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Virupakshaiah A, Moseley CE, Elicegui S, Gerwitz LM, Spencer CM, George E, Shah M, Cree BAC, Waubant E, Zamvil SS. Life-Threatening MOG Antibody-Associated Hemorrhagic ADEM With Elevated CSF IL-6. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200243. [PMID: 38630950 DOI: 10.1212/nxi.0000000000200243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Acute disseminated encephalomyelitis (ADEM) is one characteristic manifestation of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). A previously healthy man presented with retro-orbital headache and urinary retention 14 days after Tdap vaccination. Brain and spine MRI suggested a CNS demyelinating process. Despite treatment with IV steroids, he deteriorated, manifesting hemiparesis and later impaired consciousness, requiring intubation. A repeat brain MRI demonstrated new bilateral supratentorial lesions associated with venous sinus thrombosis, hemorrhage, and midline shift. Anti-MOG antibody was present at a high titer. CSF IL-6 protein was >2,000 times above the upper limits of normal. He improved after plasma exchange, then began monthly treatment alone with anti-IL-6 receptor antibody, tocilizumab, and has remained stable. This case highlights how adult-onset MOGAD, like childhood ADEM, can rapidly become life-threatening. The markedly elevated CSF IL-6 observed here supports consideration for evaluating CSF cytokines more broadly in patients with acute MOGAD.
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Affiliation(s)
- Akash Virupakshaiah
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Carson E Moseley
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Elicegui
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Lee M Gerwitz
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Collin M Spencer
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elizabeth George
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Maulik Shah
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Bruce A C Cree
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Emmanuelle Waubant
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the UCSF Weill Institute for Neurosciences (A.V., C.E.M., C.M.S., M.S., B.A.C., E.W., S.S.Z.), University of California, San Francisco; University of Nevada Reno School of Medicine (S.E.); Renown Health (L.M.G.), Reno, NV; Department of Radiology and Biomedical Imaging (E.G.); and Program in Immunology (S.S.Z.), University of California, San Francisco
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Ross LA, Lee J, Carlson AK, Conway DS, Cohen JA, Graves J, Zamvil SS, Newsome SD, Kunchok A. Progressive Encephalomyelopathy in an Older Man: A Case Report From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200210. [PMID: 38386951 PMCID: PMC10900913 DOI: 10.1212/nxi.0000000000200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
We present a case of subacute onset progressive encephalomyelopathy in a 77-year-old man with symmetric lateral column signal abnormalities on spinal MRI. We discuss the differential and presumptive final diagnosis along with a review of the postulated disease immunopathogenesis.
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Affiliation(s)
- Lindsay A Ross
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jonathan Lee
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Alise K Carlson
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Devon S Conway
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jeffrey A Cohen
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Graves
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott D Newsome
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Amy Kunchok
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
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3
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Amiola TO, Oh U, Richard H, Newsome SD, Graves J, Zamvil SS, Goldman MD. A 42-Year-Old Woman With Rapidly Expanding White Matter Lesions: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200201. [PMID: 38285968 DOI: 10.1212/nxi.0000000000200201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
A 42-year-old woman and active cocaine user complained of subacutely worsening blurred vision and imbalance. Examination of the brain MRI showed rapidly expanding white matter lesions. Brain biopsy was consistent with inflammatory demyelination. Given an unusual presentation and a history of cocaine use, a broad differential diagnosis was considered including neurologic toxidromes.
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Affiliation(s)
- Tolulope O Amiola
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Unsong Oh
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Hope Richard
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Scott D Newsome
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Jennifer Graves
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Scott S Zamvil
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Myla D Goldman
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
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4
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Zamecnik CR, Sowa GM, Abdelhak A, Dandekar R, Bair RD, Wade KJ, Bartley CM, Kizer K, Augusto DG, Tubati A, Gomez R, Fouassier C, Gerungan C, Caspar CM, Alexander J, Wapniarski AE, Loudermilk RP, Eggers EL, Zorn KC, Ananth K, Jabassini N, Mann SA, Ragan NR, Santaniello A, Henry RG, Baranzini SE, Zamvil SS, Sabatino JJ, Bove RM, Guo CY, Gelfand JM, Cuneo R, von Büdingen HC, Oksenberg JR, Cree BAC, Hollenbach JA, Green AJ, Hauser SL, Wallin MT, DeRisi JL, Wilson MR. An autoantibody signature predictive for multiple sclerosis. Nat Med 2024:10.1038/s41591-024-02938-3. [PMID: 38641750 DOI: 10.1038/s41591-024-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
Although B cells are implicated in multiple sclerosis (MS) pathophysiology, a predictive or diagnostic autoantibody remains elusive. In this study, the Department of Defense Serum Repository (DoDSR), a cohort of over 10 million individuals, was used to generate whole-proteome autoantibody profiles of hundreds of patients with MS (PwMS) years before and subsequently after MS onset. This analysis defines a unique cluster in approximately 10% of PwMS who share an autoantibody signature against a common motif that has similarity with many human pathogens. These patients exhibit antibody reactivity years before developing MS symptoms and have higher levels of serum neurofilament light (sNfL) compared to other PwMS. Furthermore, this profile is preserved over time, providing molecular evidence for an immunologically active preclinical period years before clinical onset. This autoantibody reactivity was validated in samples from a separate incident MS cohort in both cerebrospinal fluid and serum, where it is highly specific for patients eventually diagnosed with MS. This signature is a starting point for further immunological characterization of this MS patient subset and may be clinically useful as an antigen-specific biomarker for high-risk patients with clinically or radiologically isolated neuroinflammatory syndromes.
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Affiliation(s)
- Colin R Zamecnik
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Gavin M Sowa
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Ahmed Abdelhak
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ravi Dandekar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca D Bair
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kristen J Wade
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher M Bartley
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kerry Kizer
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Danillo G Augusto
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Asritha Tubati
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Refujia Gomez
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Camille Fouassier
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chloe Gerungan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Colette M Caspar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Alexander
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Anne E Wapniarski
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P Loudermilk
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erica L Eggers
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nora Jabassini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Nicholas R Ragan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Santaniello
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Roland G Henry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sergio E Baranzini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph J Sabatino
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chu-Yueh Guo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Richard Cuneo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - H-Christian von Büdingen
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jorge R Oksenberg
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jill A Hollenbach
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ari J Green
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchell T Wallin
- Department of Veterans Affairs, Multiple Sclerosis Center of Excellence, Washington, DC, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
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5
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Poisson KE, Newsome SD, Graves J, Zamvil SS, Marcus LR. Teenager With Recurrent Ataxia, Ophthalmoplegia, and Encephalopathy Associated With Demyelination: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200193. [PMID: 38181318 DOI: 10.1212/nxi.0000000000200193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
A 15-year-old adolescent boy developed subacute ataxia, encephalopathy, ophthalmoplegia, and dysarthria following a sore throat. An MRI examination revealed multifocal enhancing and nonenhancing supratentorial white matter and symmetric brainstem lesions. After 2 additional presentations with worsening symptoms and lesion accumulation, he was ultimately successfully treated with rituximab for his condition.
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Affiliation(s)
- Kelsey E Poisson
- From the Nationwide Children's Hospital (K.E.P.), Columbus, OH; Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; University of California San Diego School of Medicine (J.G.); University of California, San Francisco (S.S.Z.); and Children's of Alabama (L.R.M.), Birmingham
| | - Scott D Newsome
- From the Nationwide Children's Hospital (K.E.P.), Columbus, OH; Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; University of California San Diego School of Medicine (J.G.); University of California, San Francisco (S.S.Z.); and Children's of Alabama (L.R.M.), Birmingham
| | - Jennifer Graves
- From the Nationwide Children's Hospital (K.E.P.), Columbus, OH; Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; University of California San Diego School of Medicine (J.G.); University of California, San Francisco (S.S.Z.); and Children's of Alabama (L.R.M.), Birmingham
| | - Scott S Zamvil
- From the Nationwide Children's Hospital (K.E.P.), Columbus, OH; Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; University of California San Diego School of Medicine (J.G.); University of California, San Francisco (S.S.Z.); and Children's of Alabama (L.R.M.), Birmingham
| | - Lydia R Marcus
- From the Nationwide Children's Hospital (K.E.P.), Columbus, OH; Johns Hopkins University School of Medicine (S.D.N.), Baltimore, MD; University of California San Diego School of Medicine (J.G.); University of California, San Francisco (S.S.Z.); and Children's of Alabama (L.R.M.), Birmingham
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6
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O'Neill KA, Dugue A, Abreu NJ, Balcer LJ, Branche M, Galetta S, Graves J, Kister I, Magro C, Miller C, Newsome SD, Pappas J, Rucker J, Steigerwald C, William CM, Zamvil SS, Grossman SN, Krupp LB. Relapsing White Matter Disease and Subclinical Optic Neuropathy: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200194. [PMID: 38181317 DOI: 10.1212/nxi.0000000000200194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
A 16-year-old adolescent boy presented with recurrent episodes of weakness and numbness. Brain MRI demonstrated subcortical, juxtacortical, and periventricular white matter T2 hyperintensities with gadolinium enhancement. CSF was positive for oligoclonal bands that were not present in serum. Despite treatment with steroids, IV immunoglobulins, plasmapheresis, and rituximab, he continued to have episodes of weakness and numbness and new areas of T2 hyperintensity on imaging. Neuro-ophthalmologic examination revealed a subclinical optic neuropathy with predominant involvement of the papillomacular bundle. Genetic evaluation and brain biopsy led to an unexpected diagnosis.
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Affiliation(s)
- Kimberly A O'Neill
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Andrew Dugue
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Nicolas J Abreu
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Marc Branche
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Jennifer Graves
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Ilya Kister
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Cynthia Magro
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Claire Miller
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - John Pappas
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Janet Rucker
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Connolly Steigerwald
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Christopher M William
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Scott N Grossman
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
| | - Lauren B Krupp
- From the Department of Neurology (K.A.O., A.D., N.J.A., L.J.B., S.G., I.K., C.M., J.R., C.M.W., S.N.G., L.B.K.); Department of Ophthalmology (A.D.); Division of Neurogenetics (NJA, CS); Department of Ophthalmology (L.J.B., S.G., S.N.G.); Department of Population Health (L.J.B.); Department of Radiology (M.B.), NYU Grossman School of Medicine, New York, NY; Department of Neurosciences (J.G.), University of California, San Diego; Department of Pathology (C.M.), Weill Cornell Medicine, New York, NY; Department of Neurology (S.D.N.), Johns Hopkins University, Baltimore, MD; Departments of Pediatrics (J.P.) and Pathology (C.M.W.), NYU Grossman School of Medicine, New York, NY; and Department of Neurology (S.S.Z.), University of California, San Francisco
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Lin J, Pulst-Korenberg J, Zamvil SS, Graves J, Newsome SD, Amezcua L. Tuberculous Meningitis or Neurosarcoidosis-a Diagnostic Quandary. From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200184. [PMID: 38118077 PMCID: PMC10732344 DOI: 10.1212/nxi.0000000000200184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Abstract
Distinguishing granulomatous diseases remains diagnostically challenging. Clinical phenotypes and neuroimaging findings resemble many infectious and noninfectious disorders. We describe a Hispanic/Latino man diagnosed with tuberculous meningitis who deteriorated neurologically after treatments. Additional workup revealed a pathology more consistent with neurosarcoidosis. Care access delays and social circumstances likely complicated his diagnosis.
