifying treatments. Our data deserve further studies with larger sample size and longitudinal design.
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Affiliation(s)
| | - Silvia Romano
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Simona Giglio
- Department of Experimental Medicine, Policlinico Umberto i of Rome, Sapienza University, Rome, Italy
| | - Carmela Romano
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Emanuele Morena
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Istituti di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, San Raffaele Roma Open University, Rome, Italy
| | - Viviana Annibali
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Martina Ubaldi
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Renato Umeton
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, MA, United States.,Massachusetts Institute of Technology, Cambridge, MA, United States.,Harvard School of Public Health, Boston, MA, United States.,Weill Cornell Medicine, New York City, NY, United States
| | - Gabriele Sani
- Section of Psychiatry, Department of Neuroscience, University Cattolica del Sacro Cuore, Rome, Italy.,Department of Psychiatry, Fondazione Policlinico Agostino Gemelli Istituti di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Andrea Vecchione
- Surgical Pathology Units, Department of Clinical and Molecular Medicine, Ospedale Sant'Andrea, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy.,Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Department of Neurosciences, Centre for Experimental Neurological Therapies (CENTERS), Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy.,Neuroimmunology Unit, Istituti di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Rome, Italy
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19
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Angeloni B, Bigi R, Bellucci G, Mechelli R, Ballerini C, Romano C, Morena E, Pellicciari G, Reniè R, Rinaldi V, Buscarinu MC, Romano S, Ristori G, Salvetti M. A Case of Double Standard: Sex Differences in Multiple Sclerosis Risk Factors. Int J Mol Sci 2021; 22:ijms22073696. [PMID: 33918133 PMCID: PMC8037645 DOI: 10.3390/ijms22073696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis is a complex, multifactorial, dysimmune disease prevalent in women. Its etiopathogenesis is extremely intricate, since each risk factor behaves as a variable that is interconnected with others. In order to understand these interactions, sex must be considered as a determining element, either in a protective or pathological sense, and not as one of many variables. In particular, sex seems to highly influence immune response at chromosomal, epigenetic, and hormonal levels. Environmental and genetic risk factors cannot be considered without sex, since sex-based immunological differences deeply affect disease onset, course, and prognosis. Understanding the mechanisms underlying sex-based differences is necessary in order to develop a more effective and personalized therapeutic approach.
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Affiliation(s)
- Benedetta Angeloni
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Rachele Bigi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Correspondence: (R.B.); (G.R.)
| | - Gianmarco Bellucci
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Rosella Mechelli
- San Raffaele Roma Open University, 00166 Rome, Italy;
- Scientific Institute for Research, Hospitalization and Healthcare San Raffaele Pisana (IRCCS), 00166 Rome, Italy
| | - Chiara Ballerini
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Carmela Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Emanuele Morena
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Giulia Pellicciari
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Roberta Reniè
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Virginia Rinaldi
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Silvia Romano
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Neuroimmunology Unit, Scientific Institute for Research, Hospitalization and Healthcare Fondazione Santa Lucia (IRCCS), 00179 Rome, Italy
- Correspondence: (R.B.); (G.R.)
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, 00189 Rome, Italy; (B.A.); (G.B.); (C.B.); (C.R.); (E.M.); (G.P.); (R.R.); (V.R.); (M.C.B.); (S.R.); (M.S.)
- Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, Italy
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20
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Belvisi D, Canevelli M, Baione V, Buscarinu MC, Pellicciari G, Fantozzi R, Creta A, Cecchi G, Cola G, Nicoletti CG, Cortese A, De Giglio L, Tartaglia M, Crisafulli SG, Bruno G, Ferraro E, Marfia GA, Centonze D, Salvetti M, Conte A. Operationalization of a frailty index in patients with multiple sclerosis: A cross-sectional investigation. Mult Scler 2021; 27:1939-1947. [PMID: 33565913 DOI: 10.1177/1352458520987541] [Citation(s) in RCA: 6] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Frailty is an age-related status of increased vulnerability to stressors caused by the accumulation of multiple health deficits. This construct may allow to capture the clinical complexity of patients with multiple sclerosis (MS). OBJECTIVE To investigate the relationship between frailty and the clinical manifestations of MS. METHODS Patients with MS were consecutively enrolled at five tertiary dedicated services. Disability and fatigue were assessed. The phenotypes of MS were also identified. Frailty was measured using a frailty index (FI), computed by cumulatively considering 42 age-related multidimensional health deficits. RESULTS Overall, 745 MS patients (mean age = 48.2 years, standard deviation = 11.7 years; women 68%) were considered. The median FI value was 0.12 (interquartile range = 0.05-0.19) and the 99th percentile was 0.40. FI scores were associated with MS disease duration, disability, fatigue, as well as with the number of previous disease-modifying treatments and current symptomatic therapies. A logistic regression analysis model showed that FI score was independently associated with the secondary progressive phenotype. CONCLUSION Frailty is significantly associated with major characteristics of MS. The findings of the present cross-sectional investigation should be explored in future longitudinal studies.
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Affiliation(s)
- Daniele Belvisi
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy
| | - Marco Canevelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
| | - Viola Baione
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Giulia Pellicciari
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | | | | | - Gianluca Cecchi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Gaia Cola
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | | | - Matteo Tartaglia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Giuseppe Bruno
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Girolama Alessandra Marfia
- IRCCS Neuromed, Pozzilli, Italy/Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, Italy/Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, Italy/Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy/IRCCS Neuromed, Pozzilli, Italy
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21
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Lucchini M, Prosperini L, Buscarinu MC, Centonze D, Conte A, Cortese A, Elia G, Fantozzi R, Ferraro E, Gasperini C, Ianniello A, Landi D, Marfia GA, Nociti V, Pozzilli C, Salvetti M, Tortorella C, Mirabella M. Predictors of lymphocyte count recovery after dimethyl fumarate-induced lymphopenia in people with multiple sclerosis. J Neurol 2021; 268:2238-2245. [PMID: 33496861 PMCID: PMC8179888 DOI: 10.1007/s00415-021-10412-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dimethyl fumarate (DMF) is an oral drug approved for Relapsing Multiple Sclerosis (RMS) patients. Grade III lymphopenia is reported in 5-10% DMF-treated patients. Data on lymphocyte count (ALC) recovery after DMF withdrawal following prolonged lymphopenia are still scarce. OBJECTIVES To characterize ALC recovery and to identify predictors of slower recovery after DMF interruption. METHODS Multicenter data from RMS patients who started DMF and developed lymphopenia during treatment were collected. In patients with grade II-III lymphopenia, ALCs were evaluated from DMF withdrawal until reaching lymphocyte counts > 800/mm3. RESULTS Among 1034 patients who started DMF, we found 198 (19.1%) patients with lymphopenia and 65 patients (6.3%) who discontinued DMF due to persistent grade II-III lymphopenia. Complete data were available for 51 patients. All patients recovered to ALC > 800 cells/mm3 with a median time of 3.4 months. Lower ALCs at DMF suspension (HR 0.98; p = 0.005), longer disease duration (HR 1.29; p = 0.014) and prior exposure to MS treatments (HR 0.03; p = 0.025) were found predictive of delayed ALC recovery. CONCLUSION ALC recovery after DMF withdrawal is usually rapid, nevertheless it may require longer time in patients with lower ALC count at DMF interruption, longer disease duration and previous exposure to MS treatments, potentially leading to delayed initiation of a new therapy.
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Affiliation(s)
- Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | - Diego Centonze
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Antonella Conte
- IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Antonio Cortese
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- San Filippo Neri Hospital, Rome, Italy
| | - Giorgia Elia
- Multiple Sclerosis Center, Ospedale S. Andrea, Rome, Italy
| | | | | | | | | | - Doriana Landi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico di Tor Vergata, Rome, Italy
| | - Girolama Alessandra Marfia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
- Multiple Sclerosis Clinical and Research Unit, Fondazione Policlinico di Tor Vergata, Rome, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Ospedale S. Andrea, Rome, Italy
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Center for Experimental Neurological Therapies, NESMOS, S. Andrea Hospital, Rome, Italy
- IRCCS Neuromed, Pozzilli, Isernia, Italy
| | | | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Di Gregorio M, Torri Clerici VLA, Fenu G, Gaetani L, Gallo A, Cavalla P, Ragonese P, Annovazzi P, Gajofatto A, Prosperini L, Landi D, Nicoletti CG, Di Carmine C, Totaro R, Nociti V, De Fino C, Ferraro D, Tomassini V, Tortorella C, Righini I, Amato MP, Manni A, Paolicelli D, Iaffaldano P, Lanzillo R, Moccia M, Buttari F, Fantozzi R, Cerqua R, Zagaglia S, Farina D, De Luca G, Buscarinu MC, Pinardi F, Cocco E, Gasperini C, Solaro CM, Di Filippo M. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study. Eur J Neurol 2021; 28:1299-1307. [PMID: 33305459 DOI: 10.1111/ene.14672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. METHODS One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. RESULTS TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5 years, range: 11-68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3 years (range: 0.1-10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0-7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, p < 0.01), a higher number of TDLs (OR: 1.67, 95% CI: 1.02-2.74, p < 0.05) and the presence of infiltrative TDLs (OR: 3.34, 95% CI: 1.18-9.5, p < 0.001) at baseline. CONCLUSIONS The management of TuMS might be challenging because of its peculiar characteristics. Large prospective studies could help to define the clinical characteristics and the best treatment algorithms for people with TuMS.
