1
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Redondo J, Bailey S, Kemp KC, Scolding NJ, Rice CM. The Bone Marrow Microenvironment in Immune-Mediated Inflammatory Diseases: Implications for Mesenchymal Stromal Cell-Based Therapies. Stem Cells Transl Med 2024; 13:219-229. [PMID: 38097199 PMCID: PMC10940816 DOI: 10.1093/stcltm/szad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/09/2023] [Indexed: 03/16/2024] Open
Abstract
Bone marrow (BM)-derived mesenchymal stromal cells (MSCs) are promising candidates for cell-based therapy for several immune-mediated inflammatory diseases (IMIDs) due to their multiplicity of immunomodulatory and reparative properties and favorable safety profile. However, although preclinical data were encouraging, the clinical benefit demonstrated in clinical trials of autologous MSC transplantation in a number of conditions has been less robust. This may be explained by the growing body of evidence pointing to abnormalities of the bone marrow microenvironment in IMIDs, including impaired MSC function. However, it is not currently known whether these abnormalities arise as a cause or consequence of disease, the role they play in disease initiation and/or progression, or whether they themselves are targets for disease modification. Here, we review current knowledge about the function of the BM microenvironment in IMIDs including multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and type I diabetes, focusing on MSCs in particular. We predict that an improved understanding of disease-related changes in the bone marrow microenvironment including the role of MSCs in vivo, will yield new insights into pathophysiology and aid identification of new drug targets and optimization of cell-based therapy in IMIDs.
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Affiliation(s)
- Juliana Redondo
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steven Bailey
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kevin C Kemp
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Neil J Scolding
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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2
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Brittain G, Coles AJ, Giovannoni G, Muraro PA, Palace J, Petrie J, Roldan E, Scolding NJ, Snowden JA, Sharrack B. Autologous haematopoietic stem cell transplantation for immune-mediated neurological diseases: what, how, who and why? Pract Neurol 2023; 23:139-145. [PMID: 36162855 DOI: 10.1136/pn-2022-003531] [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] [Accepted: 08/26/2022] [Indexed: 11/04/2022]
Abstract
In carefully selected patients, autologous haematopoietic stem cell transplantation (HSCT) is a safe, highly effective and cost-saving treatment modality for treatment-resistant, and potentially treatment-naïve, immune-mediated neurological disorders. Although the evidence base has been growing in the last decade, limited understanding has led to confusion, mistrust and increasing use of health tourism. In this article, we discuss what autologous HSCT is, which immune-mediated conditions can be treated with it, how to select patients, what are the expected outcomes and potential adverse effects, and how cost-effective this treatment is.
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Affiliation(s)
- Gavin Brittain
- Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
| | - Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - G Giovannoni
- Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, London, UK
| | | | | | - Jennifer Petrie
- Clinical Trials Research Unit, The University of Sheffield, Sheffield, UK
| | - Elisa Roldan
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N J Scolding
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Basil Sharrack
- Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
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3
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Rice CM, Sarkar P, Walsh P, Owen D, Bidgood C, Smith P, Kane NM, Asghar S, Marks DI, Scolding NJ. Repeat infusion of autologous bone marrow cells in progressive multiple sclerosis - A phase I extension study (SIAMMS II). Mult Scler Relat Disord 2022; 61:103782. [PMID: 35397289 DOI: 10.1016/j.msard.2022.103782] [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: 01/11/2022] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND During the safety and feasibility 'Study of Intravenous Autologous Marrow in Multiple Sclerosis (SIAMMS)', intravenous infusion of autologous marrow was well tolerated. The efficacy of the approach is being explored in a placebo-controlled randomised controlled trial (ACTiMuS, NCT01815632) but it is not known whether repeated infusions will be required to optimise benefit. The objective of the current study was to explore the safety and feasibility of repeat treatment with intravenous autologous bone marrow for patients with progressive multiple sclerosis (MS). METHODS 'SIAMMS II' was a prospective, single centre phase I extension study in which participants in the SIAMMS study were offered repeat bone marrow harvest and infusion of autologous, unfractionated bone marrow as a day-case procedure. The primary outcome measure was number of adverse events and secondary outcome measures included change in clinical rating scales of disability, global evoked potential and cranial magnetic resonance imaging (MRI). RESULTS In total, 4 of the 6 participants in the SIAMMS study had repeat bone marrow harvest and infusion of filtered autologous marrow as a day case procedure which was well tolerated. There were no serious adverse effects. Additional outcome measures including clinical scales, global evoked potentials and cranial MRI were stable. CONCLUSION SIAMMS II demonstrates the safety and feasibility of repeated, non-myeloablative autologous bone marrow-derived cell therapy in progressive MS.
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Affiliation(s)
- Claire M Rice
- Clinical Neuroscience, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NBww, UK; Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Pamela Sarkar
- Clinical Neuroscience, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NBww, UK; Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Peter Walsh
- Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Denise Owen
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Bidgood
- Adult BMT Unit, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, St Michael's Hill, Bristol BS2 8BJ, UK
| | - Paul Smith
- Department of Neuroradiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nick M Kane
- Department of Neurophysiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Suhail Asghar
- NHS Blood and Transplant, North Bristol Park, Filton, Bristol, UK
| | - David I Marks
- Clinical Neuroscience, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NBww, UK; Adult BMT Unit, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, St Michael's Hill, Bristol BS2 8BJ, UK
| | - Neil J Scolding
- Clinical Neuroscience, Bristol Medical School, University of Bristol, Level 1 Learning and Research Building, Southmead Hospital, Bristol, BS10 5NBww, UK
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4
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Scolding NJ. Amyloid cerebrovasculopathies. Pract Neurol 2022; 22:181-182. [DOI: 10.1136/practneurol-2022-003386] [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] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
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5
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Sarkar P, Redondo J, Hares K, Bailey S, Georgievskaya A, Heesom K, Kemp KC, Scolding NJ, Rice CM. Reduced expression of mitochondrial fumarate hydratase in progressive multiple sclerosis contributes to impaired in vitro mesenchymal stromal cell-mediated neuroprotection. Mult Scler 2021; 28:1179-1188. [PMID: 34841955 PMCID: PMC9189727 DOI: 10.1177/13524585211060686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Background: Cell-based therapies for multiple sclerosis (MS), including those employing
autologous bone marrow-derived mesenchymal stromal cells (MSC) are being
examined in clinical trials. However, recent studies have identified
abnormalities in the MS bone marrow microenvironment. Objective: We aimed to compare the secretome of MSC isolated from control subjects
(C-MSC) and people with MS (MS-MSC) and explore the functional relevance of
findings. Methods: We employed high throughput proteomic analysis, enzyme-linked immunosorbent
assays and immunoblotting, as well as in vitro assays of enzyme activity and
neuroprotection. Results: We demonstrated that, in progressive MS, the MSC secretome has lower levels
of mitochondrial fumarate hydratase (mFH). Exogenous mFH restores the in
vitro neuroprotective potential of MS-MSC. Furthermore, MS-MSC expresses
reduced levels of fumarate hydratase (FH) with downstream reduction in
expression of master regulators of oxidative stress. Conclusions: Our findings are further evidence of dysregulation of the bone marrow
microenvironment in progressive MS with respect to anti-oxidative capacity
and immunoregulatory potential. Given the clinical utility of the fumaric
acid ester dimethyl fumarate in relapsing–remitting MS, our findings have
potential implication for understanding MS pathophysiology and personalised
therapeutic intervention.