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Affiliation(s)
- Jia Lin
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Johannes Pulst-Korenberg
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Scott S Zamvil
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Jennifer Graves
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Scott D Newsome
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
| | - Lilyana Amezcua
- From the Department of Neurology (J.L., J.P.-K., L.A.), University of Southern California, Keck School of Medicine, Los Angeles; Department of Neurology (S.S.Z.), University of California San Francisco; Department of Neurosciences (J.G.), University of California San Diego; and Department of Neurology and Neurosurgery (S.D.N.), Johns Hopkins University, Baltimore, MD
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8
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Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, Arona J, Stern WA, Chong J, Hart J, Zamvil SS, Sati P, Henry RG, Waubant E. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:1736-1747. [PMID: 37897254 PMCID: PMC10687802 DOI: 10.1177/13524585231204414] [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: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. METHODS T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. RESULTS The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1-10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). CONCLUSION The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.
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Affiliation(s)
- Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akash Virupakshaiah
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vinicius A Schoeps
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amit Akula
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Haojun Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Arona
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janace Hart
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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9
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Moseley CE, Zamvil SS. Targeting PGLYRP1 in cancer and autoimmunity. Nat Immunol 2023; 24:1785-1786. [PMID: 37828380 DOI: 10.1038/s41590-023-01649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Carson E Moseley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Program in Immunology, University of California, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
- Program in Immunology, University of California, San Francisco, CA, USA.
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Novak F, Bajwa HM, Coia JE, Nilsson AC, Nielsen C, Holm DK, Østergaard K, Hvidt MVM, Byg KE, Johansen IS, Mittl K, Rowles W, Zamvil SS, Bove R, Sabatino JJ, Sejbaek T. Low protection from breakthrough SARS-CoV-2 infection and mild disease course in ocrelizumab-treated patients with multiple sclerosis after three mRNA vaccine doses. J Neurol Neurosurg Psychiatry 2023; 94:934-937. [PMID: 37185261 PMCID: PMC10579504 DOI: 10.1136/jnnp-2022-330757] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Our study investigated the rate of breakthrough SARS-CoV-2 infection and clinical outcomes in a cohort of multiple sclerosis (MS) patients who were treated with the anti-CD20 monoclonal antibody (Ab), ocrelizumab, before first, second and third BNT162b2 mRNA vaccinations. To correlate clinical outcomes with the humoral and cellular response. METHODS The study was a prospective non-randomised controlled multicentre trial observational study. Participants with a diagnosis of MS who were treated for at least 12 months with ocrelizumab prior to the first BNT162b2 mRNA vaccination were prospectively followed up from January 2021 to June 2022. RESULTS Out of 54 participants, 32 (59.3%) developed a positive SARS-CoV-2 PCR test in the study period. Mild infection was observed in all infected participants. After the third vaccination, the non-infected participants had higher mean Ab levels compared to the infected participants (54.3 binding antibody unit (BAU)/mL vs 26.5 BAU/mL, p=0.030). The difference in reactivity between spike-specific CD4+ and CD8+ T lymphocytes in the two groups was not significant. CONCLUSION AND RELEVANCE The study results demonstrate rates of 59% in breakthrough infections after the third SARS-CoV-2 mRNA vaccination in ocrelizumab-treated patients with MS, without resulting in critical disease courses. These findings suggest the need for continuous development of prophylactic treatments when proved important in the protection of severe breakthrough infection.
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Affiliation(s)
- Frederik Novak
- Neurology, Southwest Jutland Hospital, Esbjerg, Region of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Hamza Mahmood Bajwa
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Southwest Jutland Hospital, Esbjerg, Denmark
| | - John Eugenio Coia
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | | | - Keld-Erik Byg
- Department of Rheumatology, Odense Universitetshospital, Odense, Denmark
| | - Isik S Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Kristen Mittl
- Department of Neurology, University California San Francisco, San Francisco, California, USA
| | - William Rowles
- Department of Neurology, University California San Francisco, San Francisco, California, USA
| | - Scott S Zamvil
- Department of Neurology, University California San Francisco, San Francisco, California, USA
| | - Riley Bove
- Department of Neurology, Multiple Sclerosis Center at UCSF, San Francisco, California, USA
| | - Joseph J Sabatino
- Department of Neurology, University California San Francisco, San Francisco, California, USA
| | - Tobias Sejbaek
- Department of Neurology, Southwest Jutland Hospital, Esbjerg, Denmark
- Department of Regional Health Research, University Hospital of Southern Denmark, Esbjerg, Denmark
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Safadi AL, Osborne B, Chitnis T, Graves JS, Newsome SD, Zamvil SS, Solomon IH, Shin RK. A 28-Year-Old Woman With Left-Sided Weakness and Atypical MRI Lesions: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200157. [PMID: 37673687 PMCID: PMC10482384 DOI: 10.1212/nxi.0000000000200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
A 28-year-old woman presented with subacute relapsing left-sided weakness. MRI demonstrated both enhancing C3-C6 and nonenhancing T2-T4 lesions. Initial provisional diagnosis was inflammatory/autoimmune. Her left-sided weakness progressed despite immunosuppressive therapies. We reassessed our original suspected diagnosis because of an atypical clinicoradiologic course, leading to biopsy and a definitive diagnosis.
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Affiliation(s)
- Amy L Safadi
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA.
| | - Benjamin Osborne
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Tanuja Chitnis
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Jennifer S Graves
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Scott D Newsome
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Scott S Zamvil
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Isaac H Solomon
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
| | - Robert K Shin
- From the Georgetown Multiple Sclerosis and Neuroimmunology Center (A.L.S., B.O., R.K.S.), Department of Neurology, MedStar Georgetown University Hospital, Washington, DC; Brigham Multiple Sclerosis Center (T.C.), Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurosciences (J.S.G.), University of California San Diego School of Medicine, La Jolla; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; and Department of Pathology (I.H.S.), Brigham and Women's Hospital, Boston, MA
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12
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Sagan SA, Moinfar Z, Moseley CE, Dandekar R, Spencer CM, Verkman AS, Ottersen OP, Sobel RA, Sidney J, Sette A, Anderson MS, Steinman L, Wilson MR, Sabatino JJ, Zamvil SS. T cell deletional tolerance restricts AQP4 but not MOG CNS autoimmunity. Proc Natl Acad Sci U S A 2023; 120:e2306572120. [PMID: 37463205 PMCID: PMC10372680 DOI: 10.1073/pnas.2306572120] [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: 04/26/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Aquaporin-4 (AQP4)-specific Th17 cells are thought to have a central role in neuromyelitis optica (NMO) pathogenesis. When modeling NMO, only AQP4-reactive Th17 cells from AQP4-deficient (AQP4-/-), but not wild-type (WT) mice, caused CNS autoimmunity in recipient WT mice, indicating that a tightly regulated mechanism normally ensures tolerance to AQP4. Here, we found that pathogenic AQP4 T cell epitopes bind MHC II with exceptionally high affinity. Examination of T cell receptor (TCR) α/β usage revealed that AQP4-specific T cells from AQP4-/- mice employed a distinct TCR repertoire and exhibited clonal expansion. Selective thymic AQP4 deficiency did not fully restore AQP4-reactive T cells, demonstrating that thymic negative selection alone did not account for AQP4-specific tolerance in WT mice. Indeed, AQP4-specific Th17 cells caused paralysis in recipient WT or B cell-deficient mice, which was followed by complete recovery that was associated with apoptosis of donor T cells. However, donor AQP4-reactive T cells survived and caused persistent paralysis in recipient mice deficient in both T and B cells or mice lacking T cells only. Thus, AQP4 CNS autoimmunity was limited by T cell-dependent deletion of AQP4-reactive T cells. In contrast, myelin oligodendrocyte glycoprotein (MOG)-specific T cells survived and caused sustained disease in WT mice. These findings underscore the importance of peripheral T cell deletional tolerance to AQP4, which may be relevant to understanding the balance of AQP4-reactive T cells in health and in NMO. T cell tolerance to AQP4, expressed in multiple tissues, is distinct from tolerance to MOG, an autoantigen restricted in its expression.