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Affiliation(s)
- Maria Di Gregorio
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.,Azienda Ospedaliero-Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Giuseppe Fenu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lorenzo Gaetani
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Pietro Annovazzi
- U.O.C. Centro Sclerosi Multipla, ASST Valle Olona, Varese, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Doriana Landi
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Carolina Gabri Nicoletti
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Ospedale San Salvatore, L'Aquila, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara De Fino
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Isabella Righini
- UO Neurologia-Dipartimento di Specialità Mediche- Nuovo Ospedale delle Apuane, Massa, Italy
| | - Maria Pia Amato
- Dipartimento NEUROFARBA, Sezione di Neuroscienze, Università degli Studi di Firenze, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessia Manni
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy
| | - Marcello Moccia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy.,UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Buttari
- Unità di Neurologia, IRCCS Neuromed, Pozzilli, Italy
| | | | - Raffaella Cerqua
- Clinica Neurologica, Dipartimento di Medicina Sperimentale e Clinica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sara Zagaglia
- Department of Clinical and Experimental Epilepsy, Queen Square, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, UK
| | - Deborah Farina
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Chiara Buscarinu
- Dipartimento di Neuroscienze, Salute Mentale ed Organi di Senso, Università degli Studi di Roma "LaSapienza", Rome, Italy
| | - Federica Pinardi
- IRCCS Istituto delle scienze neurologiche di Bologna, UOSI riabilitazione SM, Bologna, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
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23
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Guerrera G, Ruggieri S, Picozza M, Piras E, Gargano F, Placido R, Gasperini C, Salvetti M, Buscarinu MC, Battistini L, Borsellino G, Angelini DF. EBV-specific CD8 T lymphocytes and B cells during glatiramer acetate therapy in patients with MS. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e876. [PMID: 32817203 PMCID: PMC7455312 DOI: 10.1212/nxi.0000000000000876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/08/2020] [Indexed: 12/31/2022]
Abstract
Objective Infection with Epstein-Barr virus (EBV) has been associated with clinical activity and risk of developing MS. The purpose of this study is to investigate the impact of glatiramer acetate (GA) therapy on EBV-specific immune responses and disease course. Methods We characterized EBV-specific CD8 T lymphocytes and B cells during disease-modifying treatments in 2 groups of patients with MS. We designed a 2-pronged approach consisting of a cross-sectional study (39 untreated patients, 38 patients who had undergone 12 months of GA treatment, and 48 healthy donors compatible for age and sex with the patients with MS) and a 12-month longitudinal study (35 patients treated with GA). CD8 EBV-specific T cells and B lymphocytes were studied using pentamers and multiparametric flow cytometry. Results We find that treatment with GA enhances viral recognition by inducing an increased number of circulating virus-specific CD8 T cells (p = 0.0043) and by relieving their features of exhaustion (p = 0.0053) and senescence (p < 0.0001, p = 0.0001). B cells, phenotypically and numerically tracked along the 1-year follow-up study, show a steady decrease in memory B-cell frequencies (p = 0.025), paralleled by an increase of the naive B subset. Conclusion GA therapy acts as a disease-modifying therapy restoring homeostasis in the immune system, including anti-EBV responses.
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Affiliation(s)
- Gisella Guerrera
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Serena Ruggieri
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Mario Picozza
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Eleonora Piras
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Francesca Gargano
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Roberta Placido
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Claudio Gasperini
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Marco Salvetti
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Maria Chiara Buscarinu
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Luca Battistini
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Giovanna Borsellino
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy
| | - Daniela F Angelini
- From the Neuroimmunology Unit (G.G., S.R., M.P., E.P., F.G., R.P., B.L., G.B., D.F.A.), IRCSS Fondazione Santa Lucia, Rome; Department of Neurosciences (C.G.), San Camillo-Forlanini Hospital, Rome; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS) (M.S., M.C.B.), Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome; and Neurological Institute (M.S.), NEUROMED, Molise, Italy.
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Bellucci G, Ballerini C, Mechelli R, Bigi R, Rinaldi V, Reniè R, Buscarinu MC, Baranzini SE, Madireddy L, Matarese G, Salvetti M, Ristori G. SARS-CoV-2 meta-interactome suggests disease-specific, autoimmune pathophysiologies and therapeutic targets. F1000Res 2020; 9:992. [PMID: 33456761 PMCID: PMC7791351 DOI: 10.12688/f1000research.25593.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Severe coronavirus disease 2019 (COVID-19) is associated with multiple comorbidities and is characterized by an auto-aggressive inflammatory state leading to massive collateral damage. To identify preventive and therapeutic strategies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is important to ascertain the molecular interactions between virus and host, and how they translate into disease pathophysiology. Methods: We matched virus-human protein interactions of human coronaviruses and other respiratory viruses with lists of genes associated with autoimmune diseases and comorbidities associated to worse COVID-19 course. We then selected the genes included in the statistically significant intersection between SARS-CoV-2 network and disease associated gene sets, identifying a meta-interactome. We analyzed the meta-interactome genes expression in samples derived from lungs of infected humans, and their regulation by IFN-β. Finally, we performed a drug repurposing screening to target the network's most critical nodes. Results: We found a significant enrichment of SARS-CoV-2 interactors in immunological pathways and a strong association with autoimmunity and three prognostically relevant conditions (type 2 diabetes, coronary artery diseases, asthma), that present more independent physiopathological subnetworks. We observed a reduced expression of meta-interactome genes in human lungs after SARS-CoV-2 infection, and a regulatory potential of type I interferons. We also underscored multiple repurposable drugs to tailor the therapeutic strategies. Conclusions: Our data underscored a plausible genetic background that may contribute to the distinct observed pathophysiologies of severe COVID-19. Also, these results may help identify the most promising therapeutic targets and treatments for this condition.
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Affiliation(s)
- Gianmarco Bellucci
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Chiara Ballerini
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Rosella Mechelli
- San Raffaele Roma Open University; IRCCS San Raffaele Pisana, Rome, 00166, Italy
| | - Rachele Bigi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Virginia Rinaldi
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Roberta Reniè
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
| | - Sergio E. Baranzini
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, 94158, USA
| | - Lohith Madireddy
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, 94158, USA
| | - Giuseppe Matarese
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, University of Naples Federico II, Naples, 80131, Italy
- Istituto di Endocrinologia e Oncologia Sperimentale, Consiglio Nazionale Delle Ricerche (IEOS-CNR), Naples, 80131, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
- Neuromed: IRCCS Istituto Neurologico Mediterraneo (INM), Pozzilli, 86077, Italy
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, 00189, Italy
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25
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Moccia M, Annovazzi P, Buscarinu MC, Calabrese M, Cavalla P, Cordioli C, Di Filippo M, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Lorefice L, Mallucchi S, Nociti V, Paolicelli D, Pinardi F, Prosperini L, Radaelli M, Ragonese P, Tomassini V, Tortorella C, Cocco E, Gasperini C, Solaro C. Harmonization of real-world studies in multiple sclerosis: Retrospective analysis from the rirems group. Mult Scler Relat Disord 2020; 45:102394. [PMID: 32683308 DOI: 10.1016/j.msard.2020.102394] [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] [Received: 05/05/2020] [Revised: 06/25/2020] [Accepted: 07/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Worldwide multiple sclerosis (MS) centers have coordinated their efforts to use data acquired in clinical practice for real-world observational studies. In this retrospective study, we aim to harmonize outcome measures, and to evaluate their heterogeneity within the Rising Italian Researchers in MS (RIReMS) study group. METHODS RIReMS members filled in a structured questionnaire evaluating the use of different outcome measures in clinical practice. Thereafter, thirty-four already-published papers from RIReMS centers were used for heterogeneity analyses, using the DerSimonian and Laird random-effects method to compute the between-study variance (τ2). RESULTS Based on questionnaire results, we defined basic modules for diagnosis and follow-up, consisting of outcome measures recorded by all participating centers at the time of diagnosis, and, then, at least annually; we also defined more detailed/optional modules, with outcome measures recorded less frequently and/or in the presence of specific clinical indications. Looking at heterogeneity, we found 5-year variance in age at onset (ES=27.34; 95%CI=26.18, 28.49; p<0.01; τ2=4.76), and 7% in female percent (ES=66.42; 95%CI=63.08, 69.76; p<0.01; τ2=7.15). EDSS variance was 0.2 in studies including patients with average age <36.1 years (ES=1.96; 95%CI=1.69, 2.24; p<0.01; τ2=0.19), or from 36.8 to 41.1 years (ES=2.70; 95%CI=2.39, 3.01; p<0.01; τ2=0.18), but increased to 3 in studies including patients aged >41.4 years (ES=4.37; 95%CI=3.40, 5.35; p<0.01; τ2=2.96). The lowest variance of relapse rate was found in studies with follow-up duration ≤2 years (ES=9.07; 95%CI=5.21, 12.93; p = 0.02; τ2=5.53), whilst the lowest variance in EDSS progression was found in studies with follow-up duration >2 years (ES=5.41; 95%CI=3.22, 7.60; p = 0.02; τ2=1.00). DISCUSSION We suggest common sets of biomarkers to be acquired in clinical practice, that can be used for research purposes. Also, we provide researchers with specific indications for improving inclusion criteria and data analysis, ultimately allowing data harmonization and high-quality collaborative studies.