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Affiliation(s)
- Pamela Sarkar
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Juliana Redondo
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kelly Hares
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steven Bailey
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Anastasia Georgievskaya
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Heesom
- Bristol Proteomics Facility, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Kevin C Kemp
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Neil J Scolding
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Claire M Rice
- Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Department of Neurology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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6
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Olum S, Scolding P, Hardy C, Obol J, Scolding NJ. Response to: 'Nodding syndrome, many questions remain but we can prevent it by eliminating onchocerciasis'. Brain Commun 2021; 3:fcaa229. [PMID: 33502386 PMCID: PMC7811753 DOI: 10.1093/braincomms/fcaa229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sam Olum
- Faculty of Medicine, Gulu University, Uganda
| | | | - Charlotte Hardy
- Faculty of Medicine, Gulu University, Uganda
- Royal United Hospital, Bath, UK
| | - James Obol
- Faculty of Medicine, Gulu University, Uganda
| | - Neil J Scolding
- Faculty of Medicine, Gulu University, Uganda
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
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7
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Abstract
Nodding syndrome is an uncommon epileptic disorder of childhood onset, which appears to occur exclusively in clusters in sub-Saharan Africa. It was first reported in the 1960s, in what is now southern Tanzania, then in Liberia, and later in South Sudan and northern Uganda, with both epidemic and endemic patterns described. The cause remains unknown. Here we describe the background and development of descriptions of the disorder, review its clinical features and summarize current theories and studies concerning its cause, outlining the principal remaining research questions relating to this highly unusual disease.
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Affiliation(s)
- Sam Olum
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Peter Scolding
- Department of Medicine, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Charlotte Hardy
- Faculty of Medicine, Gulu University, Gulu, Uganda.,Emergency Department, Royal United Hospital, Bath BA1 3NG, UK
| | - James Obol
- Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Neil J Scolding
- Faculty of Medicine, Gulu University, Gulu, Uganda.,Institute of Clinical Neurosciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK
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8
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Snethen H, Ye J, Gillespie KM, Scolding NJ. Maternal micro-chimeric cells in the multiple sclerosis brain. Mult Scler Relat Disord 2020; 40:101925. [PMID: 31986425 DOI: 10.1016/j.msard.2020.101925] [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: 10/11/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/26/2022]
Abstract
Maternal microchimeric cells (MMC) pass across the placenta from a mother to her baby during pregnancy. MMC have been identified in healthy adults, but have been reported to be more frequent and at a higher concentration in individuals with autoimmune diseases. MMC in brain tissue from individuals with autoimmune neurological disease has never previously been explored. The present study aims to identify and quantify MMC in adult human brain from control and multiple sclerosis (MS) affected individuals using fluorescent in situ hybridization (FISH) with a probe for the X and Y chromosomes. Post mortem brain tissue from 6 male MS cases and 6 male control cases were examined. Female cells presumed to be MMC were identified in 5/6 MS cases and 6/6 control cases. Cell specific labeling identified female cells of neuronal and immune phenotype in both control and active MS lesion tissue. This study shows that female cells presumed to be MMC are a common phenomenon in adult human brain where they appear to have embedded into brain tissue with the ability to express tissue specific markers.
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Affiliation(s)
- Heidi Snethen
- MS and stem cell group, Clinical Neuroscience, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jody Ye
- Diabetes and Metabolism Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kathleen M Gillespie
- Diabetes and Metabolism Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Neil J Scolding
- MS and stem cell group, Clinical Neuroscience, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
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9
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Okidi R, Ogwang DM, Okello TR, Ezati D, Kyegombe W, Nyeko D, Scolding NJ. Factors affecting mortality after traumatic brain injury in a resource-poor setting. BJS Open 2019; 4:320-325. [PMID: 32207576 PMCID: PMC7093795 DOI: 10.1002/bjs5.50243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/18/2019] [Accepted: 11/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background Traumatic brain injury (TBI) is a major cause of long‐term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource‐poor setting. Methods Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary's Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In‐hospital management and mortality were recorded. Severe head injury was defined as a Glasgow Coma Scale score below 9. Results A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4·9 : 1). Some 30·9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8·8 per cent. Treatment was mainly conservative in 94·8 per cent of patients; three patients (1·5 per cent) had burr‐holes, four (2·1 per cent) had a craniotomy, and three (1·5 per cent) had skull fracture elevation. The mortality rate was 33·0 per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr‐hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0·012), referral status (P = 0·001), respiratory distress (P = 0·040), severe head injury (P = 0·011) and pupil reactivity (P = 0·011). Conclusion TBI in a resource‐poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes.
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Affiliation(s)
- R Okidi
- Department of Surgery, St Mary's Hospital, Lacor, Uganda.,Faculty of Medicine, Gulu University, Gulu, Uganda
| | - D M Ogwang
- Department of Surgery, St Mary's Hospital, Lacor, Uganda.,Faculty of Medicine, Gulu University, Gulu, Uganda
| | - T R Okello
- Department of Surgery, Faculty of Medicine, Lira University, Lira, Uganda
| | - D Ezati
- Department of Surgery, St Mary's Hospital, Lacor, Uganda
| | - W Kyegombe
- Department of Surgery, St Mary's Hospital, Lacor, Uganda
| | - D Nyeko
- Department of Surgery, St Mary's Hospital, Lacor, Uganda
| | - N J Scolding
- Faculty of Medicine, Gulu University, Gulu, Uganda.,Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
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10
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Affiliation(s)
- Neil J Scolding
- Burden Professor of Clinical Neurosciences (NJS), University of Bristol and Southmead Hospital, Bristol, United Kingdom; Consultant Pathologist (HA), United Kingdom; Professor of Cardiovascular Pathology (MS), Department of Cardiovascular Pathology, St George's Medical School, University of London, United Kingdom; and Director of Transplant and Consultant Cardiac Surgeon (ARS), Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Hiam Ali
- Burden Professor of Clinical Neurosciences (NJS), University of Bristol and Southmead Hospital, Bristol, United Kingdom; Consultant Pathologist (HA), United Kingdom; Professor of Cardiovascular Pathology (MS), Department of Cardiovascular Pathology, St George's Medical School, University of London, United Kingdom; and Director of Transplant and Consultant Cardiac Surgeon (ARS), Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Mary Sheppard
- Burden Professor of Clinical Neurosciences (NJS), University of Bristol and Southmead Hospital, Bristol, United Kingdom; Consultant Pathologist (HA), United Kingdom; Professor of Cardiovascular Pathology (MS), Department of Cardiovascular Pathology, St George's Medical School, University of London, United Kingdom; and Director of Transplant and Consultant Cardiac Surgeon (ARS), Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
| | - Andre R Simon
- Burden Professor of Clinical Neurosciences (NJS), University of Bristol and Southmead Hospital, Bristol, United Kingdom; Consultant Pathologist (HA), United Kingdom; Professor of Cardiovascular Pathology (MS), Department of Cardiovascular Pathology, St George's Medical School, University of London, United Kingdom; and Director of Transplant and Consultant Cardiac Surgeon (ARS), Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, United Kingdom
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11
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Abstract
The diagnosis of primary central nervous system (CNS) vasculitis is often difficult. There are neither specific clinical features nor a classical clinical course, and no blood or imaging investigations that can confirm the diagnosis. Contrast catheter cerebral angiography is neither specific nor sensitive, yet still underpins the diagnosis in many published studies. Here we describe an approach to its diagnosis, emphasising the importance of obtaining tissue, and present for discussion a new, binary set of diagnostic criteria, dividing cases into only ‘definite’ primary CNS vasculitis, where tissue proof is available, and ‘possible,’ where it is not. We hope that these criteria will be modified and improved by discussion among experts, and that these (improved) criteria may then be adopted and used as the basis for future prospective studies of the clinical features and diagnosis of this difficult and dangerous disorder, particularly for coordinated multicentre therapeutic trials.