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Affiliation(s)
- Sharon A Sagan
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
- Program in Immunology, University of California, San Francisco, CA 94143
| | - Zahra Moinfar
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
- Program in Immunology, University of California, San Francisco, CA 94143
| | - Carson E Moseley
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
- Program in Immunology, University of California, San Francisco, CA 94143
| | - Ravi Dandekar
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
| | - Collin M Spencer
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
- Program in Immunology, University of California, San Francisco, CA 94143
| | - Alan S Verkman
- Department of Medicine, University of California, San Francisco, CA 94143
- Department of Physiology, University of California, San Francisco, CA 94143
| | - Ole Petter Ottersen
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo NO-0316, Norway
| | - Raymond A Sobel
- Department of Pathology, Stanford University School of Medicine, Palo Alto VA Health Care System, Palo Alto, CA 94305
| | - John Sidney
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037
| | - Alessandro Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA 92037
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA 92093
| | - Mark S Anderson
- Program in Immunology, University of California, San Francisco, CA 94143
- Diabetes Center, University of California, San Francisco, CA 94143
| | - Lawrence Steinman
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305
| | - Michael R Wilson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
| | - Joseph J Sabatino
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
| | - Scott S Zamvil
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143
- Program in Immunology, University of California, San Francisco, CA 94143
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13
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Mendiola AS, Yan Z, Dixit K, Johnson JR, Bouhaddou M, Meyer-Franke A, Shin MG, Yong Y, Agrawal A, MacDonald E, Muthukumar G, Pearce C, Arun N, Cabriga B, Meza-Acevedo R, Alzamora MDPS, Zamvil SS, Pico AR, Ryu JK, Krogan NJ, Akassoglou K. Defining blood-induced microglia functions in neurodegeneration through multiomic profiling. Nat Immunol 2023; 24:1173-1187. [PMID: 37291385 PMCID: PMC10307624 DOI: 10.1038/s41590-023-01522-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 11/04/2021] [Accepted: 04/24/2023] [Indexed: 06/10/2023]
Abstract
Blood protein extravasation through a disrupted blood-brain barrier and innate immune activation are hallmarks of neurological diseases and emerging therapeutic targets. However, how blood proteins polarize innate immune cells remains largely unknown. Here, we established an unbiased blood-innate immunity multiomic and genetic loss-of-function pipeline to define the transcriptome and global phosphoproteome of blood-induced innate immune polarization and its role in microglia neurotoxicity. Blood induced widespread microglial transcriptional changes, including changes involving oxidative stress and neurodegenerative genes. Comparative functional multiomics showed that blood proteins induce distinct receptor-mediated transcriptional programs in microglia and macrophages, such as redox, type I interferon and lymphocyte recruitment. Deletion of the blood coagulation factor fibrinogen largely reversed blood-induced microglia neurodegenerative signatures. Genetic elimination of the fibrinogen-binding motif to CD11b in Alzheimer's disease mice reduced microglial lipid metabolism and neurodegenerative signatures that were shared with autoimmune-driven neuroinflammation in multiple sclerosis mice. Our data provide an interactive resource for investigation of the immunology of blood proteins that could support therapeutic targeting of microglia activation by immune and vascular signals.
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Affiliation(s)
- Andrew S Mendiola
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Zhaoqi Yan
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Karuna Dixit
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | | | - Mehdi Bouhaddou
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
| | | | | | - Yu Yong
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | | | - Eilidh MacDonald
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | | | - Clairice Pearce
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Nikhita Arun
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Belinda Cabriga
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Rosa Meza-Acevedo
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Maria Del Pilar S Alzamora
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | | | - Jae Kyu Ryu
- Gladstone Institutes, San Francisco, CA, USA
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Nevan J Krogan
- Gladstone Institutes, San Francisco, CA, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA, USA
- Department of Cellular and Molecular Pharmacology, University of California, San Francisco, CA, USA
| | - Katerina Akassoglou
- Gladstone Institutes, San Francisco, CA, USA.
- Center for Neurovascular Brain Immunology at Gladstone and UCSF, San Francisco, CA, USA.
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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14
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Zamecnik CR, Sowa GM, Abdelhak A, Dandekar R, Bair RD, Wade KJ, Bartley CM, Tubati A, Gomez R, Fouassier C, Gerungan C, Alexander J, Wapniarski AE, Loudermilk RP, Eggers EL, Zorn KC, Ananth K, Jabassini N, Mann SA, Ragan NR, Santaniello A, Henry RG, Baranzini SE, Zamvil SS, Bove RM, Guo CY, Gelfand JM, Cuneo R, von Büdingen HC, Oksenberg JR, Cree BAC, Hollenbach JA, Green AJ, Hauser SL, Wallin MT, DeRisi JL, Wilson MR. A Predictive Autoantibody Signature in Multiple Sclerosis. medRxiv 2023:2023.05.01.23288943. [PMID: 37205595 PMCID: PMC10187343 DOI: 10.1101/2023.05.01.23288943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Although B cells are implicated in multiple sclerosis (MS) pathophysiology, a predictive or diagnostic autoantibody remains elusive. Here, the Department of Defense Serum Repository (DoDSR), a cohort of over 10 million individuals, was used to generate whole-proteome autoantibody profiles of hundreds of patients with MS (PwMS) years before and subsequently after MS onset. This analysis defines a unique cluster of PwMS that share an autoantibody signature against a common motif that has similarity with many human pathogens. These patients exhibit antibody reactivity years before developing MS symptoms and have higher levels of serum neurofilament light (sNfL) compared to other PwMS. Furthermore, this profile is preserved over time, providing molecular evidence for an immunologically active prodromal period years before clinical onset. This autoantibody reactivity was validated in samples from a separate incident MS cohort in both cerebrospinal fluid (CSF) and serum, where it is highly specific for patients eventually diagnosed with MS. This signature is a starting point for further immunological characterization of this MS patient subset and may be clinically useful as an antigen-specific biomarker for high-risk patients with clinically- or radiologically-isolated neuroinflammatory syndromes.
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Affiliation(s)
- Colin R. Zamecnik
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gavin M. Sowa
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ravi Dandekar
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rebecca D. Bair
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kristen J. Wade
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christopher M. Bartley
- UCSF Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Asritha Tubati
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Refujia Gomez
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Camille Fouassier
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Chloe Gerungan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica Alexander
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Anne E. Wapniarski
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rita P. Loudermilk
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Erica L. Eggers
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kelsey C. Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Kirtana Ananth
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Nora Jabassini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sabrina A. Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Nicholas R. Ragan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Adam Santaniello
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Roland G. Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sergio E. Baranzini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Scott S. Zamvil
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Riley M. Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Chu-Yueh Guo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeffrey M. Gelfand
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Richard Cuneo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - H.-Christian von Büdingen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jorge R. Oksenberg
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce AC Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jill A. Hollenbach
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Ari J. Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Stephen L. Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Mitchell T. Wallin
- Veterans Affairs, Multiple Sclerosis Center of Excellence, Washington, DC and University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Michael R. Wilson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
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15
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Roy S, Barreras P, Pardo CA, Graves JS, Zamvil SS, Newsome SD. Relapsing Encephalomyelitis After COVID-19 Infection and Vaccination: From the National MS Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/3/e200112. [PMID: 37015826 PMCID: PMC10074377 DOI: 10.1212/nxi.0000000000200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/09/2023] [Indexed: 04/06/2023]
Abstract
Prior case studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines may unmask CNS neuroinflammatory conditions. We present a case of relapsing steroid-responsive encephalomyelitis after SARS-CoV-2 infection and subsequent COVID-19 vaccination. We also characterize the frequency of CNS neuroinflammatory events reported in the literature after both SARS-CoV-2 infection and COVID-19 vaccination.
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Affiliation(s)
- Shuvro Roy
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine
| | - Paula Barreras
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine
| | - Carlos A Pardo
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine
| | - Jennifer S Graves
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine
| | - Scott S Zamvil
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine
| | - Scott D Newsome
- From the Department of Neurology (S.R., P.B., C.A.P., S.D.N.), Johns Hopkins School of Medicine; Department of Neurology (J.S.G.), University of California San Diego School of Medicine; and Department of Neurology (S.S.Z.), University of California San Francisco School of Medicine.
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16
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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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17
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Gupta S, Simic M, Sagan SA, Shepherd C, Duecker J, Sobel RA, Dandekar R, Wu GF, Wu W, Pak JE, Hauser SL, Lim W, Wilson MR, Zamvil SS. CAR-T Cell-Mediated B-Cell Depletion in Central Nervous System Autoimmunity. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200080. [PMID: 36657993 PMCID: PMC9853314 DOI: 10.1212/nxi.0000000000200080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-CD20 monoclonal antibody (mAb) B-cell depletion is a remarkably successful multiple sclerosis (MS) treatment. Chimeric antigen receptor (CAR)-T cells, which target antigens in a non-major histocompatibility complex (MHC)-restricted manner, can penetrate tissues more thoroughly than mAbs. However, a previous study indicated that anti-CD19 CAR-T cells can paradoxically exacerbate experimental autoimmune encephalomyelitis (EAE) disease. We tested anti-CD19 CAR-T cells in a B-cell-dependent EAE model that is responsive to anti-CD20 B-cell depletion similar to the clinical benefit of anti-CD20 mAb treatment in MS. METHODS Anti-CD19 CAR-T cells or control cells that overexpressed green fluorescent protein were transferred into C57BL/6 mice pretreated with cyclophosphamide (Cy). Mice were immunized with recombinant human (rh) myelin oligodendrocyte protein (MOG), which causes EAE in a B-cell-dependent manner. Mice were evaluated for B-cell depletion, clinical and histologic signs of EAE, and immune modulation. RESULTS Clinical scores and lymphocyte infiltration were reduced in mice treated with either anti-CD19 CAR-T cells with Cy or control cells with Cy, but not with Cy alone. B-cell depletion was observed in peripheral lymphoid tissue and in the CNS of mice treated with anti-CD19 CAR-T cells with Cy pretreatment. Th1 or Th17 populations did not differ in anti-CD19 CAR-T cell, control cell-treated animals, or Cy alone. DISCUSSION In contrast to previous data showing that anti-CD19 CAR-T cell treatment exacerbated EAE, we observed that anti-CD19 CAR-T cells ameliorated EAE. In addition, anti-CD19 CAR-T cells thoroughly depleted B cells in peripheral tissues and in the CNS. However, the clinical benefit occurred independently of antigen specificity or B-cell depletion.
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Affiliation(s)
- Sasha Gupta
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Milos Simic
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Sharon A Sagan
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Chanelle Shepherd
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Jason Duecker
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Raymond A Sobel
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Ravi Dandekar
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Gregory F Wu
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Wesley Wu
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - John E Pak
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Stephen L Hauser
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Wendell Lim
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Michael R Wilson
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Scott S Zamvil
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA.