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Affiliation(s)
- Marcello Moccia
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Italy.
| | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | | | - Paola Cavalla
- MS Center, Department of Neurosciences and Mental Health, AOU City of Health & Science University Hospital, Turin, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberta Lanzillo
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Italy
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Simona Mallucchi
- Multiple Sclerosis Centre, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | | | - Luca Prosperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Marta Radaelli
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Paolo Ragonese
- Department of Biomedicine Neurosciences and advanced Diagnostic (BiND), University of Palermo, Italy
| | - Valentina Tomassini
- Institute for Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy; MS Centre, Neurology Unit, SS. Annunziata University Hospital, Chieti, Italy; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom
| | - Carla Tortorella
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Claudio Gasperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Claudio Solaro
- Rehabilitation Department, Mons. L. Novarese, Moncrivello, Vercelli, Italy
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26
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Tortorella C, Solaro C, Annovazzi P, Boffa L, Buscarinu MC, Buttari F, Calabrese M, Cavalla P, Cocco E, Cordioli C, De Luca G, Di Filippo M, Fantozzi R, Ferraro D, Gajofatto A, Gallo A, Lanzillo R, Laroni A, Fermo SL, Malucchi S, Maniscalco GT, Moccia M, Nociti V, Paolicelli D, Pesci I, Prosperini L, Ragonese P, Tomassini V, Clerici VLAT, Rodegher M, Gherardi M, Gasperini C. Informing MS patients on treatment options: a consensus on the process of consent taking. Neurol Sci 2020; 41:2249-2253. [PMID: 32240416 DOI: 10.1007/s10072-020-04339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
In the last years, change in multiple sclerosis (MS) therapeutic scenario has highlighted the need for an improved doctor-patient communication in advance of treatment initiation in order to allow patient's empowerment in the decision-making process. AIMS: The aims of our project were to review the strategies used by Italian MS specialists to inform patients about treatment options and to design a multicentre shared document that homogenizes the information about disease-modifying treatment (DMTs) and the procedure of taking informed consent in clinical practice. RESULTS: The new resource, obtained by consensus among 31 neurologists from 27 MS Centres in Italy with the supervision of a medico-legal advisor, received the aegis of Italian Neurological Society (SIN) and constitutes a step toward a standardized decision process around DMTs in MS.
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Affiliation(s)
- C Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
| | - C Solaro
- Department of Rehabilitation, Mons L Novarese Hospital, Moncrivello, Italy
| | - P Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, PO di Gallarate, (VA), Italy
| | - L Boffa
- Department of Neurosciences, MS Center, Tor Vergata University, Rome, Italy
| | - M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs Sapienza University Rome, Rome, Italy
| | - F Buttari
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - M Calabrese
- Neurology B, Department of Neurosciences Biomedicine and Movements, University of Verona, Verona, Italy
| | - P Cavalla
- MS Center (P.C.), City of Health & Science University Hospital, Turin, Italy
| | - E Cocco
- Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cordioli
- Multiple Sclerosis Center, ospedale di Montichiari, Spedali Civili di Brescia, Montichiari, Italy
| | - G De Luca
- Neurology Clinic, Multiple Sclerosis Center SS. Annunziata Hospital, Chieti, Italy
| | - M Di Filippo
- Clinica Neurologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - R Fantozzi
- I.R.C.C.S. Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - D Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - A Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Gallo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Science, University of Campania, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - A Laroni
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health and Center of Excellence for Biomedical Research, University of Genova, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Lo Fermo
- Clinica Neurologica A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - S Malucchi
- Neurologia 2-CRESM, AOU San Luigi Gonzaga, Orbassano, Italy
| | - G T Maniscalco
- Department of Neurology and Stroke Unit, "A. Cardarelli Hospital", Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy.,Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - V Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario 'A Gemelli' IRCCS, Rome, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy
| | - I Pesci
- Ospedale di Vaio, Centro SM, Fidenza, Parma, Italy
| | - L Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - P Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Palermo, Italy
| | - V Tomassini
- Department of Neurosciences, Imaging and Clinical Sciences, School of Medicine, Institute for Advanced Biomedical Technologies (ITAB), University of Chieti-Pescara "G. d'Annunzio, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - V L A Torri Clerici
- Neuro-immunology and Neuromuscolar Diseases Unit, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - M Rodegher
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - M Gherardi
- SC Medicina Legale AUSL Valle D'Aosta, Aosta, Italy
| | - C Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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27
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Buscarinu MC, Fornasiero A, Ferraldeschi M, Romano S, Reniè R, Morena E, Romano C, Pellicciari G, Landi AC, Fagnani C, Salvetti M, Ristori G. Disentangling the molecular mechanisms of multiple sclerosis: The contribution of twin studies. Neurosci Biobehav Rev 2020; 111:194-198. [PMID: 31978439 DOI: 10.1016/j.neubiorev.2020.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/12/2019] [Accepted: 01/20/2020] [Indexed: 02/05/2023]
Abstract
Twin studies of disease concordance are useful to weight the relative contribution of genetic and environmental factors to the cause of common complex disorders. In multiple sclerosis (MS) different twinning rates from geographic areas at different prevalence suggested that heritable and non-heritable factors contribute in different proportions and ways to MS risk in diverse populations. This concept prompted genome-wide association studies, and the implementation of the co-twin control design, that allows stringent experimental approaches in MS-discordant identical pairs, controlling for genetic influences and many other known and unknown factors. The co-twin control design provided important clues on MS molecular model. These studies will be reviewed, focusing on those showing significant differences between affected and healthy co-twins. In some cases, differences that emerged in non-twin patients compared to matched controls were not confirmed in identical MS-discordant pairs, suggesting an 'MS subclinical trait'. Early patterns of magnetic resonance imaging and predictive biomarkers that characterize 'healthy' co-twins may be useful for the identification of a prodromal reversible phase of the disease.
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Affiliation(s)
- M C Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University, Rome, Italy
| | - A Fornasiero
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University, Rome, Italy
| | - M Ferraldeschi
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - S Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University, Rome, Italy
| | - R Reniè
- Sapienza University, Rome, Italy
| | - E Morena
- Sapienza University, Rome, Italy
| | - C Romano
- Sapienza University, Rome, Italy
| | | | | | - C Fagnani
- Centro di Riferimento per le Scienze Comportamentali e la Salute Mentale, Istituto Superiore di Sanità, Italy
| | - M Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University, Rome, Italy; IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.
| | - G Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University, Rome, Italy.
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28
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Buscarinu MC, Fornasiero A, Pellicciari G, Reniè R, Landi AC, Bozzao A, Cappelletti C, Bernasconi P, Ristori G, Salvetti M. Autoimmune Encephalitis and CSF Anti-GluR3 Antibodies in an MS Patient after Alemtuzumab Treatment. Brain Sci 2019; 9:brainsci9110299. [PMID: 31671619 PMCID: PMC6895826 DOI: 10.3390/brainsci9110299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/10/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 11/16/2022] Open
Abstract
A 45-year-old Italian woman, affected by relapsing–remitting multiple sclerosis (RR-MS) starting from 2011, started treatment with alemtuzumab in July 2016. Nine months after the second infusion, she had an immune thrombocytopenic purpura (ITP) with complete recovery after steroid treatment. Three months after the ITP, the patient presented with transient aphasia, cognitive deficits, and focal epilepsy. Serial brain magnetic resonance imaging showed a pattern compatible with encephalitis. Autoantibodies to glutamate receptor 3 peptide A and B were detected in cerebrospinal fluid and serum, in the absence of any other diagnostic cues. After three courses of intravenous immunoglobulin (0.4 mg/kg/day for 5 days, 1 month apart), followed by boosters (0.4 mg/kg/day) every 4–6 weeks, her neurological status improved and is currently comparable with that preceding the encephalitis. Autoimmune complications of the central nervous system during alemtuzumab therapy are relatively rare: only one previous case of autoimmune encephalitis following alemtuzumab treatment has been reported to date.
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Affiliation(s)
- Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Arianna Fornasiero
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Giulia Pellicciari
- Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Roberta Reniè
- Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Anna Chiara Landi
- Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Alessandro Bozzao
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Cristina Cappelletti
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
| | - Pia Bernasconi
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Faculty of Medicine and Psychology, Sapienza University, 00189 Rome, Italy.
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, Italy.
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29
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Ferraro D, Annovazzi P, Moccia M, Lanzillo R, De Luca G, Nociti V, Fantozzi R, Paolicelli D, Ragonese P, Gajofatto A, Boffa L, Cavalla P, Lo Fermo S, Buscarinu MC, Lorefice L, Cordioli C, Calabrese M, Gallo A, Pinardi F, Tortorella C, Di Filippo M, Camera V, Maniscalco GT, Radaelli M, Buttari F, Tomassini V, Cocco E, Gasperini C, Solaro C. Characteristics and treatment of Multiple Sclerosis-related trigeminal neuralgia: An Italian multi-centre study. Mult Scler Relat Disord 2019; 37:101461. [PMID: 31678859 DOI: 10.1016/j.msard.2019.101461] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population and its management can be particularly challenging. Our aim is to describe the characteristics, treatment and prognostic factors of MS-related TN in a retrospective multicentre study. METHODS Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. RESULTS Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier. CONCLUSION MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.