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12
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Muraro PA, Scolding NJ, Fox RJ. Author response: Rare side effects of alemtuzumab remind us of the need for postmarketing surveillance. Neurology 2019; 92:586. [DOI: 10.1212/wnl.0000000000007128] [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: 11/15/2022] Open
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13
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Redondo J, Sarkar P, Kemp K, Heesom KJ, Wilkins A, Scolding NJ, Rice CM. Dysregulation of Mesenchymal Stromal Cell Antioxidant Responses in Progressive Multiple Sclerosis. Stem Cells Transl Med 2018; 7:748-758. [PMID: 30063300 PMCID: PMC6186266 DOI: 10.1002/sctm.18-0045] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/03/2018] [Revised: 05/31/2018] [Accepted: 06/05/2018] [Indexed: 12/15/2022] Open
Abstract
The potential of autologous cell-based therapies including those using multipotent mesenchymal stromal cells (MSCs) is being investigated for multiple sclerosis (MS) and other neurological conditions. However, the phenotype of MSC in neurological diseases has not been fully characterized. We have previously shown that MSC isolated from patients with progressive MS (MS-MSC) have reduced expansion potential, premature senescence, and reduced neuroprotective potential in vitro. In view of the role of antioxidants in ageing and neuroprotection, we examined the antioxidant capacity of MS-MSC demonstrating that MS-MSC secretion of antioxidants superoxide dismutase 1 (SOD1) and glutathione S-transferase P (GSTP) is reduced and correlates negatively with the duration of progressive phase of MS. We confirmed reduced expression of SOD1 and GSTP by MS-MSC along with reduced activity of SOD and GST and, to examine the antioxidant capacity of MS-MSC under conditions of nitrosative stress, we established an in vitro cell survival assay using nitric oxide-induced cell death. MS-MSC displayed differential susceptibility to nitrosative stress with accelerated senescence and greater decline in expression of SOD1 and GSTP in keeping with reduced expression of master regulators of antioxidant responses nuclear factor erythroid 2-related factor 2 and peroxisome proliferator-activated receptor gamma coactivator 1-α. Our results are compatible with dysregulation of antioxidant responses in MS-MSC and have significant implications for development of autologous MSC-based therapies for MS, optimization of which may require that these functional deficits are reversed. Furthermore, improved understanding of the underlying mechanisms may yield novel insights into MS pathophysiology and biomarker identification. Stem Cells Translational Medicine 2018;7:748-758.
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Affiliation(s)
- Juliana Redondo
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pamela Sarkar
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kevin Kemp
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kate J Heesom
- Proteomics Facility, University of Bristol, Bristol, United Kingdom
| | - Alastair Wilkins
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Neil J Scolding
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Claire M Rice
- Clinical Neuroscience, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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14
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Abstract
Bone marrow-derived cells are known to infiltrate the adult brain and fuse with cerebellar Purkinje cells. Histological observations that such heterotypic cell fusion events are substantially more frequent following cerebellar injury suggest they could have a role in the protection of mature brain neurons. To date, the possibility that cell fusion can preserve or restore the structure and function of adult brain neurons has not been directly addressed; indeed, though frequently suggested, the possibility of benefit has always been rather speculative. Here we report, for the first time, that fusion of a bone marrow-derived cell with a neuron in vivo, in the mature brain, results in the formation of a spontaneously firing neuron. Notably, we also provide evidence supporting the concept that heterotypic cell fusion acts as a biological mechanism to repair pathological changes in Purkinje cell structure and electrophysiology. We induced chronic central nervous system inflammation in chimeric mice expressing bone marrow cells tagged with enhanced green fluorescent protein. Subsequent in-depth histological analysis revealed significant Purkinje cell injury. In addition, there was an increased incidence of cell fusion between bone marrow-derived cells and Purkinje cells, revealed as enhanced green fluorescent protein-expressing binucleate heterokaryons. These fused cells resembled healthy Purkinje cells in their morphology, soma size, ability to synthesize the neurotransmitter gamma-aminobutyric acid, and synaptic innervation from neighbouring cells. Extracellular recording of spontaneous firing ex vivo revealed a shift in the predominant mode of firing of non-fused Purkinje cells in the context of cerebellar inflammation. By contrast, the firing patterns of fused Purkinje cells were the same as in healthy control cerebellum, indicating that fusion of bone marrow-derived cells with Purkinje cells mitigated the effects of cell injury on electrical activity. Together, our histological and electrophysiological results provide novel fundamental insights into physiological processes by which nerve cells are protected in adult life.
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Affiliation(s)
- Kevin C Kemp
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Rimi Dey
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Johan Verhagen
- Infection and Immunity, School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
- Department of Immunobiology, Faculty of Life Sciences and Medicine, King's College London, Guy's Hospital, London, UK
| | - Neil J Scolding
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria M Usowicz
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Alastair Wilkins
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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von Wunster B, Bailey S, Wilkins A, Marks DI, Scolding NJ, Rice CM. Advising patients seeking stem cell interventions for multiple sclerosis. Pract Neurol 2018; 18:472-476. [PMID: 29848512 DOI: 10.1136/practneurol-2018-001956] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/29/2022]
Abstract
Given the intuitive potential of stem cell therapy and limitations of current treatment options for progressive multiple sclerosis (MS), it is not surprising that patients consider undertaking significant clinical and financial risks to access stem cell transplantation. However, while increasing evidence supports autologous haematopoietic stem cell transplantation (AHSCT) in aggressive relapsing-remitting MS, interventions employing haematopoietic or other stem cells should otherwise be considered experimental and recommended only in the context of a properly regulated clinical study. Understandably, most neurologists are unfamiliar with AHSCT procedures and the specific requirements for quality assurance and safety standards, as well as post-procedure precautions and follow-up. Consequently they may feel ill-equipped to advise patients. Here, we highlight important points for discussion in consultations with patients considering stem cell 'tourism' for MS.
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Affiliation(s)
- Beatrice von Wunster
- Clinical Neurosciences, Translational Health Sciences, University of Bristol, Bristol, UK.,School of Medicine, Vita-Salute san Raffaele University, Milan, Italy
| | - Steven Bailey
- Clinical Neurosciences, Translational Health Sciences, University of Bristol, Bristol, UK.,Bristol and Avon MS Unit, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Alastair Wilkins
- Clinical Neurosciences, Translational Health Sciences, University of Bristol, Bristol, UK.,Bristol and Avon MS Unit, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David I Marks
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Neil J Scolding
- Clinical Neurosciences, Translational Health Sciences, University of Bristol, Bristol, UK.,Bristol and Avon MS Unit, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Claire M Rice
- Clinical Neurosciences, Translational Health Sciences, University of Bristol, Bristol, UK.,Bristol and Avon MS Unit, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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16
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Kemp KC, Hares K, Redondo J, Cook AJ, Haynes HR, Burton BR, Pook MA, Rice CM, Scolding NJ, Wilkins A. Bone marrow transplantation stimulates neural repair in Friedreich's ataxia mice. Ann Neurol 2018; 83:779-793. [PMID: 29534309 PMCID: PMC5947591 DOI: 10.1002/ana.25207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/19/2017] [Revised: 02/26/2018] [Accepted: 03/09/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Friedreich's ataxia is an incurable inherited neurological disease caused by frataxin deficiency. Here, we report the neuroreparative effects of myeloablative allogeneic bone marrow transplantation in a humanized murine model of the disease. METHODS Mice received a transplant of fluorescently tagged sex-mismatched bone marrow cells expressing wild-type frataxin and were assessed at monthly intervals using a range of behavioral motor performance tests. At 6 months post-transplant, mice were euthanized for protein and histological analysis. In an attempt to augment numbers of bone marrow-derived cells integrating within the nervous system and improve therapeutic efficacy, a subgroup of transplanted mice also received monthly subcutaneous infusions of the cytokines granulocyte-colony stimulating factor and stem cell factor. RESULTS Transplantation caused improvements in several indicators of motor coordination and locomotor activity. Elevations in frataxin levels and antioxidant defenses were detected. Abrogation of disease pathology throughout the nervous system was apparent, together with extensive integration of bone marrow-derived cells in areas of nervous tissue injury that contributed genetic material to mature neurons, satellite-like cells, and myelinating Schwann cells by processes including cell fusion. Elevations in circulating bone marrow-derived cell numbers were detected after cytokine administration and were associated with increased frequencies of Purkinje cell fusion and bone marrow-derived dorsal root ganglion satellite-like cells. Further improvements in motor coordination and activity were evident. INTERPRETATION Our data provide proof of concept of gene replacement therapy, via allogeneic bone marrow transplantation, that reverses neurological features of Friedreich's ataxia with the potential for rapid clinical translation. Ann Neurol 2018;83:779-793.