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18
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Bennett JL, Fujihara K, Kim HJ, Marignier R, O'Connor KC, Sergott RC, Traboulsee A, Wiendl H, Wuerfel J, Zamvil SS, Anania VG, Buffels R, Künzel T, Lekkerkerker AN, Lennon-Chrimes S, Pittock SJ. SAkuraBONSAI: Protocol design of a novel, prospective study to explore clinical, imaging, and biomarker outcomes in patients with AQP4-IgG-seropositive neuromyelitis optica spectrum disorder receiving open-label satralizumab. Front Neurol 2023; 14:1114667. [PMID: 36873431 PMCID: PMC9982113 DOI: 10.3389/fneur.2023.1114667] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare, autoimmune disease of the central nervous system that produces acute, unpredictable relapses causing cumulative neurological disability. Satralizumab, a humanized, monoclonal recycling antibody that targets the interleukin-6 receptor, reduced NMOSD relapse risk vs. placebo in two Phase 3 trials: SAkuraSky (satralizumab ± immunosuppressive therapy; NCT02028884) and SAkuraStar (satralizumab monotherapy; NCT02073279). Satralizumab is approved to treat aquaporin-4 IgG-seropositive (AQP4-IgG+) NMOSD. SAkuraBONSAI (NCT05269667) will explore fluid and imaging biomarkers to better understand the mechanism of action of satralizumab and the neuronal and immunological changes following treatment in AQP4-IgG+ NMOSD. Objectives SAkuraBONSAI will evaluate clinical disease activity measures, patient-reported outcomes (PROs), pharmacokinetics, and safety of satralizumab in AQP4-IgG+ NMOSD. Correlations between imaging markers (magnetic resonance imaging [MRI] and optical coherence tomography [OCT]) and blood and cerebrospinal fluid (CSF) biomarkers will be investigated. Study design SAkuraBONSAI is a prospective, open-label, multicenter, international, Phase 4 study that will enroll approximately 100 adults (18-74 years) with AQP4-IgG+ NMOSD. This study includes two patient cohorts: newly diagnosed, treatment-naïve patients (Cohort 1; n = 60); and inadequate responders to recent (<6 months) rituximab infusion (Cohort 2; n = 40). Satralizumab monotherapy (120 mg) will be administered subcutaneously at Weeks 0, 2, 4, and Q4W thereafter for a total of 92 weeks. Endpoints Disease activity related to relapses (proportion relapse-free, annualized relapse rate, time to relapse, and relapse severity), disability progression (Expanded Disability Status Scale), cognition (Symbol Digit Modalities Test), and ophthalmological changes (visual acuity; National Eye Institute Visual Function Questionnaire-25) will all be assessed. Peri-papillary retinal nerve fiber layer and ganglion cell complex thickness will be monitored using advanced OCT (retinal nerve fiber layer and ganglion cell plus inner plexiform layer thickness). Lesion activity and atrophy will be monitored by MRI. Pharmacokinetics, PROs, and blood and CSF mechanistic biomarkers will be assessed regularly. Safety outcomes include the incidence and severity of adverse events. Conclusions SAkuraBONSAI will incorporate comprehensive imaging, fluid biomarker, and clinical assessments in patients with AQP4-IgG+ NMOSD. SAkuraBONSAI will provide new insights into the mechanism of action of satralizumab in NMOSD, while offering the opportunity to identify clinically relevant neurological, immunological, and imaging markers.
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Affiliation(s)
- Jeffrey L. Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Kevin C. O'Connor
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, United States
| | - Robert C. Sergott
- Annesley EyeBrain Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Heinz Wiendl
- Department of Neurology, University of Muenster, Münster, Germany
| | - Jens Wuerfel
- Medical Image Analysis Centre (MIAC AG) and University of Basel, Basel, Switzerland
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Scott S. Zamvil
- Department of Neurology and Program in Immunology, University of California, San Francisco, San Francisco, CA, United States
| | | | | | | | | | | | - Sean J. Pittock
- Department of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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19
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Sabatino JJ, Mittl K, Rowles W, Zamecnik CR, Loudermilk RP, Gerungan C, Spencer CM, Sagan SA, Alexander J, Mcpolin K, Chen P, Deshpande C, Wyse K, Maiese EM, Wilson MR, Zamvil SS, Bove R. Longitudinal adaptive immune responses following sequential SARS-CoV-2 vaccinations in MS patients on anti-CD20 therapies and sphingosine-1-phosphate receptor modulators. Mult Scler Relat Disord 2023; 70:104484. [PMID: 36608538 PMCID: PMC9794398 DOI: 10.1016/j.msard.2022.104484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Adequate response to the SARS-CoV-2 vaccine represents an important treatment goal in caring for patients with multiple sclerosis (MS) during the ongoing COVID-19 pandemic. Previous data so far have demonstrated lower spike-specific IgG responses following two SARS-CoV-2 vaccinations in MS patients treated with sphingosine-1-phosphate (S1P) receptor modulators and anti-CD20 monoclonal antibodies (mAb) compared to other disease modifying therapies (DMTs). It is unknown whether subsequent vaccinations can augment antibody responses in these patients. OBJECTIVES The goal of this observational study was to determine the effects of a third SARS-CoV-2 vaccination on antibody and T cell responses in MS patients treated with anti-CD20 mAb or S1P receptor modulators. METHODS Vaccine responses in patients treated with anti-CD20 antibodies (ocrelizumab and ofatumumab) or S1P receptor modulators (fingolimod and siponimod) were evaluated before and after third SARS-CoV-2 vaccination as part of an ongoing longitudinal study. Total spike protein and spike receptor binding domain (RBD)-specific IgG responses were measured by Luminex bead-based assay. Spike-specific CD4+ and CD8+ T cell responses were measured by activation-induced marker expression. RESULTS MS patients and healthy controls were enrolled before and following SARS-CoV-2 vaccination. A total of 31 MS patients (n = 10 ofatumumab, n = 13 ocrelizumab, n = 8 S1P) and 10 healthy controls were evaluated through three SARS-CoV-2 vaccinations. Compared to healthy controls, total spike IgG was significantly lower in anti-CD20 mAb-treated patients and spike RBD IgG was significantly lower in anti-CD20 mAb and S1P-treated patients following a third vaccination. While seropositivity was 100% in healthy controls after a third vaccination, total spike IgG and spike RBD IgG seropositivity were lower in ofatumumab (60% and 60%, respectively), ocrelizumab (85% and 46%, respectively), and S1P-treated patients (100% and 75%, respectively). Longer treatment duration, including prior treatment history, appeared to negatively impact antibody responses. Spike-specific CD4+ and CD8+ T cell responses were well maintained across all groups following a third vaccination. Finally, immune responses were also compared in patients who were vaccinated prior to or following ofatumumab treatment. Antibody responses were significantly higher in those patients who received their primary SARS-CoV-2 vaccination prior to initiating ofatumumab treatment. CONCLUSIONS This study adds to the evolving understanding of SARS-CoV-2 vaccine responses in people with MS treated with disease-modifying therapies (DMTs) known to suppress humoral immunity. Our findings provide important information for optimizing vaccine immunity in at-risk MS patient populations.
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Affiliation(s)
- Joseph J Sabatino
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kristen Mittl
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - William Rowles
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Colin R Zamecnik
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rita P Loudermilk
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Chloe Gerungan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Collin M Spencer
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sharon A Sagan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessa Alexander
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kira Mcpolin
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - PeiXi Chen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Kerri Wyse
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | | | - Michael R Wilson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Scott S Zamvil
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA.
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Dalmau J, Dalakas MC, Kolson DL, Paul F, Sánchez-Valle R, Zamvil SS. N2 Year in Review. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/1/e200076. [PMID: 36596717 PMCID: PMC9827124 DOI: 10.1212/nxi.0000000000200076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Josep Dalmau
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco.
| | - Marinos C Dalakas
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Dennis L Kolson
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Friedemann Paul
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Raquel Sánchez-Valle
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Scott S Zamvil
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D., R.S.-V.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
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21
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Pimentel Maldonado DA, Lisak R, Galetta S, Balcer L, Varkey T, Goodman A, Graves J, Racke M, Zamvil SS, Newsome S, Frohman EM, Frohman TC. Recurrent Optic Neuritis and Perineuritis Followed by an Unexpected Discovery. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/1/e200051. [DOI: 10.1212/nxi.0000000000200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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22
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Goldschmidt C, Galetta SL, Lisak RP, Balcer LJ, Hellman A, Racke MK, Lovett-Racke AE, Cruz R, Parsons MS, Sattarnezhad N, Steinman L, Zamvil SS, Frohman EM, Frohman TC. Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200037. [PMID: 36270950 PMCID: PMC9673749 DOI: 10.1212/nxi.0000000000200037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.
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Affiliation(s)
- Carolyn Goldschmidt
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Steven L Galetta
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Robert P Lisak
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Laura J Balcer
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Andrew Hellman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael K Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Amy E Lovett-Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Roberto Cruz
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Matthew S Parsons
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Neda Sattarnezhad
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence Steinman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Elliot M Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA.
| | - Teresa C Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
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23
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Zhou X, Baumann R, Gao X, Mendoza M, Singh S, Sand IK, Xia Z, Cox LM, Chitnis T, Yoon H, Moles L, Caillier SJ, Santaniello A, Ackermann G, Harroud A, Lincoln R, Gomez R, Peña AG, Digga E, Hakim DJ, Vazquez-Baeza Y, Soman K, Warto S, Humphrey G, Farez M, Gerdes LA, Oksenberg JR, Zamvil SS, Chandran S, Connick P, Otaegui D, Castillo-Triviño T, Hauser SL, Gelfand JM, Weiner HL, Hohlfeld R, Wekerle H, Graves J, Bar-Or A, Cree BA, Correale J, Knight R, Baranzini SE. Gut microbiome of multiple sclerosis patients and paired household healthy controls reveal associations with disease risk and course. Cell 2022; 185:3467-3486.e16. [PMID: 36113426 PMCID: PMC10143502 DOI: 10.1016/j.cell.2022.08.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/21/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
Changes in gut microbiota have been associated with several diseases. Here, the International Multiple Sclerosis Microbiome Study (iMSMS) studied the gut microbiome of 576 MS patients (36% untreated) and genetically unrelated household healthy controls (1,152 total subjects). We observed a significantly increased proportion of Akkermansia muciniphila, Ruthenibacterium lactatiformans, Hungatella hathewayi, and Eisenbergiella tayi and decreased Faecalibacterium prausnitzii and Blautia species. The phytate degradation pathway was over-represented in untreated MS, while pyruvate-producing carbohydrate metabolism pathways were significantly reduced. Microbiome composition, function, and derived metabolites also differed in response to disease-modifying treatments. The therapeutic activity of interferon-β may in part be associated with upregulation of short-chain fatty acid transporters. Distinct microbial networks were observed in untreated MS and healthy controls. These results strongly support specific gut microbiome associations with MS risk, course and progression, and functional changes in response to treatment.