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Affiliation(s)
- Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy.
| | | | - Marcello Moccia
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- MS Clinical Care and Research Centre, Department of Neuroscience, Federico II University of Naples, Naples, Italy
| | | | - Viviana Nociti
- Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Paolo Ragonese
- Department of Biomedicine Neurosciences and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Alberto Gajofatto
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Laura Boffa
- Neurology Unit, Tor Vergata Hospital, Rome, Italy
| | - Paola Cavalla
- MS Center, Department of Neurosciences and Mental Health, AOU City of Health & Science University Hospital, Turin, Italy
| | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | | | - Valentina Camera
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, Modena 41126, Italy
| | | | - Marta Radaelli
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | | | - Valentina Tomassini
- Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudio Gasperini
- Department of Neurosciences, Ospedale San Camillo Forlanini, Rome, Italy
| | - Claudio Solaro
- Rehabilitation Department, Mons. L. Novarese, Moncrivello, Vercelli, Italy
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30
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Buscarinu MC, Fornasiero A, Romano S, Ferraldeschi M, Mechelli R, Reniè R, Morena E, Romano C, Pellicciari G, Landi AC, Salvetti M, Ristori G. The Contribution of Gut Barrier Changes to Multiple Sclerosis Pathophysiology. Front Immunol 2019; 10:1916. [PMID: 31555257 PMCID: PMC6724505 DOI: 10.3389/fimmu.2019.01916] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
The gut barrier consists of several components, including the mucus layer, made of mucins and anti-bacterial molecule, the epithelial cells, connected by tight junction proteins, and a mixed population of cells involved in the interplay with microbes, such as M cells, elongations of “antigen presenting cells” dwelling the lamina propria, intraepithelial lymphocytes and Paneth cells secreting anti-bacterial peptides. Recently, the influence of intestinal permeability (IP) changes on organs far from gut has been investigated, and IP changes in multiple sclerosis (MS) have been described. A related topic is the microbiota dysfunction that underpins the development of neuroinflammation in animal models and human diseases, including MS. It becomes now of interest to better understand the mechanisms through which IP changes contribute to pathophysiology of neuroinflammation. The following aspects seem of relevance: studies on other biomarkers of IP alterations; the relationship with known risk factors for MS development, such as vitamin D deficiency; the link between blood brain barrier and gut barrier breakdown; the effects of IP increase on microbial translocation and microglial activation; the parallel patterns of IP and neuroimmune changes in MS and neuropsychiatric disorders, that afflict a sizable proportion of patients with MS. We will also discuss the therapeutic implications of IP changes, considering the impact of MS-modifying therapies on gut barrier, as well as potential approaches to enhance or protect IP homeostasis.
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Affiliation(s)
- Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Arianna Fornasiero
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | | | - Rosella Mechelli
- Department of Human Science and Promotion of Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Roberta Reniè
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Emanuele Morena
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Carmela Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Giulia Pellicciari
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Anna Chiara Landi
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sapienza University, Rome, Italy
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31
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Solari A, Giovannetti AM, Giordano A, Tortorella C, Torri Clerici V, Brichetto G, Granella F, Lugaresi A, Patti F, Salvetti M, Pesci I, Pucci E, Centonze D, Danni MC, Bonavita S, Ferraro D, Gallo A, Gajofatto A, Nociti V, Grimaldi L, Grobberio M, Lanzillo R, Di Giovanni R, Gregori S, Manni A, Pietrolongo E, Bertagnoli S, Ronzoni M, Compagnucci L, Fantozzi R, Allegri B, Arena S, Buscarinu MC, Sabattini L, Quartuccio ME, Tsantes E, Confaloneri P, Tacchino A, Schiffmann I, Rahn AC, Kleiter I, Messmer Uccelli M, Barabasch A, Heesen C, The ManTra Project. Conversion to Secondary Progressive Multiple Sclerosis: Patient Awareness and Needs. Results From an Online Survey in Italy and Germany. Front Neurol 2019; 10:916. [PMID: 31507519 PMCID: PMC6713887 DOI: 10.3389/fneur.2019.00916] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 02/11/2019] [Accepted: 08/07/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Few studies have investigated the experiences of patients around the conversion to secondary progressive multiple sclerosis (SPMS). ManTra is a mixed-method, co-production research project conducted in Italy and Germany to develop an intervention for newly-diagnosed SPMS patients. In previous project actions, we identified the needs and experiences of patients converting to SPMS via literature review and qualitative research which involved key stakeholders. Aims: The online patient survey aimed to assess, on a larger and independent sample of recently-diagnosed SPMS patients: (a) the characteristics associated to patient awareness of SPMS conversion; (b) the experience of conversion; (c) importance and prioritization of the needs previously identified. Methods: Participants were consenting adults with SPMS since ≤5 years. The survey consisted of three sections: on general and clinical characteristics; on experience of SPMS diagnosis disclosure (aware participants only); and on importance and prioritization of 33 pre-specified needs. Results: Of 215 participants, those aware of their SPMS diagnosis were 57% in Italy vs. 77% in Germany (p = 0.004). In both countries, over 80% of aware participants received a SPMS diagnosis from the neurologist; satisfaction with SPMS disclosure was moderate to high. Nevertheless, 28-35% obtained second opinions, and 48-56% reported they did not receive any information on SPMS. Participants actively seeking further information were 63% in Germany vs. 31% in Italy (p < 0.001). Variables independently associated to patient awareness were geographic area (odds ratio, OR 0.32, 95% CI 0.13-0.78 for Central Italy; OR 0.21, 95% CI 0.08-0.58 for Southern Italy [vs. Germany]) and activity limitations (OR 7.80, 95% CI 1.47-41.37 for dependent vs. autonomous patients). All pre-specified needs were scored a lot or extremely important, and two prioritized needs were shared by Italian and German patients: "physiotherapy" and "active patient care involvement." The other two differed across countries: "an individualized health care plan" and "information on social rights and policies" in Italy, and "psychological support" and "cognitive rehabilitation" in Germany. Conclusions: Around 40% of SPMS patients were not aware of their disease form indicating a need to improve patient-physician communication. Physiotherapy and active patient care involvement were prioritized in both countries.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Giampaolo Brichetto
- Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Francesco Patti
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Marco Salvetti
- IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Ilaria Pesci
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Eugenio Pucci
- UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | | | - Simona Bonavita
- II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Gallo
- I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Viviana Nociti
- Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Luigi Grimaldi
- UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy
| | - Monica Grobberio
- Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy
| | - Roberta Lanzillo
- Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy
| | | | - Silvia Gregori
- UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Marco Ronzoni
- Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy
| | - Laura Compagnucci
- Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Beatrice Allegri
- Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy
| | - Sebastiano Arena
- Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy
| | - Maria Chiara Buscarinu
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Loredana Sabattini
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Elena Tsantes
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Confaloneri
- Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Insa Schiffmann
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Kleiter
- Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany
| | | | - Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - The ManTra Project
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Multiple Sclerosis Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Psychology, University of Turin, Turin, Italy.,Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.,Rehabilitation Centre, Italian Multiple Sclerosis Society, Genoa, Italy.,Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy.,Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.,UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,Sezione Neuroscienze, Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università di Catania, Catania, Italy.,Centro Sclerosi Multipla, PO Policlinico "G. Rodolico", Catania, Italy.,IRCCS Neuromed, Pozzilli, Italy.,Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy.,Unità di Neurologia, Centro Sclerosi Multipla, Ospedale di Vaio, Fidenza, Italy.,UOC Neurologia, Ospedale "A. Murri", ASUR Marche-AV4, Fermo, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Clinica Neurologica, Università Politecnica delle Marche, Ancona, Italy.,II Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,I Clinica Neurologica, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy.,Istituto di Neurologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,UOC Neurologia e Centro Regionale SM, Fondazione Istituto "G. Giglio", Cefalù, Italy.,Laboratory of Clinical Neuropsychology, Department of Neurology and Psychology, ASST Lariana, Como, Italy.,Neurosciences, Reproductive and Odontostomatological Sciences Department, Federico II University of Naples, Naples, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Italy.,UOC Neurologia, Ospedale San Camillo de Lellis, Rieti, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University of Bari, Bari, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,Italian Multiple Sclerosis Society, Mantua, Italy.,Centro Sclerosi Multipla, Ospedale "G. Salvini"-ASST Rhodense, Garbagnate Milanese, Italy.,Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Kempfenhausen Centre for Treatment of Multiple Sclerosis, Marianne-Strauß-Klinik, Berg, Germany.,Italian Multiple Sclerosis Society Research Foundation (FISM), Genoa, Italy