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Affiliation(s)
- Kevin C. Kemp
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Kelly Hares
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Juliana Redondo
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Amelia J. Cook
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Harry R. Haynes
- Department of Cellular PathologyNorth Bristol National Health Service TrustBristolUnited Kingdom
| | - Bronwen R. Burton
- Infection and Immunity, School of Cellular and Molecular MedicineUniversity of BristolBristolUnited Kingdom
| | - Mark A. Pook
- Synthetic Biology Theme, Institute of Environment, Health and Societies, Biosciences, Department of Life Sciences, College of Health and Life SciencesBrunel University LondonLondonUnited Kingdom
| | - Claire M. Rice
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Neil J. Scolding
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
| | - Alastair Wilkins
- Multiple Sclerosis and Stem Cell Group, Translational Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUnited Kingdom
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17
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18
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Scolding NJ, Pasquini M, Reingold SC, Cohen JA. Cell-based therapeutic strategies for multiple sclerosis. Brain 2017; 140:2776-2796. [PMID: 29053779 PMCID: PMC5841198 DOI: 10.1093/brain/awx154] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/03/2017] [Accepted: 05/06/2017] [Indexed: 12/23/2022] Open
Abstract
The availability of multiple disease-modifying medications with regulatory approval to treat multiple sclerosis illustrates the substantial progress made in therapy of the disease. However, all are only partially effective in preventing inflammatory tissue damage in the central nervous system and none directly promotes repair. Cell-based therapies, including immunoablation followed by autologous haematopoietic stem cell transplantation, mesenchymal and related stem cell transplantation, pharmacologic manipulation of endogenous stem cells to enhance their reparative capabilities, and transplantation of oligodendrocyte progenitor cells, have generated substantial interest as novel therapeutic strategies for immune modulation, neuroprotection, or repair of the damaged central nervous system in multiple sclerosis. Each approach has potential advantages but also safety concerns and unresolved questions. Moreover, clinical trials of cell-based therapies present several unique methodological and ethical issues. We summarize here the status of cell-based therapies to treat multiple sclerosis and make consensus recommendations for future research and clinical trials.
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Affiliation(s)
- Neil J Scolding
- Department of Neurology, University of Bristol Southmead Hospital, Bristol BS10 5NB, UK
| | - Marcelo Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Stephen C Reingold
- Scientific and Clinical Research Associates, LLC, Salisbury, CT 06068, USA
| | - Jeffrey A Cohen
- Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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19
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Sarkar P, Redondo J, Kemp K, Ginty M, Wilkins A, Scolding NJ, Rice CM. Reduced neuroprotective potential of the mesenchymal stromal cell secretome with ex vivo expansion, age and progressive multiple sclerosis. Cytotherapy 2017; 20:21-28. [PMID: 28917625 PMCID: PMC5758344 DOI: 10.1016/j.jcyt.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical trials using ex vivo expansion of autologous mesenchymal stromal cells (MSCs) are in progress for several neurological diseases including multiple sclerosis (MS). Given that environment alters MSC function, we examined whether in vitro expansion, increasing donor age and progressive MS affect the neuroprotective properties of the MSC secretome. METHODS Comparative analyses of neuronal survival in the presence of MSC-conditioned medium (MSCcm) isolated from control subjects (C-MSCcm) and those with MS (MS-MSCcm) were performed following (1) trophic factor withdrawal and (2) nitric oxide-induced neurotoxicity. RESULTS Reduced neuronal survival following trophic factor withdrawal was seen in association with increasing expansion of MSCs in vitro and MSC donor age. Controlling for these factors, there was an independent, negative effect of progressive MS. In nitric oxide neurotoxicity, MSCcm-mediated neuroprotection was reduced when C-MSCcm was isolated from higher-passage MSCs and was negatively associated with increasing MSC passage number and donor age. Furthermore, the neuroprotective effect of MSCcm was lost when MSCs were isolated from patients with MS. DISCUSSION Our findings have significant implications for MSC-based therapy in neurodegenerative conditions, particularly for autologous MSC therapy in MS. Impaired neuroprotection mediated by the MSC secretome in progressive MS may reflect reduced reparative potential of autologous MSC-based therapy in MS and it is likely that the causes must be addressed before the full potential of MSC-based therapy is realized. Additionally, we anticipate that understanding the mechanisms responsible will contribute new insights into MS pathogenesis and may also be of wider relevance to other neurodegenerative conditions.
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Affiliation(s)
- Pamela Sarkar
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Juliana Redondo
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Kevin Kemp
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Mark Ginty
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Neil J Scolding
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Claire M Rice
- School of Clinical Sciences, University of Bristol, Bristol, UK.
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20
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Redondo J, Sarkar P, Kemp K, Virgo PF, Pawade J, Norton A, Emery DC, Guttridge MG, Marks DI, Wilkins A, Scolding NJ, Rice CM. Reduced cellularity of bone marrow in multiple sclerosis with decreased MSC expansion potential and premature ageing in vitro. Mult Scler 2017; 24:919-931. [PMID: 28548004 PMCID: PMC6029147 DOI: 10.1177/1352458517711276] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 12/16/2022]
Abstract
Background: Autologous bone-marrow-derived cells are currently employed in clinical
studies of cell-based therapy in multiple sclerosis (MS) although the bone
marrow microenvironment and marrow-derived cells isolated from patients with
MS have not been extensively characterised. Objectives: To examine the bone marrow microenvironment and assess the proliferative
potential of multipotent mesenchymal stromal cells (MSCs) in progressive
MS. Methods: Comparative phenotypic analysis of bone marrow and marrow-derived MSCs
isolated from patients with progressive MS and control subjects was
undertaken. Results: In MS marrow, there was an interstitial infiltrate of inflammatory cells with
lymphoid (predominantly T-cell) nodules although total cellularity was
reduced. Controlling for age, MSCs isolated from patients with MS had
reduced in vitro expansion potential as determined by population doubling
time, colony-forming unit assay, and expression of β-galactosidase. MS MSCs
expressed reduced levels of Stro-1 and displayed accelerated shortening of
telomere terminal restriction fragments (TRF) in vitro. Conclusion: Our results are consistent with reduced proliferative capacity and ex vivo
premature ageing of bone-marrow-derived cells, particularly MSCs, in MS.
They have significant implication for MSC-based therapies for MS and suggest
that accelerated cellular ageing and senescence may contribute to the
pathophysiology of progressive MS.
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Affiliation(s)
- Juliana Redondo
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Pamela Sarkar
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Kevin Kemp
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul F Virgo
- Department of Immunology, Southmead Hospital, Bristol, UK
| | - Joya Pawade
- Department of Pathology, Southmead Hospital, Bristol, UK
| | - Aimie Norton
- Department of Pathology, Southmead Hospital, Bristol, UK
| | - David C Emery
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - David I Marks
- Blood and Marrow Transplant Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Neil J Scolding
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Claire M Rice
- School of Clinical Sciences, University of Bristol, Bristol, UK
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21
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Kemp KC, Cerminara N, Hares K, Redondo J, Cook AJ, Haynes HR, Burton BR, Pook M, Apps R, Scolding NJ, Wilkins A. Cytokine therapy-mediated neuroprotection in a Friedreich's ataxia mouse model. Ann Neurol 2017; 81:212-226. [PMID: 28009062 PMCID: PMC5324580 DOI: 10.1002/ana.24846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/30/2016] [Revised: 12/06/2016] [Accepted: 12/11/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Friedreich's ataxia is a devastating neurological disease currently lacking any proven treatment. We studied the neuroprotective effects of the cytokines, granulocyte-colony stimulating factor (G-CSF) and stem cell factor (SCF) in a humanized murine model of Friedreich's ataxia. METHODS Mice received monthly subcutaneous infusions of cytokines while also being assessed at monthly time points using an extensive range of behavioral motor performance tests. After 6 months of treatment, neurophysiological evaluation of both sensory and motor nerve conduction was performed. Subsequently, mice were sacrificed for messenger RNA, protein, and histological analysis of the dorsal root ganglia, spinal cord, and cerebellum. RESULTS Cytokine administration resulted in significant reversal of biochemical, neuropathological, neurophysiological, and behavioural deficits associated with Friedreich's ataxia. Both G-CSF and SCF had pronounced effects on frataxin levels (the primary molecular defect in the pathogenesis of the disease) and a regulators of frataxin expression. Sustained improvements in motor coordination and locomotor activity were observed, even after onset of neurological symptoms. Treatment also restored the duration of sensory nerve compound potentials. Improvements in peripheral nerve conduction positively correlated with cytokine-induced increases in frataxin expression, providing a link between increases in frataxin and neurophysiological function. Abrogation of disease-related pathology was also evident, with reductions in inflammation/gliosis and increased neural stem cell numbers in areas of tissue injury. INTERPRETATION These experiments show that cytokines already clinically used in other conditions offer the prospect of a novel, rapidly translatable, disease-modifying, and neuroprotective treatment for Friedreich's ataxia. Ann Neurol 2017;81:212-226.