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Affiliation(s)
- Xiaoyuan Zhou
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Ryan Baumann
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Xiaohui Gao
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Myra Mendoza
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Sneha Singh
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lau M. Cox
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hongsup Yoon
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospitals, Ludwig-Maximilians-Universität München, and Munich Cluster of Systems Neurology (SyNergy), München, Germany
- Department Neuroimmunology, Max Planck Institute (MPI) of Neurobiology, Munich, Germany
| | - Laura Moles
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Stacy J. Caillier
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Gail Ackermann
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Adil Harroud
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Robin Lincoln
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Elise Digga
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Joseph Hakim
- Department of Bioinformatics and Systems Biology, University of California, San Diego, La Jolla, CA, USA
| | - Yoshiki Vazquez-Baeza
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
| | - Karthik Soman
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Shannon Warto
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Mauricio Farez
- Department of Neurology, Institute for Neurological Research Dr. Raul Carrea (FLENI), Buenos Aires, Argentina
| | - Lisa Ann Gerdes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jorge R. Oksenberg
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Scott S. Zamvil
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Otaegui
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Tamara Castillo-Triviño
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
- Department of Neurology, Hospital Universitario Donostia and Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Stephen L. Hauser
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeffrey M. Gelfand
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Howard L. Weiner
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospitals, Ludwig-Maximilians-Universität München, and Munich Cluster of Systems Neurology (SyNergy), München, Germany
| | - Hartmut Wekerle
- Department Neuroimmunology, Max Planck Institute (MPI) of Neurobiology, Munich, Germany
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania, Pennsylvania, PA, USA
| | - Bruce A.C. Cree
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raul Carrea (FLENI), Buenos Aires, Argentina
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
| | - Sergio E. Baranzini
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
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Bove R, Anderson A, Rowles W, Rankin KA, Hills NK, Carleton M, Cooper J, Cree BA, Gelfand JM, Graves J, Henry RG, Krysko KM, Rush G, Zamvil SS, Joffe H, Chan JR, Green A. A Hormonal therapy for menopausal women with MS: A Phase Ib/IIa Randomized Controlled Trial. Mult Scler Relat Disord 2022; 61:103747. [DOI: 10.1016/j.msard.2022.103747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022]
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Reply to "Spinal cord atrophy is a preclinical marker of progressive MS". Ann Neurol 2022; 91:735-736. [PMID: 35233827 PMCID: PMC9511767 DOI: 10.1002/ana.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA.,Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Germany
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Bajwa HM, Novak F, Nilsson AC, Nielsen C, Holm DK, Østergaard K, Witt AH, Byg KE, Johansen IS, Mittl K, Rowles W, Zamvil SS, Bove R, Sabatino JJ, Sejbaek T. Persistently reduced humoral and sustained cellular immune response from first to third SARS-CoV-2 mRNA vaccination in anti-CD20-treated multiple sclerosis patients. Mult Scler Relat Disord 2022; 60:103729. [PMID: 35334278 PMCID: PMC8898195 DOI: 10.1016/j.msard.2022.103729] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 01/14/2023]
Abstract
Objective To examine humoral and cellular response in multiple sclerosis patients on anti-CD20 therapy after third BNT162b2 mRNA SARS-CoV-2 vaccination. Methods A prospective longitudinal study design from first throughout third vaccination in Danish and American MS centers. All participants were treated with ocrelizumab. Antibody (Ab) levels were assessed before and after third vaccination using SARS-CoV-2 IgG II Quant assay (Abbott Laboratories). B- and T-lymphocytes enumeration was done with BD Multitest™6-color TBNK reagent. Spike-specific T-cell responses were measured through PBMC stimulation with spike peptide pools (JPT Peptide Technologies). Results We found that 14.0%, 37.7%, and 33.3% were seropositive after first, second and third vaccination. The median Ab-levels were 74.2 BAU/mL (range: 8.5–2427) after second vaccination, as well as 43.7 BAU/ml (range: 7.8–366.1) and 31.3 BAU/mL (range: 7.9–507.0) before and after third vaccination, respectively. No difference was found in levels after second and third vaccination (p = 0.1475). Seropositivity dropped to 25.0% of participants before the third vaccination, a relative reduction of 33.3% (p = 0.0020). No difference was found between frequencies of spike reactive CD4+and CD8+ T-cells after second (0.65 ± 0.08% and 0.95 ± 0.20%, respectively) and third vaccination (0.99 ± 0.22% and 1.3 ± 0.34%, respectively). Conclusion In this longitudinal cohort we found no significant increased humoral or cellular response with administration of a third SARS-CoV-2 mRNA vaccination. These findings suggest the need for clinical strategies to include allowance of B cell reconstitution before repeat vaccination and/or provision of pre-exposure prophylactic monoclonal antibodies.
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Sabatino JJ, Mittl K, Rowles WM, McPolin K, Rajan JV, Laurie MT, Zamecnik CR, Dandekar R, Alvarenga BD, Loudermilk RP, Gerungan C, Spencer CM, Sagan SA, Augusto DG, Alexander JR, DeRisi JL, Hollenbach JA, Wilson MR, Zamvil SS, Bove R. Multiple sclerosis therapies differentially impact SARS-CoV-2 vaccine-induced antibody and T cell immunity and function. JCI Insight 2022; 7:156978. [PMID: 35030101 PMCID: PMC8876469 DOI: 10.1172/jci.insight.156978] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [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: 11/29/2021] [Accepted: 01/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vaccine-elicited adaptive immunity is a prerequisite for control of SARS-CoV-2 infection. Multiple sclerosis (MS) disease-modifying therapies (DMTs) differentially target humoral and cellular immunity. A comprehensive comparison of the effects of MS DMTs on SARS-CoV-2 vaccine–specific immunity is needed, including quantitative and functional B and T cell responses. METHODS Spike-specific Ab and T cell responses were measured before and following SARS-CoV-2 vaccination in a cohort of 80 study participants, including healthy controls and patients with MS in 6 DMT groups: untreated and treated with glatiramer acetate (GA), dimethyl fumarate (DMF), natalizumab (NTZ), sphingosine-1-phosphate (S1P) receptor modulators, and anti-CD20 mAbs. Anti–spike-Ab responses were assessed by Luminex assay, VirScan, and pseudovirus neutralization. Spike-specific CD4+ and CD8+ T cell responses were characterized by activation-induced marker and cytokine expression and tetramer. RESULTS Anti-spike IgG levels were similar between healthy control participants and patients with untreated MS and those receiving GA, DMF, or NTZ but were reduced in anti-CD20 mAb– and S1P-treated patients. Anti-spike seropositivity in anti-CD20 mAb–treated patients was correlated with CD19+ B cell levels and inversely correlated with cumulative treatment duration. Spike epitope reactivity and pseudovirus neutralization were reduced in anti-CD20 mAb– and S1P-treated patients. Spike-specific CD4+ and CD8+ T cell reactivity remained robust across all groups, except in S1P-treated patients, in whom postvaccine CD4+ T cell responses were attenuated. CONCLUSION These findings from a large cohort of patients with MS exposed to a wide spectrum of MS immunotherapies have important implications for treatment-specific COVID-19 clinical guidelines. FUNDING NIH grants 1K08NS107619, K08NS096117, R01AI159260, R01NS092835, R01AI131624, and R21NS108159; NMSS grants TA-1903-33713 and RG1701-26628; Westridge Foundation; Chan Zuckerberg Biohub; Maisin Foundation.
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Affiliation(s)
- Joseph J Sabatino
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Kristen Mittl
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - William M Rowles
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Kira McPolin
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Jayant V Rajan
- Department of Medicine, University of California, San Francisco, San Francisco, United States of America
| | - Matthew T Laurie
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, United States of America
| | - Colin R Zamecnik
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Ravi Dandekar
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Bonny D Alvarenga
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Rita P Loudermilk
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Chloe Gerungan
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Collin M Spencer
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Sharon A Sagan
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Danillo G Augusto
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Jessa R Alexander
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, United States of America
| | - Jill A Hollenbach
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Michael R Wilson
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
| | - Scott S Zamvil
- University of California, San Francisco, San Francisco, United States of America
| | - Riley Bove
- Department of Neurology, University of California, San Francisco, San Francisco, United States of America
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
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Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Novak F, Nilsson AC, Nielsen C, Holm DK, Østergaard K, Bystrup A, Byg KE, Johansen IS, Mittl K, Rowles W, Mcpolin K, Spencer C, Sagan S, Gerungan C, Wilson MR, Zamvil SS, Bove R, Sabatino JJ, Sejbaek T. Humoral immune response following SARS-CoV-2 mRNA vaccination concomitant to anti-CD20 therapy in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103251. [PMID: 34571415 PMCID: PMC8426319 DOI: 10.1016/j.msard.2021.103251] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The immunogenicity of COVID-19 vaccine among patients receiving anti-CD20 monoclonal antibody (Ab) treatment has not been fully investigated. Detectable levels of SARS-CoV-2 immunoglobulin G (IgG) are believed to have a predictive value for immune protection against COVID-19 and is currently a surrogate indicator for vaccine efficacy. OBJECTIVE To determine IgG Abs in anti-CD20 treated patients with multiple sclerosis (MS). METHOD IgG Abs against SARS-CoV-2 spike receptor-binding domain were measured with the SARS-CoV-2 IgG II Quant assay (Abbott Laboratories) before and after vaccination (n = 60). RESULTS 36.7% of patients mounted a positive SARS-CoV-2 spike Ab response after the second dose of vaccine. Five patients (8.3%) developed Abs >264 BAU/mL, another 12 patients (20%) developed intermediate Abs between 54 BAU/mL and 264 BAU/mL and five patients (8.3%) had low levels <54 BAU/mL. Of all seropositive patients, 63.6% converted from seronegative to seropositive after the 2nd vaccine. CONCLUSION Our study demonstrates decreased humoral response after BNT162b2 mRNA SARS-CoV-2 vaccine in MS patients receiving B-cell depleting therapy. Clinicians should advise patients treated with anti-CD20 to avoid exposure to SARS-CoV-2. Future studies should investigate the implications of a third booster vaccine in patients with low or absent Abs after vaccination.