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Romano S, Ferraldeschi M, Bagnato F, Mechelli R, Morena E, Caldano M, Buscarinu MC, Fornasiero A, Frontoni M, Nociti V, Mirabella M, Mayer F, Bertolotto A, Pozzilli C, Vanacore N, Salvetti M, Ristori G. Drug Holiday of Interferon Beta 1b in Multiple Sclerosis: A Pilot, Randomized, Single Blind Study of Non-inferiority. Front Neurol 2019; 10:695. [PMID: 31379701 PMCID: PMC6646514 DOI: 10.3389/fneur.2019.00695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/13/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction: To compare a schedule with cyclic withdrawal (CW) of interferon beta (IFN-b) 1b, respect to the full regimen (FR), in relapsing-remitting MS (RR-MS). Methods: Participants were randomly assigned to CW or FR schedule and monthly monitored with brain MRI scans for 12 months (three of run-in and 9 of treatment). CW schedule included drug withdrawal for 1 month after two of treatment for a total of three quarters over the 9-month treatment period. The assessing neurologist and the expert neuroradiologists were blind. After the blind phase of the study all participants took their indicated disease modifying therapies in a prospectively planned, open-label extension phase (up to 120 months). Results: Of 60 randomized subjects 56 (29 in FR and 27 in CW group) completed the single-blind phase: the two groups were comparable, except for a non-significant difference in the number of contrast-enhanced lesions (CEL) at the end of run-in. The two-sided 90% CI for the ratio between median number of cumulative CEL was 0.29–1.07, allowing to significantly reject the null hypothesis of a ratio ≥1.2 and to meet the primary end-point of non-inferiority (the threshold and the ratio between median were chosen according to the non-normal distribution of the data). The differences (CW vs. FR) were also non-significant for secondary end points: mean cumulative number of T2-weighted new and enlarging lesions (3.48 ± 5.34 vs. 3.86 ± 6.76); mean number and volume (cm3) of black holes (1.24 ± 1.61 vs. 2.71 ± 4.56; 489.11 ± 1488.12 vs. 204.48 ± 396.98); number of patients with at least an active scan (21 vs. 22); mean relapse rate (0.52 ± 0.89 vs. 0.34 ± 0.66), relapse risk ratio adjusted for baseline variables (2.15 [0.64–7.18]), EDSS score (1.0 [1–1.56] vs. 1.5 [1–1.78]), proportion of patients with antibodies anti-IFN (5 [21%] vs. 8 [36%]). Fifty-four patients (27 for each study arm) completed the open-label phase. The annualized RR, EDSS, proportion of patients shifting to progressive disease and hazard ratio of shifting, adjusting for baseline covariates, were comparable between the two study groups. Conclusions: A calendar with CW was non-inferior than FR at the beginning of IFN-b therapy, and may not affect the long-term outcome. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT00270816
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Affiliation(s)
- Silvia Romano
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
| | - Michela Ferraldeschi
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Bagnato
- Neuroimmunology Division, Department of Neurology, Neuroimaging Unit, Vanderbilt University Medical Centre, Nashville, TN, United States
| | - Rosella Mechelli
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
| | - Emanuele Morena
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
| | - Marzia Caldano
- Neurologia - Centro Riferimento Regionale Sclerosi Multipla and Neuroscience Institute Cavalieri Ottolenghi, San Luigi Hospital, Turin, Italy
| | - Maria Chiara Buscarinu
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
| | - Arianna Fornasiero
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
| | - Marco Frontoni
- D.A.I. Neurosciences and Mental Health, "Sapienza" University of Rome, Rome, Italy
| | - Viviana Nociti
- Università Cattolica, Fondazione Policlinico Universitario "A. Gemelli, " Rome, Italy.,Don Carlo Gnocchi Foundation Onlus, Milan, Italy
| | | | - Flavia Mayer
- National Centre of Epidemiology, National Institute of Health, Rome, Italy
| | - Antonio Bertolotto
- Neurologia - Centro Riferimento Regionale Sclerosi Multipla and Neuroscience Institute Cavalieri Ottolenghi, San Luigi Hospital, Turin, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Nicola Vanacore
- National Centre of Epidemiology, National Institute of Health, Rome, Italy
| | - Marco Salvetti
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Center for Experimental Neurological Therapies, S. Andrea Hospital-site, "Sapienza" University of Rome, Rome, Italy
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Severa M, Rizzo F, Srinivasan S, Di Dario M, Giacomini E, Buscarinu MC, Cruciani M, Etna MP, Sandini S, Mechelli R, Farina A, Trivedi P, Hertzog PJ, Salvetti M, Farina C, Coccia EM. A cell type-specific transcriptomic approach to map B cell and monocyte type I interferon-linked pathogenic signatures in Multiple Sclerosis. J Autoimmun 2019; 101:1-16. [PMID: 31047767 DOI: 10.1016/j.jaut.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
Alteration in endogenous Interferon (IFN) system may profoundly impact immune cell function in autoimmune diseases. Here, we provide evidence that dysregulation in IFN-regulated genes and pathways are involved in B cell- and monocyte-driven pathogenic contribution to Multiple Sclerosis (MS) development and maintenance. In particular, by using an Interferome-based cell type-specific approach, we characterized an increased susceptibility to an IFN-linked caspase-3 dependent apoptotic cell death in both B cells and monocytes of MS patients that may arise from their chronic activation and persistent stimulation by activated T cells. Ongoing caspase-3 activation functionally impacts on MS monocyte properties influencing the STAT-3/IL-16 axis, thus, driving increased expression and massive release of the bio-active IL-16 triggering and perpetuating CD4+ T cell migration. Importantly, our analysis also identified a previously unknown multi-component defect in type I IFN-mediated signaling and response to virus pathways specific of MS B cells, impacting on induction of anti-viral responses and Epstein-barr virus infection control in patients. Taking advantage of cell type-specific transcriptomics and in-depth functional validation, this study revealed pathogenic contribution of endogenous IFN signaling and IFN-regulated cell processes to MS pathogenesis with implications on fate and functions of B cells and monocytes that may hold therapeutic potential.
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Affiliation(s)
- Martina Severa
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Fabiana Rizzo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Sundararajan Srinivasan
- Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Di Dario
- Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Giacomini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Chiara Buscarinu
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy
| | - Melania Cruciani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marilena P Etna
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Sandini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rosella Mechelli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy; Department of Human Science and Promotion of Quality of Life, San Raffaele Roma Open University and IRCCS San Raffaele-Pisana, Rome, Italy
| | - Antonella Farina
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Pankaj Trivedi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Paul J Hertzog
- Department of Molecular and Translational Sciences, Monash University, Clayton, Australia
| | - Marco Salvetti
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University, Rome, Italy; Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Isernia, Italy
| | - Cinthia Farina
- Institute of Experimental Neurology (INSpe), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Eliana M Coccia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
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La Starza S, Ferraldeschi M, Buscarinu MC, Romano S, Fornasiero A, Mechelli R, Umeton R, Ristori G, Salvetti M. Genome-Wide Multiple Sclerosis Association Data and Coagulation. Front Neurol 2019; 10:95. [PMID: 30837932 PMCID: PMC6383413 DOI: 10.3389/fneur.2019.00095] [Citation(s) in RCA: 5] [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: 09/30/2018] [Accepted: 01/24/2019] [Indexed: 12/28/2022] Open
Abstract
The emerging concept of a crosstalk between hemostasis, inflammation, and immune system prompt recent works on coagulation cascade in multiple sclerosis (MS). Studies on MS pathology identified several coagulation factors since the beginning of the disease pathophysiology: fibrin deposition with breakdown of blood brain barrier, and coagulation factors within active plaques may exert pathogenic role, especially through the innate immune system. Studies on circulating coagulation factors showed complex imbalance involving several components of hemostasis cascade (thrombin, factor X, factor XII). To analyze the role of the coagulation process in connection with other pathogenic pathways, we implemented a systematic matching of genome-wide association studies (GWAS) data with an informative and unbiased network of coagulation pathways. Using MetaCore (version 6.35 build 69300, 2018) we analyzed the connectivity (i.e., direct and indirect interactions among two networks) between the network of the coagulation process and the network resulting from feeding into MetaCore the MS GWAS data. The two networks presented a remarkable over-connectivity: 958 connections vs. 561 expected by chance; z-score = 17.39; p-value < 0.00001. Moreover, genes coding for cluster of differentiation 40 (CD40) and plasminogen activator, urokinase (PLAU) shared both networks, pointed to an integral interplay between coagulation cascade and main pathogenic immune effectors. In fact, CD40 pathways is especially operative in B cells, that are currently a major therapeutic target in MS field. The potential interaction of PLAU with a signal of paramount importance for B cell pathogenicity, such as CD40, suggest new lines of research and pave the way to implement new therapeutic targets.
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Affiliation(s)
- Sara La Starza
- Geriatrics, Neuroscience, Orthopaedics, Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michela Ferraldeschi
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Silvia Romano
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Arianna Fornasiero
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Rosella Mechelli
- Department of Human Science and Promotion of Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Renato Umeton
- Department of Informatics & Analytics, Dana-Farber Cancer Institute, Boston, MA, United States.,Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital, Sapienza University, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
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Landi D, Ragonese P, Prosperini L, Nociti V, Haggiag S, Cortese A, Fantozzi R, Pontecorvo S, Ferraro E, Buscarinu MC, Mataluni G, Monteleone F, Salvetti M, Di Battista G, Francia A, Millefiorini E, Gasperini C, Mirabella M, Salemi G, Boffa L, Pozzilli C, Centonze D, Marfia GA. Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:1272-1278. [PMID: 29970387 DOI: 10.1136/jnnp-2018-318468] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/25/2018] [Accepted: 06/11/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate clinical and radiological outcomes of women with relapsing-remitting multiple sclerosis (RRMS) undergoing abortion. METHODS An independent, multicentre retrospective study was conducted collecting data from eight Italian MS centres. We compared the preconception and postabortion annualised relapse rate (ARR) and number of Gadolinium enhancing (Gd+) lesions, by analyses of covariance. Variables associated with postabortion clinical and MRI activity were investigated using Poisson regression models; each abortion was considered as a statistical unit. RESULTS From 1995 to 2017, we observed 188 abortions (17 elective) in 153 women with RRMS. Abortions occurred after a mean time of 9.5 (4.4) weeks from estimated conception date. In 86 events out of 188, conception happened during treatment with disease modifying drugs. The mean postabortion ARR (0.63±0.74) was significantly increased (p=0.037) compared with the preconception year (0.50±0.71) as well as the postabortion mean number of new Gd+ lesions (0.77±1.40 vs 0.39±1.04; p=0.004). Higher likelihood of relapses was predicted by higher preconception ARR, discontinuation of preconception treatment and elective abortion; the occurrence of new Gd+ lesions was associated with higher preconception number of active lesions, discontinuation of preconception treatment, shorter length of pregnancy maintenance and elective abortion. CONCLUSIONS Abortion was associated with clinical and radiological inflammatory rebound remarkably in the first 12 months postevent. Deregulated proinflammatory processes arising at the early stages of pregnancy might play a role both in MS reactivation and abortion. Women with MS should be counselled about these risks of abortion and followed up accordingly.