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Affiliation(s)
- Kevin C. Kemp
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Nadia Cerminara
- Sensory and Motor Systems Group, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUnited Kingdom
| | - Kelly Hares
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Juliana Redondo
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Amelia J. Cook
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Harry R. Haynes
- Brain Tumour Research Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Bronwen R. Burton
- Infection and Immunity, School of Cellular and Molecular MedicineUniversity of BristolBristolUnited Kingdom
| | - Mark Pook
- Synthetic Biology Theme, Institute of Environment, Health & Societies, Biosciences, Dept. of Life Sciences, College of Health & Life SciencesBrunel University LondonLondonUnited Kingdom
| | - Richard Apps
- Sensory and Motor Systems Group, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUnited Kingdom
| | - Neil J. Scolding
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
| | - Alastair Wilkins
- Multiple Sclerosis and Stem Cell Group, School of Clinical SciencesUniversity of BristolBristolUnited Kingdom
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22
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Porretta E, Jeffery SM, Jordan SL, Male J, Edwards RJ, Love S, Scolding NJ, Rice CM. SAFETY AND UTILITY OF BRAINSTEM BIOPSY AND RESECTION. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Sarkar P, Cole A, Scolding NJ, Rice CM. Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review. Clin Endosc 2016; 50:270-278. [PMID: 27737522 PMCID: PMC5475517 DOI: 10.5946/ce.2016.106] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/16/2016] [Accepted: 09/09/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome. METHODS A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items "percutaneous endoscopic gastrostomy" and "neurology" or "neurodegenerative disease." RESULTS Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin. CONCLUSIONS This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.
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Affiliation(s)
- Pamela Sarkar
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Alice Cole
- Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil J Scolding
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Claire M Rice
- Department of Neurology, Southmead Hospital, Bristol, UK.,Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
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24
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Rice CM, Hall CA, McCoubrie P, Renowden SA, Cohen N, Scolding NJ. Erdheim-Chester disease: 25-year history with early CNS involvement. BMJ Case Rep 2016; 2016:bcr-2016-216747. [PMID: 27702933 DOI: 10.1136/bcr-2016-216747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report a case of Erdheim-Chester disease (ECD) with a 25-year history following initial presentation with diabetes insipidus and brainstem involvement. The exceptionally long history is particularly notable, given that ECD is a life-threatening disorder and there is a recognised association between central nervous system involvement and poor outcome. The case is a timely reminder of the presenting features of the condition, given the emergence of potential new treatment options.
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Affiliation(s)
- C M Rice
- Department of Clinical Neuroscience, University of Bristol, Bristol, UK
| | - C A Hall
- North Bristol NHS Trust, Bristol, UK
| | | | | | - N Cohen
- North Bristol NHS Trust, Bristol, UK
| | - N J Scolding
- Department of Clinical Neuroscience, University of Bristol, Bristol, UK North Bristol NHS Trust, Bristol, UK
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25
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Abstract
Ovarioleukodystrophy-the co-occurrence of leukodystrophy and premature ovarian failure-is a rare presentation now recognised to be part of the clinical spectrum of vanishing white matter disease. We describe a woman with epilepsy and neuroimaging changes consistent with leukoencephalopathy who presented with non-convulsive status epilepticus after starting hormone replacement therapy in the context of premature ovarian failure. Genetic testing confirmed her to be a compound heterozygote for EIF2B5 mutations; the gene encodes a subunit of eukaryotic translation initiation factor 2B. Mutations in EIF2B1-5 result in vanishing white matter disease. We highlight the importance of ovarian failure as a diagnostic pointer to eukaryotic translation initiation factor 2B (eIF2B)-related ovarioleukodystrophy and present a brief literature review of ovarioleukodystrophy.
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Affiliation(s)
- R T Ibitoye
- Department of Neurology, Southmead Hospital, Bristol, UK
| | - S A Renowden
- Department of Neuroradiology, Southmead Hospital, Bristol, UK
| | - H J Faulkner
- Department of Neurology, Southmead Hospital, Bristol, UK
| | - N J Scolding
- Department of Neurology, Southmead Hospital, Bristol, UK
| | - C M Rice
- Department of Neurology, Southmead Hospital, Bristol, UK
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26
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Willis MD, Harding KE, Pickersgill TP, Wardle M, Pearson OR, Scolding NJ, Smee J, Robertson NP. Alemtuzumab for multiple sclerosis: Long term follow-up in a multi-centre cohort. Mult Scler 2016; 22:1215-23. [DOI: 10.1177/1352458515614092] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022]
Abstract
Background: Alemtuzumab has recently been approved for treatment of relapsing MS, but concerns remain about its use since long-term studies of adverse events remain limited. Furthermore, a clear understanding of its application and durability of effect in clinical practice has yet to evolve. Objectives: To investigate long-term efficacy and safety outcomes in a multicentre cohort of patients treated with alemtuzumab. Methods: Patients treated from 2000 and followed-up at three regional centres were identified. Baseline and prospective data were obtained and validated by clinical record review. Results: One hundred patients were identified with a mean follow-up of 6.1 years (range 1–13). Forty patients were retreated with at least one further treatment cycle. Annualized relapse rates fell from 2.1 to 0.2 ( p<0.0001) post-treatment and were sustained for up to eight years of follow-up. Mean change in EDSS score was +0.14. Forty-seven patients developed secondary autoimmunity. Conclusion: Observed reduction in relapse rates reflected those reported in clinical trials, but we were unable to corroborate previous observations of disability reversal. 40% of patients required additional treatment cycles. Autoimmune adverse events were common, occurring at a higher rate than previously reported, but were largely predictable, and could be managed effectively within a rigorous monitoring regime.
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Affiliation(s)
- MD Willis
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK
| | - KE Harding
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK
| | - TP Pickersgill
- Department of Neurology, University Hospital of Wales, UK
| | - M Wardle
- Department of Neurology, University Hospital of Wales, UK
| | - OR Pearson
- Department of Neurology, Morriston Hospital, UK
| | - NJ Scolding
- Department of Neurology, Southmead Hospital, UK
| | - J Smee
- Department of Neurology, University Hospital of Wales, UK
| | - NP Robertson
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, UK/Department of Neurology, University Hospital of Wales, UK
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27
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Kemp KC, Cook AJ, Redondo J, Kurian KM, Scolding NJ, Wilkins A. Erratum to: 'Purkinje cell injury, structural plasticity and fusion in patients with Friedreich's ataxia'. Acta Neuropathol Commun 2016; 4:67. [PMID: 27364877 PMCID: PMC4928345 DOI: 10.1186/s40478-016-0332-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
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28
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Kemp KC, Cook AJ, Redondo J, Kurian KM, Scolding NJ, Wilkins A. Purkinje cell injury, structural plasticity and fusion in patients with Friedreich's ataxia. Acta Neuropathol Commun 2016; 4:53. [PMID: 27215193 PMCID: PMC4877974 DOI: 10.1186/s40478-016-0326-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/11/2016] [Indexed: 12/05/2022] Open
Abstract
Purkinje cell pathology is a common finding in a range of inherited and acquired cerebellar disorders, with the degree of Purkinje cell injury dependent on the underlying aetiology. Purkinje cells have an unparalleled resistance to insult and display unique regenerative capabilities within the central nervous system. Their response to cell injury is not typical of most neurons and likely represents both degenerative, compensatory and regenerative mechanisms. Here we present a pathological study showing novel and fundamental insights into Purkinje cell injury, remodelling and repair in Friedreich’s ataxia; the most common inherited ataxia. Analysing post-mortem cerebellum tissue from patients who had Friedreich's ataxia, we provide evidence of significant injury to the Purkinje cell axonal compartment with relative preservation of both the perikaryon and its extensive dendritic arborisation. Axonal remodelling of Purkinje cells was clearly elevated in the disease. For the first time in a genetic condition, we have also shown a disease-related increase in the frequency of Purkinje cell fusion and heterokaryon formation in Friedreich's ataxia cases; with evidence that underlying levels of cerebellar inflammation influence heterokaryon formation. Our results together further demonstrate the Purkinje cell’s unique plasticity and regenerative potential. Elucidating the biological mechanisms behind these phenomena could have significant clinical implications for manipulating neuronal repair in response to neurological injury.