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Affiliation(s)
- Frederik Novak
- Department of Neurology, Hospital Southwest Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anna Christine Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Anna Bystrup
- Department of Neurology, Hospitalsenhed Midt, Viborg, Denmark
| | - Keld-Erik Byg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Isik S Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Kristen Mittl
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - William Rowles
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Kira Mcpolin
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Collin Spencer
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Sharon Sagan
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Chloe Gerungan
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Riley Bove
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Joseph J Sabatino
- Weill Institute for Neurosciences, Department of Neurology, University California San Francisco, San Francisco, United States
| | - Tobias Sejbaek
- Department of Neurology, Hospital Southwest Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Castellanos CA, Ren X, Gonzalez SL, Li HK, Schroeder AW, Liang HE, Laidlaw BJ, Hu D, Mak ACY, Eng C, Rodríguez-Santana JR, LeNoir M, Yan Q, Celedón JC, Burchard EG, Zamvil SS, Ishido S, Locksley RM, Cyster JG, Huang X, Shin JS. Lymph node-resident dendritic cells drive T H2 cell development involving MARCH1. Sci Immunol 2021; 6:eabh0707. [PMID: 34652961 DOI: 10.1126/sciimmunol.abh0707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Carlos A Castellanos
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Xin Ren
- Department of Medicine, Lung Biology Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Steven Lomeli Gonzalez
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Hong Kun Li
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Andrew W Schroeder
- Department of Pulmonology, Genomics CoLabs, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Hong-Erh Liang
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Brian J Laidlaw
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Angel C Y Mak
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | | | | | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Scott S Zamvil
- Department of Neurology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Satoshi Ishido
- Department of Microbiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan
| | - Richard M Locksley
- Department of Medicine, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Jason G Cyster
- Department of Microbiology and Immunology, Howard Hughes Medical Institute, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Xiaozhu Huang
- Department of Medicine, Lung Biology Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jeoung-Sook Shin
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California, San Francisco, San Francisco, CA 94143, USA
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Ryu JK, Sozmen EG, Dixit K, Montano M, Matsui Y, Liu Y, Helmy E, Deerinck TJ, Yan Z, Schuck R, Acevedo RM, Spencer CM, Thomas R, Pico AR, Zamvil SS, Lynch KL, Ellisman MH, Greene WC, Akassoglou K. SARS-CoV-2 spike protein induces abnormal inflammatory blood clots neutralized by fibrin immunotherapy. bioRxiv 2021. [PMID: 34671772 DOI: 10.1101/2021.10.12.464152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Blood clots are a central feature of coronavirus disease-2019 (COVID-19) and can culminate in pulmonary embolism, stroke, and sudden death. However, it is not known how abnormal blood clots form in COVID-19 or why they occur even in asymptomatic and convalescent patients. Here we report that the Spike protein from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the blood coagulation factor fibrinogen and induces structurally abnormal blood clots with heightened proinflammatory activity. SARS-CoV-2 Spike virions enhanced fibrin-mediated microglia activation and induced fibrinogen-dependent lung pathology. COVID-19 patients had fibrin autoantibodies that persisted long after acute infection. Monoclonal antibody 5B8, targeting the cryptic inflammatory fibrin epitope, inhibited thromboinflammation. Our results reveal a procoagulant role for the SARS-CoV-2 Spike and propose fibrin-targeting interventions as a treatment for thromboinflammation in COVID-19. One-Sentence Summary SARS-CoV-2 spike induces structurally abnormal blood clots and thromboinflammation neutralized by a fibrin-targeting antibody.
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32
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Sabatino JJ, Mittl K, Rowles W, Mcpolin K, Rajan JV, Zamecnik CR, Dandekar R, Alvarenga BD, Loudermilk RP, Gerungan C, Spencer CM, Sagan SA, Augusto DG, Alexander J, Hollenbach JA, Wilson MR, Zamvil SS, Bove R. Impact of multiple sclerosis disease-modifying therapies on SARS-CoV-2 vaccine-induced antibody and T cell immunity. medRxiv 2021:2021.09.10.21262933. [PMID: 34580672 PMCID: PMC8475959 DOI: 10.1101/2021.09.10.21262933] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vaccine-elicited adaptive immunity is an essential prerequisite for effective prevention and control of coronavirus 19 (COVID-19). Treatment of multiple sclerosis (MS) involves a diverse array of disease-modifying therapies (DMTs) that target antibody and cell-mediated immunity, yet a comprehensive understanding of how MS DMTs impact SARS-CoV-2 vaccine responses is lacking. We completed a detailed analysis of SARS-CoV-2 vaccine-elicited spike antigen-specific IgG and T cell responses in a cohort of healthy controls and MS participants in six different treatment categories. Two specific DMT types, sphingosine-1-phosphate (S1P) receptor modulators and anti-CD20 monoclonal antibodies (mAb), resulted in significantly reduced spike-specific IgG responses. Longer duration of anti-CD20 mAb treatment prior to SARS-CoV-2 vaccination were associated with absent antibody responses. Except for reduced CD4+ T cell responses in S1P-treated patients, spike-specific CD4+ and CD8+ T cell reactivity remained robust across all MS treatment types. These findings have important implications for clinical practice guidelines and vaccination recommendations in MS patients and other immunosuppressed populations.
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Affiliation(s)
- Joseph J. Sabatino
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristen Mittl
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William Rowles
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kira Mcpolin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jayant V. Rajan
- Division of Experimental Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Colin R. Zamecnik
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ravi Dandekar
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bonny D. Alvarenga
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P. Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Chloe Gerungan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Collin M. Spencer
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Sharon A. Sagan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Danillo G. Augusto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Programa de Pós-Graduação em Genética, Universidade Federal do Paraná, Curitiba, Brazil
| | - Jessa Alexander
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jill A. Hollenbach
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S. Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Frohman EM, Villemarette-Pittman NR, Rodriguez A, Glanzman R, Rugheimer S, Komogortsev O, Zamvil SS, Cruz RA, Varkey TC, Frohman AN, Frohman AR, Parsons MS, Konkle EH, Frohman TC. Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease. J Neurol Sci 2021; 426:117463. [PMID: 33971376 PMCID: PMC8055502 DOI: 10.1016/j.jns.2021.117463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissues, our broncho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever "world traveler".
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Affiliation(s)
- Elliot M Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
| | | | - Adriana Rodriguez
- Department of Emergency Medicine, Cook Children's Medical Center, Ft. Worth, TX, United States of America
| | - Robert Glanzman
- Clene Nanomedicine, Inc., Salt Lake City, UT 84121, United States of America.
| | - Sarah Rugheimer
- Department of Physics, University Oxford, Oxford OX1 3PU, UK.
| | - Oleg Komogortsev
- Department of Computer Sciences, Texas State University, San Marcos, TX, United States of America.
| | - Scott S Zamvil
- Department of Neurology and Program in Immunology, University of California San Francisco, San Francisco, CA, United States of America.
| | - Roberto Alejandro Cruz
- Department of Neurology, Doctor's Health at Renaissance Health Neurology Institute, United States of America; Department of Neurology, University of Texas Rio Grande Valley School of Medicine, United States of America.
| | - Thomas C Varkey
- Dell Medical School, University of Texas at Austin, United States of America.
| | | | | | - Matthew S Parsons
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, United States of America; Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States of America.
| | | | - Teresa C Frohman
- Laboratory of Neuroimmunology, Professor Lawrence Steinman, Stanford University School of Medicine, United States of America.
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34
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Gupta S, Zamvil SS. Can Systemic Anti-CD20 B Cell-Depleting Antibodies Eliminate Meningeal Follicles in Multiple Sclerosis? Neurol Neuroimmunol Neuroinflamm 2021; 8:e1000. [PMID: 34001659 PMCID: PMC8130009 DOI: 10.1212/nxi.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sasha Gupta
- From the Department of Neurology, Weill Institute of Neurosciences and Program in Immunology, University of California, San Francisco, CA.
| | - Scott S Zamvil
- From the Department of Neurology, Weill Institute of Neurosciences and Program in Immunology, University of California, San Francisco, CA.
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35
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Zarghami Esfanhani N, Wundes A, Varkey T, Lisak RP, Goodman A, Graves J, Zamvil SS, Frohman EM, Frohman TC, Newsome SD. Encephalitis and Myelitis in a Young Woman: Overlap Syndrome, Thyroiditis, and Occult Tumor From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/5/e1026. [PMID: 34162741 PMCID: PMC8223881 DOI: 10.1212/nxi.0000000000001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Neda Zarghami Esfanhani
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Annette Wundes
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Thomas Varkey
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Robert P Lisak
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Andrew Goodman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Jennifer Graves
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Scott S Zamvil
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Elliot M Frohman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Teresa C Frohman
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD
| | - Scott D Newsome
- From the Department of Neurology (N.Z.E.), Kaiser Permanente Washington, Seattle; Department of Neurology (A.W.), University of Washington, Seattle; Neuroimmunology (T.V.), Stanford University of California; Colangelo College of Business (T.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (R.P.L.), Wayne State University, Detroit, MI; Department of Neurology (A.G.), University of Rochester, NY; Department of Neurosciences (J.G.), University of California at San Diego; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; Laboratory of Neuroimmunology of Professor Laurence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, CA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD.
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36
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Harris S, Tran JQ, Southworth H, Spencer CM, Cree BA, Vancassel M, Zamvil SS. Effet d’ozanimod sur les proportions des sous-groupes de leucocytes chez les patients atteints de sclérose en plaques récurrente (SEP-R). Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kumar G, Maria Z, Kohli U, Agasing A, Quinn JL, Ko RM, Zamvil SS, Axtell RC. CNS Autoimmune Responses in BCMA-Deficient Mice Provide Insight for the Failure of Atacicept in MS. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/3/e973. [PMID: 33649164 PMCID: PMC7954465 DOI: 10.1212/nxi.0000000000000973] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE B cells have emerged as a therapeutic target for MS. Anti-CD20 antibodies, which deplete B cells, are effective therapies for MS. However, atacicept (TACI-Fc), which blocks BAFF and APRIL and reduces B cells, unexpectedly exacerbates MS. We tested the hypothesis that B cell maturation antigen (BCMA), a receptor for BAFF and APRIL, plays a role in the paradoxical effects of anti-CD20 antibody and TACI-Fc using experimental autoimmune encephalomyelitis (EAE). METHODS EAE was induced in wild-type (BCMA+/+) and BCMA-deficient (BCMA-/-) mice with an immunization of rodent myelin oligodendrocyte glycoprotein (MOG)35-55 peptide. Treatment with anti-CD20 antibody, TACI-Fc, and isotype controls was administered by intraperitoneal injections. CNS infiltration was evaluated by histology; immune cell phenotypes were evaluated by flow cytometry; MOG-specific antibodies were determined by ELISA. Mixed bone marrow chimeras and cell culture assays were used to identify the specific subsets of immune cells affected by BCMA deficiency. RESULTS First, we found that BCMA-/- mice had more severe EAE compared with BCMA+/+ mice and the increased disease was associated with elevated anti-MOG B-cell responses. Second, we found that anti-CD20 therapy attenuated EAE in BCMA-/- mice but not in BCMA+/+ mice. Third, TACI-Fc attenuated EAE in BCMA+/+ mice but not in BCMA-/- mice. Mixed bone marrow chimeric and cell culture experiments demonstrated that BCMA deficiency elevates inflammatory B-cell responses but inhibits inflammatory responses in macrophages. CONCLUSIONS BCMA has multifaceted roles during inflammation that affects therapeutic efficacies of anti-CD20 and TACI-Fc in EAE. Our results from BCMA-deficient mice provide insights into the failure of atacicept in MS.