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Affiliation(s)
- Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Paolo Ragonese
- Department of Biomedicine and Clinical Neuroscience, P. Giaccone University Hospital, Palermo, Italy
| | - Luca Prosperini
- Multiple Sclerosis Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Cattolica University, A. Gemelli University Hospital Foundation, Rome, Italy.,Neurorehabilitation Department, Don C. Gnocchi Foundation Onlus, Milan, Italy
| | - Shalom Haggiag
- Multiple Sclerosis Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Antonio Cortese
- Multiple Sclerosis Center, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Roberta Fantozzi
- Neurology and Neurorehabilitation Units, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Simona Pontecorvo
- Multiple Sclerosis Center, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Elisabetta Ferraro
- Multiple Sclerosis Center, San Filippo Neri Hospital - ASL Roma 1, Rome, Italy
| | - Maria Chiara Buscarinu
- Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabrizia Monteleone
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Marco Salvetti
- Neurology and Neurorehabilitation Units, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.,Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | | | - Ada Francia
- Multiple Sclerosis Center, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Enrico Millefiorini
- Multiple Sclerosis Center, Policlinico Umberto I, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Claudio Gasperini
- Multiple Sclerosis Center, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Cattolica University, A. Gemelli University Hospital Foundation, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine and Clinical Neuroscience, P. Giaccone University Hospital, Palermo, Italy
| | - Laura Boffa
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Diego Centonze
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Neurology and Neurorehabilitation Units, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.,Neurology and Neurorehabilitation Units, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
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Annibali V, Umeton R, Palermo A, Severa M, Etna MP, Giglio S, Romano S, Ferraldeschi M, Buscarinu MC, Vecchione A, Annese A, Policano C, Mechelli R, Pizzolato Umeton R, Fornasiero A, Angelini DF, Guerrera G, Battistini L, Coccia EM, Salvetti M, Ristori G. Analysis of coding and non-coding transcriptome of peripheral B cells reveals an altered interferon response factor (IRF)-1 pathway in multiple sclerosis patients. J Neuroimmunol 2018; 324:165-171. [PMID: 30270021 DOI: 10.1016/j.jneuroim.2018.09.005] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 01/15/2023]
Abstract
Several evidences emphasize B-cell pathogenic roles in multiple sclerosis (MS). We performed transcriptome analyses on peripheral B cells from therapy-free patients and age/sex-matched controls. Down-regulation of two transcripts (interferon response factor 1-IRF1, and C-X-C motif chemokine 10-CXCL10), belonging to the same pathway, was validated by RT-PCR in 26 patients and 21 controls. IRF1 and CXCL10 transcripts share potential seeding sequences for hsa-miR-424, that resulted up-regulated in MS patients. We confirmed this interaction and its functional effect by transfection experiments. Consistent findings indicate down-regulation of IRF1/CXCL10 axis, that may plausibly contribute to a pro-survival status of B cells in MS.
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Affiliation(s)
- Viviana Annibali
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Renato Umeton
- Department of Informatics, Dana-Farber Cancer Institute, Boston, MA, United States; Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Antonia Palermo
- Department of Mathematics and Computer Science, University of Calabria
| | - Martina Severa
- Department of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Marilena Paola Etna
- Department of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Simona Giglio
- Division of Pathology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Romano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Ferraldeschi
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Andrea Vecchione
- Division of Pathology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Anita Annese
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Claudia Policano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Arianna Fornasiero
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Eliana Marina Coccia
- Department of Infectious, Parasitic and Immune-mediated Disease, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Salvetti
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed (M.S.), Pozzilli, IS, Italy.
| | - Giovanni Ristori
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
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Prosperini L, Lucchini M, Haggiag S, Bellantonio P, Bianco A, Buscarinu MC, Buttari F, Centonze D, Cortese A, De Giglio L, Fantozzi R, Ferraro E, Fornasiero A, Francia A, Galgani S, Gasperini C, Marfia GA, Millefiorini E, Nociti V, Pontecorvo S, Pozzilli C, Ruggieri S, Salvetti M, Sgarlata E, Mirabella M. Fingolimod vs dimethyl fumarate in multiple sclerosis: A real-world propensity score-matched study. Neurology 2018; 91:e153-e161. [PMID: 29875218 DOI: 10.1212/wnl.0000000000005772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/06/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To directly compare fingolimod (FNG) and dimethyl fumarate (DMF) on no evident disease activity (NEDA) status in patients with relapsing-remitting multiple sclerosis (RRMS) from 7 multiple sclerosis outpatient clinics in Central Italy. METHODS We analyzed data of patients with RRMS who started an oral agent, namely DMF or FNG, either as first treatment (naives) or after switching from self-injectable drugs (switchers). We performed a propensity score (PS)-based nearest-neighbor matching within a caliper of 0.05 to select patients with homogeneous baseline characteristics. Pairwise censoring was adopted to adjust for difference in length of follow-up between the 2 treatment groups. Comparisons were then conducted in matched samples with Cox models (stratified by center) with NEDA-3 as the main outcome. NEDA-3 was defined as no relapses, no disability worsening, and no MRI activity. RESULTS Overall, 483 and 456 patients eligible for analysis started on FNG and DMF, respectively. The PS-matching procedure retained a total of 550 patients (275 per group). After a median on-study follow-up of 18 months, the proportions of patients with NEDA-3 were similar (FNG 73%, DMF 70%; hazard ratio [HR] 0.74, p = 0.078). Subgroup analyses showed a comparable effectiveness of the 2 drugs in naives (n = 170, HR 1.15, p = 0.689), whereas FNG was superior to DMF in the achievement of NEDA-3 status among switchers (n = 380, HR 0.57, p = 0.007). CONCLUSION We found no significant difference between FNG and DMF on NEDA-3 status, while subgroup analyses suggest the superiority of FNG over DMF in patients switching from self-injectable drugs. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with RRMS, DMF and FNG have comparable efficacy in treatment-naive patients and that FNG is superior to DMF in patients switching from self-injectable drugs.
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Affiliation(s)
- Luca Prosperini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy.
| | - Matteo Lucchini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Shalom Haggiag
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Paolo Bellantonio
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Assunta Bianco
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Maria Chiara Buscarinu
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Fabio Buttari
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Diego Centonze
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Antonio Cortese
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Laura De Giglio
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Roberta Fantozzi
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Elisabetta Ferraro
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Arianna Fornasiero
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Ada Francia
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Simonetta Galgani
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Claudio Gasperini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Girolama Alessandra Marfia
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Enrico Millefiorini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Viviana Nociti
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Simona Pontecorvo
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Carlo Pozzilli
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Serena Ruggieri
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Marco Salvetti
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Eleonora Sgarlata
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Massimiliano Mirabella
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
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Lanzillo R, Prosperini L, Gasperini C, Moccia M, Fantozzi R, Tortorella C, Nociti V, Annovazzi P, Cavalla P, Radaelli M, Malucchi S, Clerici VT, Boffa L, Buttari F, Ragonese P, Maniscalco GT, Di Filippo M, Buscarinu MC, Pinardi F, Gallo A, Coghe G, Pesci I, Laroni A, Gajofatto A, Calabrese M, Tomassini V, Cocco E, Solaro C. A multicentRE observational analysiS of PErsistenCe to Treatment in the new multiple sclerosis era: the RESPECT study. J Neurol 2018; 265:1174-1183. [PMID: 29549468 DOI: 10.1007/s00415-018-8831-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/03/2018] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Abstract
In this independent, multicenter, retrospective study, we investigated the short-term persistence to treatment with first-line self-injectable or oral disease-modifying treatments (DMTs) in patients with relapsing-remitting multiple sclerosis. Data of patients regularly attending 21 Italian MS Centres who started a self-injectable or an oral DMT in 2015 were collected to: (1) estimate the proportion of patients discontinuing the treatment; (3) explore reasons for discontinuation; (3) identify baseline predictors of treatment discontinuation over a follow-up period of 12 months. We analyzed data of 1832 consecutive patients (1289 women, 543 men); 374 (20.4%) of them discontinued the prescribed DMT after a median time of 6 months (range 3 days to 11.5 months) due to poor tolerability (n = 163; 43.6%), disease activity (n = 95; 25.4%), adverse events (n = 64; 17.1%), convenience (i.e. availability of new drug formulations) and pregnancy planning (n = 21; 1.1%). Although the proportion of discontinuers was higher with self-injectable (n = 107; 22.9%) than with oral DMT (n = 215; 16.4%), the Cox regression model revealed no significant between-group difference (p = 0.12). Female sex [hazard ratio (HR) = 1.39, p = 0.01] and previous exposure to ≥ 3 DMTs (HR = 1.71, p = 0.009) were two independent risk factors for treatment discontinuation, regardless of prescribed DMTs. Our study confirms that persistence to treatment represents a clinical challenge, irrespective of the route of administration.