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29
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Abstract
IgG4-related disease (IgG4-RD) is a newly recognised, multiorgan, inflammatory disease, and its full clinical spectrum remains undefined. We present a biopsy-proven case of IgG4-RD presenting with a parapharyngeal mass with intracranial extension and possible involvement of the brain parenchyma. We highlight the importance of considering the diagnosis in those presenting with tumefactive lesions, leptomeningitis or pachymeningitis and emphasise the value of securing a tissue diagnosis so that appropriate long-term treatment can be instigated and complications avoided.
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Affiliation(s)
- C M Rice
- Department of Neurology, North Bristol NHS Trust, Bristol, UK Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - T Spencer
- Department of Neurology, North Bristol NHS Trust, Bristol, UK
| | - G Bunea
- Department of Radiology, Sunderland Royal Hospital, Sunderland, UK
| | - N J Scolding
- Department of Neurology, North Bristol NHS Trust, Bristol, UK Clinical Neuroscience, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - P Sloan
- Department of Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - U Nath
- Department of Neurology, Sunderland Royal Hospital, Sunderland, UK
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30
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Rice CM, Rossiter D, Fehmi J, Stevens JC, Renowden SA, Cohen N, Bailey C, Scolding NJ. Tumefactive demyelination presenting during bevacizumab treatment. BMJ Case Rep 2015; 2015:bcr-2015-212173. [PMID: 26677151 DOI: 10.1136/bcr-2015-212173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We report the emergence of tumefactive demyelination during treatment with intravitreal bevacizumab (Avastin). This is of particular significance given that bevacizumab is currently being assessed as a potential treatment option for neuromyelitis optica, another demyelinating condition.
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Affiliation(s)
- Claire M Rice
- Department of Neurology, North Bristol, NHS Trust Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK
| | - David Rossiter
- Department of Neurology, North Bristol, NHS Trust Bristol, UK
| | - Janev Fehmi
- Department of Neurology, North Bristol, NHS Trust Bristol, UK
| | - James C Stevens
- Department of Neurology, North Bristol, NHS Trust Bristol, UK
| | | | - Nicki Cohen
- School of Clinical Sciences, University of Bristol, Bristol, UK Department of Neuropathology, North Bristol, NHS Trust Bristol, UK
| | - Clare Bailey
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
| | - Neil J Scolding
- Department of Neurology, North Bristol, NHS Trust Bristol, UK School of Clinical Sciences, University of Bristol, Bristol, UK
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31
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Rice CM, Marks DI, Ben-Shlomo Y, Evangelou N, Morgan PS, Metcalfe C, Walsh P, Kane NM, Guttridge MG, Miflin G, Blackmore S, Sarkar P, Redondo J, Owen D, Cottrell DA, Wilkins A, Scolding NJ. Assessment of bone marrow-derived Cellular Therapy in progressive Multiple Sclerosis (ACTiMuS): study protocol for a randomised controlled trial. Trials 2015; 16:463. [PMID: 26467901 PMCID: PMC4606493 DOI: 10.1186/s13063-015-0953-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 05/23/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We have recently completed an evaluation of the safety and feasibility of intravenous delivery of autologous bone marrow in patients with progressive multiple sclerosis (MS). The possibility of repair was suggested by improvement in the neurophysiological secondary outcome measure seen in all participants. The current study will examine the efficacy of intravenous delivery of autologous marrow in progressive MS. Laboratory studies performed in parallel with the clinical trial will further investigate the biology of bone marrow-derived stem cell infusion in MS, including mechanisms underlying repair. METHODS/DESIGN A prospective, randomised, double-blind, placebo-controlled, stepped wedge design will be employed at a single centre (Bristol, UK). Eighty patients with progressive MS will be recruited; 60 will have secondary progressive disease (SPMS) but a subset (n = 20) will have primary progressive disease (PPMS). Participants will be randomised to either early or late (1 year) intravenous infusion of autologous, unfractionated bone marrow. The placebo intervention is infusion of autologous blood. The primary outcome measure is global evoked potential derived from multimodal evoked potentials. Secondary outcome measures include adverse event reporting, clinical (EDSS and MSFC) and self-assessment (MSIS-29) rating scales, optical coherence tomography (OCT) as well as brain and spine MRI. Participants will be followed up for a further year following the final intervention. Outcomes will be analysed on an intention-to-treat basis. DISCUSSION Assessment of bone marrow-derived Cellular Therapy in progressive Multiple Sclerosis (ACTiMuS) is the first randomised, placebo-controlled trial of non-myeloablative autologous bone marrow-derived stem cell therapy in MS. It will determine whether bone marrow cell therapy can, as was suggested by the phase I safety study, improve conduction in multiple central nervous system pathways affected in progressive MS. Furthermore, laboratory studies performed in parallel with the clinical trial will inform our understanding of the cellular pharmacodynamics of bone marrow infusion in MS patients and the mechanisms underlying cell therapy. TRIAL REGISTRATION ISRCTN27232902 Registration date 11/09/2012. NCT01815632 Registration date 19/03/2013.
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Affiliation(s)
- Claire M Rice
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK. .,Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - David I Marks
- Adult BMT Unit, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust & University of Bristol, St Michael's Hill, Bristol, BS2 8BJ, UK.
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Nikos Evangelou
- Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Paul S Morgan
- Queen's Medical Centre, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Peter Walsh
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Nick M Kane
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | | | - Gail Miflin
- NHS Blood and Transplant, North Bristol Park, Bristol, BS34 7QH, UK.
| | - Stuart Blackmore
- NHS Blood and Transplant, North Bristol Park, Bristol, BS34 7QH, UK.
| | - Pamela Sarkar
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK. .,Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Juliana Redondo
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK.
| | - Denise Owen
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - David A Cottrell
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Alastair Wilkins
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK. .,Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Neil J Scolding
- School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, BS10 5NB, UK. .,Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, BS10 5NB, UK.