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Affiliation(s)
- Gaurav Kumar
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Zahra Maria
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Uday Kohli
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Agnieshka Agasing
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - James L Quinn
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Rose M Ko
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Scott S Zamvil
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco
| | - Robert C Axtell
- From the ACI (G.K., Z.M., U.K., A.A., J.L.Q., R.M.K., R.C.A.), Oklahoma Medical Research Foundation; and Department of Neurology and Program in Immunology, (S.S.Z.), University of California San Francisco.
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38
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Abstract
Neuromyelitis optica (NMO) is a central nervous system (CNS) inflammatory autoimmune disease caused by antibodies against aquaporin-4 (AQP4) expressed on astrocytes. Binding of AQP4-specific antibodies (NMO-IgG) triggers activation of the complement cascade, which is responsible for astrocyte loss and secondary demyelination. Although the role for the cytolytic complement proteins in astrocyte destruction in NMO is well established, little is known regarding the initial phase of astrocyte injury. In this issue of the JCI, Chen and colleagues evaluated the precytolytic phase when NMO-IgG binds astrocytes in vivo in the absence of exogenous complement. NMO-IgG alone caused astrocyte activation and AQP4 loss. Surprisingly, microglia, CNS-resident innate immune cells that produce endogenous complement, were required for clinical manifestations of disease, a finding that suggests microglia may serve as a therapeutic target in NMO.
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Affiliation(s)
- Scott S Zamvil
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (S.S.Z., S.L.H.), and the Program in Immunology, University of California, San Francisco (S.S.Z) - both in San Francisco
| | - Stephen L Hauser
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (S.S.Z., S.L.H.), and the Program in Immunology, University of California, San Francisco (S.S.Z) - both in San Francisco
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Graf J, Mares J, Barnett M, Aktas O, Albrecht P, Zamvil SS, Hartung HP. Targeting B Cells to Modify MS, NMOSD, and MOGAD: Part 1. Neurol Neuroimmunol Neuroinflamm 2021; 8:e918. [PMID: 33406479 PMCID: PMC8063619 DOI: 10.1212/nxi.0000000000000918] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 01/16/2023]
Abstract
Ocrelizumab, rituximab, ofatumumab, ublituximab, inebilizumab, and evobrutinib are immunotherapies that target various B cell-related proteins. Most of these treatments have proven efficacy in relapsing and progressive forms of MS and neuromyelitis optica spectrum disease (NMOSD), or are in advanced stages of clinical development. Currently, ocrelizumab, ofatumumab, and inebilizumab are licensed for treatment of MS and NMOSD, respectively. This review focuses on the current state of knowledge about the role of B lymphocytes in immune-mediated pathophysiology and its implications for the mode of action. To understand the significance of this breakthrough in the context of the current MS therapeutic armamentarium, this review more closely examines the clinical development of CD20 depletion and the pioneering contribution of rituximab. Phase 3 and the recently published postmarketing studies will be highlighted to better understand the relevant efficacy data and safety aspects of long-term B-cell depletion.
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Affiliation(s)
- Jonas Graf
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Jan Mares
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Michael Barnett
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Orhan Aktas
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Philipp Albrecht
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco
| | - Hans-Peter Hartung
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology (M.B., H.-P.H.), Brain and Mind Centre, Department of Neurology, University of Sydney, New South Wales, Australia; and UCSF Weill Institute of Neurosciences (S.S.Z.), Department of Neurology, University of California at San Francisco.
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Affiliation(s)
| | - Marinos C Dalakas
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Dennis L Kolson
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Friedemann Paul
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
| | - Scott S Zamvil
- From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) (J.D.), Hospital Clínic, Universitat de Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (J.D.), Barcelona, Spain; Department of Neurology (J.D., D.L.K.), University of Pennsylvania, Philadelphia; Neuroimmunology Unit (M.C.D.), National and Kapodistrian University of Athens Medical School, Greece; Thomas Jefferson University (M.C.D.), Philadelphia, PA; Charité-Universitätsmedizin Berlin und Max Delbrueck Center for Molecular Medicine (F.P.), Germany; and Department of Neurology (S.S.Z.), Weill Institute for Neurosciences and Program in Immunology, University of California, San Francisco
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Graf J, Mares J, Barnett M, Aktas O, Albrecht P, Zamvil SS, Hartung HP. Targeting B cells to modify MS, NMOSD, and MOGAD: Part 2. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e919. [PMID: 33411674 PMCID: PMC8063618 DOI: 10.1212/nxi.0000000000000919] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
Abstract
Ocrelizumab, rituximab, ofatumumab, ublituximab, inebilizumab, and evobrutinib
are immunotherapies that target various B cell–related proteins. Most of
these treatments have proven efficacy in relapsing and progressive forms of MS
and neuromyelitis optica spectrum disease (NMOSD) or are in advanced stages of
clinical development. Currently, ocrelizumab and inebilizumab are licensed for
treatment of MS and NMOSD, respectively. This part of the review focuses on
monoclonal antibody B cell–depleting strategies in NMOSD and the emerging
related myelin oligodendrocyte glycoprotein (MOG) immunoglobulin
G–associated disease (MOGAD). Case series and phase 2/3 studies in these
inflammatory disorders are assessed. The safety profile of long-term B-cell
depletion in MS, NMOSD, and MOGAD will be highlighted. Finally implications of
the current coronavirus disease 2019 pandemic on the management of patients with
these disorders and the use of B cell–depleting agents will be
discussed.
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Affiliation(s)
- Jonas Graf
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Jan Mares
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Michael Barnett
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Orhan Aktas
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Philipp Albrecht
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco
| | - Hans-Peter Hartung
- From the Department of Neurology (J.G., O.A., P.A., H.-P.H.), University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany; Department of Neurology (J.M.), Palacky University, Olomouc, Czech Republic; Department of Neurology, Brain and Mind Centre (M.B., H.-P.H.), Department of Neurology, University of Sydney, New South Wales, Australia; and Department of Neurology (S.S.Z.), UCSF Weill Institute of Neurosciences, University of California at San Francisco.
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Anadani N, Hyland M, Cruz RA, Lisak R, Costello K, Major EO, Jassam Y, Meltzer E, Varkey TC, Parsons MS, Goodman AD, Graves JS, Newsome S, Zamvil SS, Frohman EM, Frohman TC. Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e929. [PMID: 33411672 PMCID: PMC7803340 DOI: 10.1212/nxi.0000000000000929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Nidhiben Anadani
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Megan Hyland
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Roberto Alejandro Cruz
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Robert Lisak
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Kathleen Costello
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Eugene O Major
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Yasir Jassam
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Ethan Meltzer
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Thomas C Varkey
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Andrew D Goodman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jennifer S Graves
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott Newsome
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the University of Rochester (N.A.), NY. N. Anadani is now with Department of Neurology, University of Oklahoma Health Science Center; Department of Neurology (M.H., A.D.G.), University of Rochester, NY; Department of Neurology (R.A.C., E.M., T.C.V.), Dell Medical School at the University of Texas at Austin; Department of Neurology (R.L.), Wayne State University, Detroit, MI; The National Multiple Sclerosis Society (K.C.), New York, NY; Laboratory of Molecular Medicine and Neuroscience (E.O.M.), Neurological Institute of Neurological Disorder and Stroke (Y.J.), Bethesda, MD. Y. Jassam is now with Department of Neurology, The University of Kansas Health System; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; Department of Neurosciences (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Department of Neurology, Neurosurgery, and Ophthalmology (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
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Cruz RA, Hogan N, Sconzert J, Sconzert M, Major EO, Lisak RP, Melamed E, Varkey TC, Meltzer E, Goodman A, Komogortsev O, Parsons MS, Costello K, Graves JS, Newsome S, Zamvil SS, Frohman EM, Frohman TC. Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 2: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2020; 8:8/1/e930. [PMID: 33434885 PMCID: PMC7803334 DOI: 10.1212/nxi.0000000000000930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Roberto Alejandro Cruz
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Nick Hogan
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jayne Sconzert
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Megan Sconzert
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Eugene O Major
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Robert P Lisak
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Esther Melamed
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Thomas C Varkey
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Ethan Meltzer
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Andrew Goodman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Oleg Komogortsev
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Kathleen Costello
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Jennifer S Graves
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott Newsome
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the Department of Neurology (R.A.C., E. Melamed, T.C.V., E. Meltzer), Dell Medical School, University of Texas at Austin; Department of Ophthalmology (N.H.), University of Texas Southwestern, Dallas; Wellness Care Centers and Pediatric Rehabilitation (J.S.), Denton, TX; Ascension Seton Medical Center (M.S.), Austin, TX; National Institutes of Health (E.O.M.), Bethesda, MD; Departments of Neurology, and Biochemistry, Microbiology and Immunology (R.P.L.), Wayne State University, Detroit, MI; Colangelo College of Business (T.C.V.), Grand Canyon University, Phoenix, AZ; Department of Neurology (A.G.), University of Rochester, NY; Department of Computer Science (O.K.), Texas State University, San Marcos; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine (M.S.P.), Emory University, Atlanta, GA; The National Multiple Sclerosis Society (K.C.), New York, NY; Department of Neurology (J.S.G.), University of California at San Diego; Department of Neurology (S.N.), Johns Hopkins Hospital, Bethesda, MD; Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco; andDepartments of Neurology, Ophthalmology & Neurosurgery (E.M.F., T.C.F.), Dell Medical School at the University of Texas at Austin.