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Affiliation(s)
- Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Claudio Gasperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Viviana Nociti
- Department of Geriatrics, Neurosciences and Orthopedics, Institute of Neurology, Catholic University, Rome, Italy
| | - Pietro Annovazzi
- MS Study Center, ASST Valle Olona, Gallarate Hospital, Gallarate, VA, Italy
| | - Paola Cavalla
- MS Center, Neurology 1 Unit, City of Health and Science University Hospital, Turin, Italy
| | - Marta Radaelli
- Division of Neuroscience, Institute of Experimental Neuroscience (INSpe), S. Raffaele Scientific Institute, Milan, Italy
| | - Simona Malucchi
- SCDO Neurologia 2-Regional Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, TO, Italy
| | - Valentina Torri Clerici
- Department of Neuroimmunology and Neuromuscular Diseases, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Laura Boffa
- MS Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Department of Neurology, IRCCS NEUROMED, Pozzilli, IS, Italy
- MS Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Paolo Ragonese
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | | | | | - Maria Chiara Buscarinu
- Department of Neurosciences, Center for Experimental Neurological Therapies, S. Andrea Hospital, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Federica Pinardi
- MS Centre, Bellaria Hospital, UOSI-SM Rehabilitation, Bellaria, BO, Italy
| | - Antonio Gallo
- I Clinic of Neurology, University of Campania, Naples, Italy
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Pesci
- MS Centre, Neurology Unit, S. Secondo Hospital, Fidenza, PA, Italy
| | - Alice Laroni
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, University Hospital of Verona, Verona, Italy
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudio Solaro
- Neurology Unit, Centro di Recupero e Rieducazione Funzionale, Moncrivello, VC, Italy
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Buscarinu MC, Romano S, Mechelli R, Pizzolato Umeton R, Ferraldeschi M, Fornasiero A, Reniè R, Cerasoli B, Morena E, Romano C, Loizzo ND, Umeton R, Salvetti M, Ristori G. Intestinal Permeability in Relapsing-Remitting Multiple Sclerosis. Neurotherapeutics 2018; 15:68-74. [PMID: 29119385 PMCID: PMC5794695 DOI: 10.1007/s13311-017-0582-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 12/13/2022] Open
Abstract
Changes of intestinal permeability (IP) have been extensively investigated in inflammatory bowel diseases (IBD) and celiac disease (CD), underpinned by a known unbalance between microbiota, IP and immune responses in the gut. Recently the influence of IP on brain function has greatly been appreciated. Previous works showed an increased IP that preceded experimental autoimmune encephalomyelitis development and worsened during disease with disruption of TJ. Moreover, studying co-morbidity between Crohn's disease and MS, a report described increased IP in a minority of cases with MS. In a recent work we found that an alteration of IP is a relatively frequent event in relapsing-remitting MS, with a possible genetic influence on the determinants of IP changes (as inferable from data on twins); IP changes included a deficit of the active mechanism of absorption from intestinal lumen. The results led us to hypothesize that gut may contribute to the development of MS, as suggested by another previous work of our group: a population of CD8+CD161high T cells, belonging to the mucosal-associated invariant T (MAIT) cells, a gut- and liver-homing subset, proved to be of relevance for MS pathogenesis. We eventually suggest future lines of research on IP in MS: studies on IP changes in patients under first-line oral drugs may result useful to improve their therapeutic index; correlating IP and microbiota changes, or IP and blood-brain barrier changes may help clarify disease pathogenesis; exploiting the IP data to disclose co-morbidities in MS, especially with CD and IBD, may be important for patient care.
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Affiliation(s)
- M C Buscarinu
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - S Romano
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - R Mechelli
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - R Pizzolato Umeton
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - M Ferraldeschi
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - A Fornasiero
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - R Reniè
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - B Cerasoli
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - E Morena
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - C Romano
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - N D Loizzo
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
| | - R Umeton
- Department of Informatics, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M Salvetti
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - G Ristori
- Centre for Experimental Neurological Therapies, Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, via di Grottarossa, 1035, 00189, Rome, Italy.
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Giacomini E, Rizzo F, Etna MP, Cruciani M, Mechelli R, Buscarinu MC, Pica F, D’Agostini C, Salvetti M, Coccia EM, Severa M. Thymosin-α1 expands deficient IL-10-producing regulatory B cell subsets in relapsing–remitting multiple sclerosis patients. Mult Scler 2017; 24:127-139. [DOI: 10.1177/1352458517695892] [Citation(s) in RCA: 16] [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: 11/16/2022]
Abstract
Background: B cells are key pathogenic effectors in multiple sclerosis (MS) and several therapies have been designed to restrain B cell abnormalities by directly targeting this lymphocyte population. Objectives: Moving from our data showing a Toll-like receptor (TLR)7-driven dysregulation of B cell response in relapsing–remitting multiple sclerosis (RRMS) and having found a low serum level of Thymosin-α1 (Tα1) in patients, we investigated whether the addition of this molecule to peripheral blood mononuclear cells (PBMCs) would influence the expansion of regulatory B cell subsets, known to dampen autoimmune inflammation. Methods: Serum Tα1 level was measured by enzyme immunoassay. Cytokine expression was evaluated by Cytometric Bead Array (CBA), enzyme-linked immunosorbent assay (ELISA), and real-time reverse transcription polymerase chain reaction (RT-PCR). B cell subsets were analyzed by flow cytometry. Results: Tα1 pre-treatment induces an anti-inflammatory status in TLR7-stimulated RRMS PBMC cultures, reducing the secretion of pro-inflammatory interleukin (IL)-6, IL-8, and IL-1β while significantly increasing the regulatory IL-10 and IL-35. Indeed, Tα1 treatment enhanced expansion of CD19+CD24+CD38hi transitional-immature and CD24low/negCD38hi plasmablast-like regulatory B cell subsets, which likely inhibit both interferon (IFN)-γ and IL-17 production. Conclusion:: Our study reveals a deficient ability of B cells from MS patients to differentiate into regulatory subsets and unveils a novel anti-inflammatory and repurposing potential for Tα1 in MS targeting B cell response.
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Affiliation(s)
- Elena Giacomini
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fabiana Rizzo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marilena P Etna
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Melania Cruciani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rosella Mechelli
- Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Francesca Pica
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Cartesio D’Agostini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy/Clinical Microbiology Laboratories, Tor Vergata Hospital, Rome, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Eliana M Coccia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Severa
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Chiara M, Manzari C, Lionetti C, Mechelli R, Anastasiadou E, Chiara Buscarinu M, Ristori G, Salvetti M, Picardi E, D'Erchia AM, Pesole G, Horner DS. Geographic Population Structure in Epstein-Barr Virus Revealed by Comparative Genomics. Genome Biol Evol 2016; 8:3284-3291. [PMID: 27635051 PMCID: PMC5203774 DOI: 10.1093/gbe/evw226] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Epstein-Barr virus (EBV) latently infects the majority of the human population and is implicated as a causal or contributory factor in numerous diseases. We sequenced 27 complete EBV genomes from a cohort of Multiple Sclerosis (MS) patients and healthy controls from Italy, although no variants showed a statistically significant association with MS. Taking advantage of the availability of ∼130 EBV genomes with known geographical origins, we reveal a striking geographic distribution of EBV sub-populations with distinct allele frequency distributions. We discuss mechanisms that potentially explain these observations, and their implications for understanding the association of EBV with human disease.
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Affiliation(s)
- Matteo Chiara
- Department of Biosciences, University of Milan, Milan, Italy
| | - Caterina Manzari
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy
| | - Claudia Lionetti
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy
| | - Rosella Mechelli
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Eleni Anastasiadou
- Department of Pathology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Maria Chiara Buscarinu
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giovanni Ristori
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Marco Salvetti
- Centre for Experimental Neurological Therapies, S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Ernesto Picardi
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy.,Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, "A. Moro", Bari, Italy
| | - Anna Maria D'Erchia
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy.,Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, "A. Moro", Bari, Italy
| | - Graziano Pesole
- Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy.,Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, "A. Moro", Bari, Italy
| | - David S Horner
- Department of Biosciences, University of Milan, Milan, Italy .,Institute of Biomembranes and Bioenergetics, Consiglio Nazionale delle Ricerche, Bari, Italy
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42
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Purchiaroni F, Salvetti M, Buscarinu MC, Annibale B. Eosinophilic gastroenteritis in a woman with multiple sclerosis on dimethyl fumarate. Neurology 2016; 87:952-3. [PMID: 27466473 DOI: 10.1212/wnl.0000000000003045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/18/2016] [Indexed: 02/05/2023] Open
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43
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Buscarinu MC, Cerasoli B, Annibali V, Policano C, Lionetto L, Capi M, Mechelli R, Romano S, Fornasiero A, Mattei G, Piras E, Angelini DF, Battistini L, Simmaco M, Umeton R, Salvetti M, Ristori G. Altered intestinal permeability in patients with relapsing-remitting multiple sclerosis: A pilot study. Mult Scler 2016; 23:442-446. [PMID: 27270497 DOI: 10.1177/1352458516652498] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 12/11/2022]
Abstract
BACKGROUND Alterations of intestinal permeability (IP) may contribute to the pathophysiology of immune-mediated diseases. OBJECTIVE We investigated the possible association between IP changes and multiple sclerosis (MS). METHODS We studied 22 patients with relapsing-remitting multiple sclerosis (RRMS) and 18 age- and sex-matched healthy donors (HDs), including five twin pairs (one concordant, and four discordant for disease). Measurement of lactulose (L) and mannitol (M; two non-metabolized sugars) levels in urine samples, after an oral load, allowed to quantify gut dysfunction. RESULTS The proportion of participants with increased IP was significantly higher in patients than in HDs (16/22 (73%) versus 5/18 (28%); p = 0.001). Accordingly, the L/M urinary ratio showed significantly higher values in patients than in controls ( p = 0.0284). Urinary mannitol concentration was significantly lower in patients than in controls ( p = 0.022), suggesting a deficit of absorption from intestinal lumen. Such changes did not appear related to patients' clinical-radiological features. CONCLUSION The relatively high proportion of IP changes in RR-MS patients seems to confirm our work hypothesis and warrants more work to confirm the result on a larger sample, and to understand the implications for related immunological disturbances and intestinal microbiota alterations. Our finding may also have relevance for oral treatments, recently introduced in clinical practice.