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Rice CM, Marks DI, Walsh P, Kane NM, Guttridge MG, Redondo J, Sarkar P, Owen D, Wilkins A, Scolding NJ. Repeat infusion of autologous bone marrow cells in multiple sclerosis: protocol for a phase I extension study (SIAMMS-II). BMJ Open 2015; 5:e009090. [PMID: 26363342 PMCID: PMC4567673 DOI: 10.1136/bmjopen-2015-009090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The 'Study of Intravenous Autologous Marrow in Multiple Sclerosis (SIAMMS)' trial was a safety and feasibility study which examined the effect of intravenous infusion of autologous bone marrow without myeloablative therapy. This trial was well tolerated and improvement was noted in the global evoked potential (GEP)--a neurophysiological secondary outcome measure recording speed of conduction in central nervous system pathways. The efficacy of intravenous delivery of autologous marrow in progressive multiple sclerosis (MS) will be examined in the phase II study the 'Assessment of Bone Marrow-Derived Cellular Therapy in Progressive Multiple Sclerosis (ACTiMuS; NCT01815632)'. In parallel with the 'ACTiMuS' study, the current study 'SIAMMS-II' will explore the feasibility of repeated, non-myeloablative autologous bone marrow-derived cell therapy in progressive MS. Furthermore, information will be obtained regarding the persistence or otherwise of improvements in conduction in central nervous system pathways observed in the original 'SIAMMS' study and whether these can be reproduced or augmented by a second infusion of autologous bone marrow-derived cells. METHODS AND ANALYSIS An open, prospective, single-centre phase I extension study. The six patients with progressive MS who participated in the 'SIAMMS' study will be invited to undergo repeat bone marrow harvest and receive an intravenous infusion of autologous, unfractionated bone marrow as a day-case procedure. The primary outcome measure is the number of adverse events, and secondary outcome measures will include change in clinical rating scales of disability, GEP and cranial MRI. ETHICS AND DISSEMINATION The study has UK National Research Ethics Committee approval (13/SW/0255). Study results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT01932593.
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Affiliation(s)
- Claire M Rice
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | - David I Marks
- Adult BMT Unit, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust & University of Bristol, St Michael's Hill, Bristol, UK
| | - Peter Walsh
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | - Nick M Kane
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | | | - Juliana Redondo
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Pamela Sarkar
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | - Denise Owen
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | - Alastair Wilkins
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
| | - Neil J Scolding
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
- Bristol Institute of Clinical Neurosciences, Southmead Hospital, Bristol, UK
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Streeter HB, Rigden R, Martin KF, Scolding NJ, Wraith DC. Preclinical development and first-in-human study of ATX-MS-1467 for immunotherapy of MS. Neurol Neuroimmunol Neuroinflamm 2015; 2:e93. [PMID: 25798453 PMCID: PMC4360798 DOI: 10.1212/nxi.0000000000000093] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/10/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The study was designed to test the efficacy of ATX-MS-1467 in a relevant preclinical model and to assess its safety for the treatment of patients with secondary progressive multiple sclerosis (SPMS). METHODS ATX-MS-1467 was tested for its ability to suppress experimental autoimmune encephalomyelitis (EAE) in the (Ob x DR2)F1 mouse both before and after disease onset. Safety was assessed by clinical assessment, MRI analysis, and the measurement of immune responses to self- and nonself-antigens in patients with SPMS. RESULTS ATX-MS-1467 displayed a dose-dependent inhibition of EAE and was more effective than glatiramer acetate in the treatment of ongoing disease in humanized mice. A phase 1 open-label dose-escalating study demonstrated that ATX-MS-1467 was safe and well-tolerated in a group of 6 patients with SPMS, up to a dose of 800 µg. CONCLUSIONS The results of this study support further development of ATX-MS-1467 in a clinical trial powered to investigate the immunologic and clinical benefits of treatment in relapsing-remitting MS. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that ATX-MS-1467 is safe and tolerated in a group of 6 patients with SPMS.
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Affiliation(s)
- Heather B Streeter
- Apitope Technology Bristol Ltd. (H.B.S., R.R., K.F.M., D.C.W.), Bristol UK; School of Cellular and Molecular Medicine (H.B.S., D.C.W.) and School of Clinical Sciences (N.J.S.), University of Bristol, UK; and Southmead Hospital (N.J.S.), Bristol, UK
| | - Rachel Rigden
- Apitope Technology Bristol Ltd. (H.B.S., R.R., K.F.M., D.C.W.), Bristol UK; School of Cellular and Molecular Medicine (H.B.S., D.C.W.) and School of Clinical Sciences (N.J.S.), University of Bristol, UK; and Southmead Hospital (N.J.S.), Bristol, UK
| | - Keith F Martin
- Apitope Technology Bristol Ltd. (H.B.S., R.R., K.F.M., D.C.W.), Bristol UK; School of Cellular and Molecular Medicine (H.B.S., D.C.W.) and School of Clinical Sciences (N.J.S.), University of Bristol, UK; and Southmead Hospital (N.J.S.), Bristol, UK
| | - Neil J Scolding
- Apitope Technology Bristol Ltd. (H.B.S., R.R., K.F.M., D.C.W.), Bristol UK; School of Cellular and Molecular Medicine (H.B.S., D.C.W.) and School of Clinical Sciences (N.J.S.), University of Bristol, UK; and Southmead Hospital (N.J.S.), Bristol, UK
| | - David C Wraith
- Apitope Technology Bristol Ltd. (H.B.S., R.R., K.F.M., D.C.W.), Bristol UK; School of Cellular and Molecular Medicine (H.B.S., D.C.W.) and School of Clinical Sciences (N.J.S.), University of Bristol, UK; and Southmead Hospital (N.J.S.), Bristol, UK
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Rice CM, Marks DI, Ben-Shlomo Y, Evangelou N, Morgan PS, Metcalfe C, Kane NM, Cottrell DA, Wilkins A, Scolding NJ. ACTIMUS—PHASE II CELL THERAPY TRIAL IN PROGRESSIVE MS. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Multiple sclerosis is a major cause of neurological disability, and particularly occurs in young adults. It is characterised by conspicuous patches of damage throughout the brain and spinal cord, with loss of myelin and myelinating cells (oligodendrocytes), and damage to neurons and axons. Multiple sclerosis is incurable, but stem-cell therapy might offer valuable therapeutic potential. Efforts to develop stem-cell therapies for multiple sclerosis have been conventionally built on the principle of direct implantation of cells to replace oligodendrocytes, and therefore to regenerate myelin. Recent progress in understanding of disease processes in multiple sclerosis include observations that spontaneous myelin repair is far more widespread and successful than was previously believed, that loss of axons and neurons is more closely associated with progressive disability than is myelin loss, and that damage occurs diffusely throughout the CNS in grey and white matter, not just in discrete, isolated patches or lesions. These findings have introduced new and serious challenges that stem-cell therapy needs to overcome; the practical challenges to achieve cell replacement alone are difficult enough, but, to be useful, cell therapy for multiple sclerosis must achieve substantially more than the replacement of lost oligodendrocytes. However, parallel advances in understanding of the reparative properties of stem cells--including their distinct immunomodulatory and neuroprotective properties, interactions with resident or tissue-based stem cells, cell fusion, and neurotrophin elaboration--offer renewed hope for development of cell-based therapies. Additionally, these advances suggest avenues for translation of this approach not only for multiple sclerosis, but also for other common neurological and neurodegenerative diseases.
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Affiliation(s)
- Claire M Rice
- University of Bristol Institute of Clinical Neurosciences, Burden MS Stem Cell Laboratories and BrAMS Unit, Frenchay Hospital, Bristol, UK
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Abstract
Primary progressive multiple sclerosis (MS) has long been recognised as presenting great difficulties to our management of what is increasingly a treatable neurological disease. Here we review some basic and clinical aspects of primary progressive MS, and describe how the disorder in fact offers powerful insights and opportunities for better understanding multiple sclerosis, and from a practical perspective an invaluable clinical substrate for studying and treating progressive disability in MS. Difficult hurdles remain, however, and these too are reviewed.
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Affiliation(s)
- Claire M Rice
- University of Bristol Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, UK
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Rice CM, Ramamoorthi M, Renowden SA, Heywood P, Whone AL, Scolding NJ. Cerebral ischaemia in the context of improving, steroid-treated pneumococcal meningitis. QJM 2012; 105:473-5. [PMID: 21493690 DOI: 10.1093/qjmed/hcr056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C M Rice
- Department of Neurology, Frenchay Hospital, Bristol BS16 1LE, UK.
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Whone AL, Kemp K, Sun M, Wilkins A, Scolding NJ. Human bone marrow mesenchymal stem cells protect catecholaminergic and serotonergic neuronal perikarya and transporter function from oxidative stress by the secretion of glial-derived neurotrophic factor. Brain Res 2012; 1431:86-96. [DOI: 10.1016/j.brainres.2011.10.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 12/29/2022]
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Affiliation(s)
- C M Rice
- Department of Neurology, Frenchay Hospital, Bristol, UK.
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Rice CM, Mallam EA, Whone AL, Walsh P, Brooks DJ, Kane N, Butler SR, Marks DI, Scolding NJ. Safety and feasibility of autologous bone marrow cellular therapy in relapsing-progressive multiple sclerosis. Clin Pharmacol Ther 2010; 87:679-85. [PMID: 20445531 DOI: 10.1038/clpt.2010.44] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this phase I study, we assessed the safety and feasibility of intravenous, autologous bone marrow (BM) cell therapy, without immunosuppressive preconditioning, in six patients with clinically definite, relapsing-progressive multiple sclerosis (MS). Assessment of efficacy was a secondary objective and employed clinical disability rating scales, multimodal evoked potential (MMEP) recordings, and magnetic resonance imaging (MRI) scans. Cells were harvested, filtered and infused intravenously in a day-case procedure that was well tolerated by patients and was not associated with any serious adverse events (AEs). Over a period of 12 months after the therapy, clinical disability scores showed either no change (Extended Disability Status Score, EDSS) or improvement (MS impact scale-29, MSIS-29), and MMEPs showed neurophysiological improvement. MRI scans did not show any significant changes over a post-therapy period of 3 months. The lack of serious adverse effects and the suggestion of a beneficial effect in this small sample of patients with progressive disease justify conducting a larger phase II/III study to make a fuller assessment of the efficacy of mobilization of autologous BM in patients with MS.
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Affiliation(s)
- C M Rice
- Institute of Clinical Neurosciences, University of Bristol, Frenchay Hospital, Bristol, UK
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Gilmore CP, Cottrell DA, Scolding NJ, Wingerchuk DM, Weinshenker BG, Boggild M. A window of opportunity for no treatment in early multiple sclerosis? Mult Scler 2010; 16:756-9. [PMID: 20427417 DOI: 10.1177/1352458510366014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C P Gilmore
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
Systemic lupus erythematosus (SLE) is not an uncommon condition. Most neurologists are well aware that it can cause a wide range of neurological complications, and SLE almost invariably appears on 'differential diagnosis' lists in cases of clinical uncertainty. However, the precise nature of the manifestations of SLE in the central and peripheral nervous systems is perhaps less widely understood, and misperceptions about phenomenology and treatment are common. Here we survey some of the main primary neurological complications of SLE--'neurolupus'--while acknowledging that secondary problems, either iatrogenic or relating to other consequences of SLE (eg, hypertensive CNS disease, for example, secondary to renal lupus) are neither less serious nor less treatable.
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Affiliation(s)
- Fady G Joseph
- Consultant Neurologist, Neville Hall Hospital, Abergavenny and the Royal Gwent Hospital, Newport, UK
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Abstract
Systemic delivery of multipotent mesenchymal stem cells (MSC) may be of benefit in the treatment of neurological diseases, including multiple sclerosis (MS). Certainly, animal studies have demonstrated functional benefits following MSC transplantation, although the mechanisms by which MSCs migrate to lesions and stimulate repair remain unknown. Chemokines stimulate migration in other settings. In this study, we systematically explore the migratory and proliferative responses of human MSCs (hMSC) to chemokines expressed in MS lesions. We demonstrate that these chemokines trigger hMSC migration. In addition, we show that RANTES and IP-10 promote hMSC proliferation.
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Affiliation(s)
- Claire M Rice
- Institute of Clinical Neurosciences, University of Bristol, Frenchay Hospital, Bristol, UK.
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Abstract
BACKGROUND Neurological involvement in sarcoidosis is serious and often aggressive. Many patients respond to steroids but some show a progressive course despite treatment with steroids and even more potent immunosuppressive drugs. OBJECTIVE The aim of this study was to describe our experience in the treatment of refractory neurosarcoidosis with Infliximab--its effect on the course of the disease and side effects. METHODS A series of four patients are reported with neurosarcoidosis refractory to treatment with steroids combined with various immunosuppressive drugs in whom Infliximab was used. RESULTS A good response, with improvement or stabilisation of the neurological condition, was seen in all cases, without significant side effects. Infliximab is a chimeric monoclonal antibody that neutralises the biological activity of tumour necrosis factor alpha, a cytokine thought to play an important role in the pathophysiology of sarcoidosis. CONCLUSION Our experience using Infliximab adds to the growing evidence that it may fulfil a useful role in cases of refractory neurosarcoidosis.
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Affiliation(s)
- Ernestina Santos
- Neurology Department, Hospital Geral Santo António, Porto, Portugal
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Rice CM, Clavel C, Mazo M, Prosper F, Scolding NJ. Multipotent adult progenitor cell isolation and proliferation in cytokine and serum-free medium conditioned by rat B104 cells. Br J Haematol 2010; 148:441-4. [DOI: 10.1111/j.1365-2141.2009.07986.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Introduction Both neurosarcoidosis and central nervous system lymphoma can be very difficult to diagnose. We describe the case of a patient in whom neurosarcoidosis was strongly suspected, but who was eventually found to have lymphoma. We believe the case to be of interest and practical value to neurologists, oncologists and internists with an interest in inflammatory diseases. Case presentation A diagnosis of neurosarcoidosis was considered in a 49-year-old Caucasian man on the basis of the following symptoms and indications: a cough, bilateral hilar lymphadenopathy confirmed by thoracic computed tomography, the development of an S1 radiculopathy, cerebrospinal fluid abnormalities (raised protein level), bilateral lung hilar and lachrymal gland uptake on a gallium scan, and erythema nodosum confirmed with skin biopsy. These were followed by the development of multiple cranial neuropathies, including seventh nerve palsy. Exhaustive further investigations yielded no evidence for an alternative diagnosis. Treatments with steroids, cyclophosphamide, intravenous immunoglobulin and finally infliximab were of no benefit. He eventually developed cutaneous nodules, a biopsy of which revealed lymphoma that proved resistant to therapy. Conclusion Constant diagnostic vigilance is required in disorders such as neurosarcoidosis.
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Affiliation(s)
- Ernestina Santos
- Neurology Department, Hospital Geral Santo, António Porto, Portugal
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Wilkins A, Ingram G, Brown A, Jardine P, Steward CG, Robertson NP, Scolding NJ. Very long chain fatty acid levels in patients diagnosed with multiple sclerosis. Mult Scler 2009; 15:1525-7. [DOI: 10.1177/1352458509351731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In clinical practice it is not uncommon for patients with adrenomyeloneuropathy or female carriers of adrenoleucodystrophy to have a presenting history and examination compatible with multiple sclerosis. This suggests that there may be an under-diagnosis of adrenoleucodystrophy and its variants in the multiple sclerosis population. We measured levels of very long chain fatty acids, which are typically elevated in the plasma of patients with adrenoleucodystrophy, in a large cohort of patients diagnosed clinically with multiple sclerosis. We tested serum samples from patients with either a first degree relative with multiple sclerosis or those with a primary progressive phenotype. No elevations in very long chain fatty acids were found in the cohort. This study suggests that the number of cases of adrenomyeloneuropathy or adrenoleucodystrophy amongst patients diagnosed clinically with multiple sclerosis is likely to be extremely low. This has important diagnostic implications.
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Affiliation(s)
| | - Gillian Ingram
- Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Anny Brown
- Department of Clinical Biochemistry, Southmead Hospital, Bristol, UK
| | - Philip Jardine
- Department of Paediatrics, Royal Hospital for Children, Bristol, UK
| | - Colin G Steward
- Bone Marrow Transplant Unit, Royal Hospital for Children, Bristol, UK
| | - Neil P Robertson
- Department of Neurology, University Hospital of Wales, Cardiff, UK
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Abstract
An account of the pathology, pathogenesis, clinical features, diagnosis and management of cerebral vasculitis is presented.
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Affiliation(s)
- Neil J Scolding
- Institute of Clinical Neurosciences, Frenchay Hospital, Bristol, BS16 1JE, UK.
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