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Affiliation(s)
- Maria Chiara Buscarinu
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Benedetta Cerasoli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Viviana Annibali
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Claudia Policano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Matilde Capi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Romano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Arianna Fornasiero
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gianluca Mattei
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Eleonora Piras
- Neuroimmunology Unit, Fondazione Santa Lucia, Rome, Italy
| | | | | | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Renato Umeton
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ristori
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Severa M, Rizzo F, Giacomini E, Annibali V, Gafa V, Romano S, Buscarinu MC, Fornasiero A, Salvetti M, Coccia EM. IFN-β Therapy Regulates TLR7-Mediated Response in Plasmacytoid Dendritic Cells of Multiple Sclerosis Patients Influencing an Anti-Inflammatory Status. J Interferon Cytokine Res 2015; 35:668-81. [PMID: 25923141 DOI: 10.1089/jir.2014.0207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Plasmacytoid dendritic cells (pDCs) display altered immune-phenotype in multiple sclerosis (MS) patients and are found actively recruited in postmortem MS brain lesions, implying that their immune regulation may represent an important aspect of MS pathogenesis. Because of the reported Toll-like receptor 7 (TLR7) implication in autoimmunity, in this study we characterized how IFN-β therapy impacts on pDC activation to TLR7 triggering in MS patients, aspect only poorly investigated so far. In vivo IFN-β administration regulates pDC functions in TLR7-treated peripheral blood mononuclear cell (PBMC) cultures differently from what is observed in isolated cells, suggesting that IFN-β may activate inhibitory mechanisms in MS peripheral blood involved in turning off pDC response to dampen the ongoing inflammation. Indeed, IL-10, a key regulatory cytokine found increased upon TLR7 stimulation in in vivo IFN-β-exposed PBMCs, directly reduced pDC-mediated IFN-α production. IFN-β therapy also shaped T-cell responses by decreasing TLR7-induced pDC maturation and inducing T-cell inhibitory molecules. Accordingly, raised pDC-induced IL-27 and decreased IL-23 expression, together with high IL-10 level, contribute to inhibit Th17 cell differentiation. Our study uncovered a role for IFN-β in the regulation of TLR7-mediated pDC responses in MS toward an anti-inflammatory phenotype opening new opportunities to better understand mechanisms of action of this drug in controlling MS immunopathogenesis.
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Affiliation(s)
- Martina Severa
- 1 Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità , Rome, Italy
| | - Fabiana Rizzo
- 1 Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità , Rome, Italy
| | - Elena Giacomini
- 1 Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità , Rome, Italy
| | - Viviana Annibali
- 2 Centre for Experimental Neurological Therapies (CENTERS), S. Andrea Hospital Site, Sapienza University , Rome, Italy
| | - Valerie Gafa
- 1 Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità , Rome, Italy
| | - Silvia Romano
- 2 Centre for Experimental Neurological Therapies (CENTERS), S. Andrea Hospital Site, Sapienza University , Rome, Italy
| | - Maria Chiara Buscarinu
- 2 Centre for Experimental Neurological Therapies (CENTERS), S. Andrea Hospital Site, Sapienza University , Rome, Italy
| | - Arianna Fornasiero
- 2 Centre for Experimental Neurological Therapies (CENTERS), S. Andrea Hospital Site, Sapienza University , Rome, Italy
| | - Marco Salvetti
- 2 Centre for Experimental Neurological Therapies (CENTERS), S. Andrea Hospital Site, Sapienza University , Rome, Italy
| | - Eliana Marina Coccia
- 1 Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità , Rome, Italy
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45
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Mechelli R, Manzari C, Policano C, Annese A, Picardi E, Umeton R, Fornasiero A, D'Erchia AM, Buscarinu MC, Agliardi C, Annibali V, Serafini B, Rosicarelli B, Romano S, Angelini DF, Ricigliano VAG, Buttari F, Battistini L, Centonze D, Guerini FR, D'Alfonso S, Pesole G, Salvetti M, Ristori G. Epstein-Barr virus genetic variants are associated with multiple sclerosis. Neurology 2015; 84:1362-8. [PMID: 25740864 DOI: 10.1212/wnl.0000000000001420] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We analyzed the Epstein-Barr nuclear antigen 2 (EBNA2) gene, which contains the most variable region of the viral genome, in persons with multiple sclerosis (MS) and control subjects to verify whether virus genetic variants are involved in disease development. METHODS A seminested PCR approach and Sanger sequencing were used to analyze EBNA2 in 53 patients and 38 matched healthy donors (HDs). High-throughput sequencing by Illumina MiSeq was also applied in a subgroup of donors (17 patients and 17 HDs). Patients underwent gadolinium-enhanced MRI and human leucocyte antigen typing. RESULTS MS risk significantly correlated with an excess of 1.2 allele (odds ratio [OR] = 5.13; 95% confidence interval [CI] 1.84-14.32; p = 0.016) and underrepresentation of 1.3B allele (OR = 0.23; 95% CI 0.08-0.51; p = 0.0006). We identified new genetic variants, mostly 1.2 allele- and MS-associated (especially amino acid variation at position 245; OR = 9.4; 95% CI 1.19-78.72; p = 0.0123). In all cases, the consensus sequence from deep sequencing confirmed Sanger sequencing (including the cosegregation of newly identified variants with known EBNA2 alleles) and showed that the extent of genotype intraindividual variability was higher than expected: rare EBNA2 variants were detected in all HDs and patients with MS (range 1-17 and 3-19, respectively). EBNA2 variants did not seem to correlate with human leucocyte antigen typing or clinical/MRI features. CONCLUSIONS Our study unveils a strong association between Epstein-Barr virus genomic variants and MS, reinforcing the idea that Epstein-Barr virus contributes to disease development.
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Affiliation(s)
- Rosella Mechelli
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Caterina Manzari
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Claudia Policano
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Anita Annese
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Ernesto Picardi
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Renato Umeton
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Arianna Fornasiero
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Anna Maria D'Erchia
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Maria Chiara Buscarinu
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Cristina Agliardi
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Viviana Annibali
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Barbara Serafini
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Barbara Rosicarelli
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Silvia Romano
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Daniela F Angelini
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Vito A G Ricigliano
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Fabio Buttari
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Luca Battistini
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Diego Centonze
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Franca R Guerini
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Sandra D'Alfonso
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Graziano Pesole
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
| | - Marco Salvetti
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy.
| | - Giovanni Ristori
- From the Centre for Experimental Neurological Therapies (R.M., C.P., R.U., V.A.G.R., A.F., V.A., M.C.B., S.R., M.S., G.R.), S. Andrea Hospital-site, Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sapienza University, Rome; Don C. Gnocchi Foundation IRCCS (F.R.G., C.A.), S. Maria Nascente, Milan; Department of Health Sciences (S.D.), Interdisciplinary Research Center of Autoimmune Diseases, Eastern Piedmont University, Novara; Clinica Neurologica (F.B., D.C.), Dipartimento di Medicina dei Sistemi, University of Tor Vergata, Rome; Department of Cell Biology and Neuroscience (B.S., B.R.), Istituto Superiore di Sanità, Rome; Department of Bioscience, Biotechnology and Biopharmaceutics (C.M., A.A., A.M.D., E.P., G.P.) University of Bari "Aldo Moro"; Institute of Biomembranes and Bioenergetics (G.P.), CNR, Bari; and Neuroimmunology Unit (D.F.A., L.B.), Fondazione Santa Lucia (I.R.C.C.S.), Rome, Italy
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Annibali V, Mechelli R, Romano S, Buscarinu MC, Fornasiero A, Umeton R, Ricigliano VAG, Orzi F, Coccia EM, Salvetti M, Ristori G. IFN-β and multiple sclerosis: from etiology to therapy and back. Cytokine Growth Factor Rev 2014; 26:221-8. [PMID: 25466632 DOI: 10.1016/j.cytogfr.2014.10.010] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/22/2014] [Indexed: 01/09/2023]
Abstract
Several immunomodulatory treatments are currently available for relapsing-remitting forms of multiple sclerosis (RRMS). Interferon beta (IFN) was the first therapeutic intervention able to modify the course of the disease and it is still the most used first-line treatment in RRMS. Though two decades have passed since IFN-β was introduced in the management of MS, it remains a valid approach because of its good benefit/risk profile. This is witnessed by new efforts of pharmaceutical industry to improve this line: a PEGylated form of subcutaneous IFN-β 1a, (Plegridy(®)) with a longer half-life, has been recently approved in RRMS. This review will survey the various stages of the use of type I IFN in MS, with special attention to the effect of the treatment on the supposed viral etiologic factors associated to the disease. The antiviral activities of IFN (that initially prompted its use as immunomodulatory agent in MS), and the mounting evidences in favor of a viral etiology in MS, allowed us to outline a re-appraisal from etiology to therapy and back.
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Affiliation(s)
- V Annibali
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - R Mechelli
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - S Romano
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - M C Buscarinu
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - A Fornasiero
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - R Umeton
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - V A G Ricigliano
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy; Neuroimmunology Unit, Fondazione Santa Lucia-I.R.C.C.S., Rome, Italy
| | - F Orzi
- Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
| | - E M Coccia
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - M Salvetti
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy.
| | - G Ristori
- Centre for Experimental Neurological Therapies (CENTERS), Neurology and Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Italy
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Coarelli G, Manzari C, Annese A, Anastasiadou E, Policano C, D'erchia AM, Picardi E, Buscarinu MC, Annibali V, Ricigliano VA, Tullo A, Trivedi P, Pesole G, Ristori G, Salvetti M, Mechelli R. Characterization of Epstein–Barr virus genotypes in multiple sclerosis through next generation sequencing approaches. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.209] [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: 11/27/2022]
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48
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Annibali V, Umeton R, Palermo A, Buscarinu MC, Policano C, Mechelli R, Romano S, Angelini DF, Piras E, Mattei G, Ricigliano VAG, Annese A, Battistini L, Salvetti M, Ristori G. B cell IRF1 pathway is dysregulated in multiple sclerosis. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.009] [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]
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49
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Annibali V, Policano C, Buscarinu MC, Lionetto L, Mechelli R, Capi M, Mattei C, Piras E, Angelini DF, Monteleone I, Monteleone G, Battistini L, Simmaco M, Ristori G, Salvetti M. Intestinal permeability in multiple sclerosis. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Ristori G, Romano S, Coarelli G, Buscarinu MC, Salvetti M. Author response. Neurology 2014; 83:381. [PMID: 25184184] [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: 06/03/2023] Open
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