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Sacco S, Caverzasi E, Papinutto N, Cordano C, Bischof A, Gundel T, Cheng S, Asteggiano C, Kirkish G, Mallott J, Stern WA, Bastianello S, Bove RM, Gelfand JM, Goodin DS, Green AJ, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Neurite Orientation Dispersion and Density Imaging for Assessing Acute Inflammation and Lesion Evolution in MS. AJNR Am J Neuroradiol 2020; 41:2219-2226. [PMID: 33154077 DOI: 10.3174/ajnr.a6862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/29/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging is essential for MS diagnosis and management, yet it has limitations in assessing axonal damage and remyelination. Gadolinium-based contrast agents add value by pinpointing acute inflammation and blood-brain barrier leakage, but with drawbacks in safety and cost. Neurite orientation dispersion and density imaging (NODDI) assesses microstructural features of neurites contributing to diffusion imaging signals. This approach may resolve the components of MS pathology, overcoming conventional MR imaging limitations. MATERIALS AND METHODS Twenty-one subjects with MS underwent serial enhanced MRIs (12.6 ± 9 months apart) including NODDI, whose key metrics are the neurite density and orientation dispersion index. Twenty-one age- and sex-matched healthy controls underwent unenhanced MR imaging with the same protocol. Fifty-eight gadolinium-enhancing and non-gadolinium-enhancing lesions were semiautomatically segmented at baseline and follow-up. Normal-appearing WM masks were generated by subtracting lesions and dirty-appearing WM from the whole WM. RESULTS The orientation dispersion index was higher in gadolinium-enhancing compared with non-gadolinium-enhancing lesions; logistic regression indicated discrimination, with an area under the curve of 0.73. At follow-up, in the 58 previously enhancing lesions, we identified 2 subgroups based on the neurite density index change across time: Type 1 lesions showed increased neurite density values, whereas type 2 lesions showed decreased values. Type 1 lesions showed greater reduction in size with time compared with type 2 lesions. CONCLUSIONS NODDI is a promising tool with the potential to detect acute MS inflammation. The observed heterogeneity among lesions may correspond to gradients in severity and clinical recovery after the acute phase.
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Affiliation(s)
- S Sacco
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California.,Institute of Radiology (S.S., C.A.), Department of Clinical Surgical Diagnostic and Pediatric Sciences
| | - E Caverzasi
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - N Papinutto
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - C Cordano
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - A Bischof
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - T Gundel
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - S Cheng
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - C Asteggiano
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California.,Institute of Radiology (S.S., C.A.), Department of Clinical Surgical Diagnostic and Pediatric Sciences
| | - G Kirkish
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - J Mallott
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - W A Stern
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - S Bastianello
- Department of Brain and Behavioral Sciences (S.B.), University of Pavia, Pavia, Italy.,Neuroradiology Department (S.B.), Istituto Di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - R M Bove
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - J M Gelfand
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - D S Goodin
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - A J Green
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - E Waubant
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - M R Wilson
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - S S Zamvil
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - B A Cree
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - S L Hauser
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
| | - R G Henry
- From the Department of Neurology (S.S., E.C., N.P., C.C., A.B., T.G., S.C., C.A., G.K., J.M., W.A.S., R.M.B., J.M.G., D.S.G., A.J.G., E.W., M.R.W., S.S.Z, B.A.C., S.L.H., and R.G.H.), University of California, San Francisco Weill Institute for Neurosciences, University of California, San Francisco, California
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Affiliation(s)
- Christina J Azevedo
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott S Zamvil
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
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Meltzer E, Campbell S, Ehrenfeld B, Cruz RA, Steinman L, Parsons MS, Zamvil SS, Frohman EM, Frohman TC. Mitigating alemtuzumab-associated autoimmunity in MS: A "whack-a-mole" B-cell depletion strategy. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/6/e868. [PMID: 32769201 PMCID: PMC7643549 DOI: 10.1212/nxi.0000000000000868] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 07/06/2020] [Indexed: 12/17/2022]
Abstract
Objective To determine whether the punctuated administration of low-dose rituximab,
temporally linked to B-cell hyperrepopulation (defined when the return of
CD19+ B cells approximates 40%–50% of baseline
levels as measured before alemtuzumab treatment inception), can mitigate
alemtuzumab-associated secondary autoimmunity. Methods In this hypothesis-driven pilot study, 10 patients received low-dose
rituximab (50–150 mg/m2), a chimeric anti-CD20 monoclonal
antibody, after either their first or second cycles of alemtuzumab. These
patients were then routinely assessed for the development of autoimmune
disorders and safety signals related to the use of dual monoclonal antibody
therapy. Results Five patients received at least 1 IV infusion of low-dose rituximab,
following alemtuzumab therapy, with a mean follow-up of 41 months. None of
the 5 patients developed secondary autoimmune disorders. An additional 5
patients with follow-up over less than 24 months received at least 1
infusion of low-dose rituximab treatment following alemtuzumab treatment. No
secondary autoimmune diseases were observed. Conclusions An anti-CD20 “whack-a-mole” B-cell depletion strategy may serve
to mitigate alemtuzumab-associated secondary autoimmunity in MS by reducing
the imbalance in B- and T-cell regulatory networks during immune
reconstitution. We believe that these observations warrant further
investigation. Classification of evidence This study provides Class IV evidence that for people with MS, low-dose
rituximab following alemtuzumab treatment decreases the risk of
alemtuzumab-associated secondary autoimmune diseases.
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Affiliation(s)
- Ethan Meltzer
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Sarah Campbell
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Benjamin Ehrenfeld
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Roberto A Cruz
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Lawrence Steinman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Matthew S Parsons
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Scott S Zamvil
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin
| | - Elliot M Frohman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin.
| | - Teresa C Frohman
- From the Department of Neurology (E.M., S.C., B.E., R.A.C.), Dell Medical School, University of Texas at Austin; Department of Neurology (L.S.), Stanford University School of Medicine, Palo Alto, CA; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Departments of Neurology (E.M.F., T.C.F.), Ophthalmology & Neurosurgery, Dell Medical School at the University of Texas at Austin.
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Harris S, Tran JQ, Southworth H, Spencer CM, Cree BAC, Zamvil SS. Effect of the sphingosine-1-phosphate receptor modulator ozanimod on leukocyte subtypes in relapsing MS. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/5/e839. [PMID: 32737072 PMCID: PMC7413711 DOI: 10.1212/nxi.0000000000000839] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022]
Abstract
Objective To better understand ozanimod's mechanism of action (MOA), we conducted exploratory analyses from a phase 1 study to characterize ozanimod's effect on circulating leukocyte subsets in patients with relapsing multiple sclerosis. Methods An open-label pharmacodynamic study randomized patients to oral ozanimod hydrochloride (HCl) 0.5 (n = 13) or 1 mg/d (n = 11) for ∼12 weeks (including 7-day dose escalation). Circulating leukocyte subsets were quantified using flow cytometry (days 28, 56, and 85) and epigenetic cell counting (days 2, 5, 28, 56, and 85) and compared with baseline (day 1) using descriptive statistics. Results Ozanimod caused dose-dependent reductions in absolute lymphocyte counts. Observed by both methodologies, circulating CD19+ B- and CD3+ T-cell counts were reduced by >50% with ozanimod HCl 0.5 mg and >75% with 1 mg at day 85. Based on flow cytometry, ozanimod HCl 1 mg showed greater decreases in CD4+ than CD8+ T cells, greater decreases in both CD4+ and CD8+ central memory vs effector memory T cells, and reductions in mean CD4+ and CD8+ naive T cells by ≥90% at day 85. In the flow cytometry analysis, changes in monocytes, natural killer, and natural killer T cells were minimal. Using epigenetic cell counting, greater reductions for Th17 than T regulatory cells were determined. Conclusion Ozanimod induced dose-dependent reductions in circulating B- and T-cell counts and differential effects on naive and memory CD4+ and CD8+ T cells and CD19+ B cells. Data characterized with both a novel epigenetic cell-counting method and flow cytometry support ozanimod's MOA. Clinical trial registration: clinicaltrials.gov NCT02797015.
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Affiliation(s)
- Sarah Harris
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF).
| | - Jonathan Q Tran
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF)
| | - Harry Southworth
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF)
| | - Collin M Spencer
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF)
| | - Bruce A C Cree
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF)
| | - Scott S Zamvil
- From Bristol-Myers Squibb Company (S.H., J.Q.T.), Princeton, NJ; Data Clarity Consulting Ltd. (H.S.), Stockport, England, United Kingdom; and Department of Neurology, Weill Institute for Neurosciences (C.M.S., B.A.C.C., S.S.Z.), and Program in Immunology (C.M.S., S.S.Z.), University of California San Francisco (UCSF)
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Mendiola AS, Ryu JK, Bardehle S, Meyer-Franke A, Ang KKH, Wilson C, Baeten KM, Hanspers K, Merlini M, Thomas S, Petersen MA, Williams A, Thomas R, Rafalski VA, Meza-Acevedo R, Tognatta R, Yan Z, Pfaff SJ, Machado MR, Bedard C, Coronado PER, Jiang X, Wang J, Pleiss MA, Green AJ, Zamvil SS, Pico AR, Bruneau BG, Arkin MR, Akassoglou K. Author Correction: Transcriptional profiling and therapeutic targeting of oxidative stress in neuroinflammation. Nat Immunol 2020; 21:1135. [PMID: 32661365 DOI: 10.1038/s41590-020-0754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
| | - Jae Kyu Ryu
- Gladstone Institutes, San Francisco, CA, USA.,Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Kenny Kean-Hooi Ang
- Small Molecule Discovery Center, University of California San Francisco, San Francisco, CA, USA.,Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Chris Wilson
- Small Molecule Discovery Center, University of California San Francisco, San Francisco, CA, USA.,Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Sean Thomas
- Gladstone Institutes, San Francisco, CA, USA
| | - Mark A Petersen
- Gladstone Institutes, San Francisco, CA, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Zhaoqi Yan
- Gladstone Institutes, San Francisco, CA, USA
| | - Samuel J Pfaff
- Small Molecule Discovery Center, University of California San Francisco, San Francisco, CA, USA.,Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Xiqian Jiang
- Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX, USA
| | - Jin Wang
- Department of Pharmacology and Chemical Biology, Baylor College of Medicine, Houston, TX, USA
| | | | - Ari J Green
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Benoit G Bruneau
- Gladstone Institutes, San Francisco, CA, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.,Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Michelle R Arkin
- Small Molecule Discovery Center, University of California San Francisco, San Francisco, CA, USA.,Department of Pharmaceutical Chemistry, School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Katerina Akassoglou
- Gladstone Institutes, San Francisco, CA, USA. .,Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
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Zhou X, Singh S, Baumann R, Barba P, Landefeld J, Casaccia P, Sand IK, Xia Z, Weiner H, Chitnis T, Chandran S, Connick P, Otaegui D, Castillo-Triviño T, Caillier SJ, Santaniello A, Ackermann G, Humphrey G, Negrotto L, Farez M, Hohlfeld R, Pröbstel AK, Jia X, Graves J, Bar-or A, Oksenberg JR, Gelfand J, Wilson MR, Crabtree E, Zamvil SS, Correale J, Cree BA, Hauser SL, Knight R, Baranzini SE. Household paired design reduces variance and increases power in multi-city gut microbiome study in multiple sclerosis. Mult Scler 2020; 27:1352458520924594. [PMID: 33115343 PMCID: PMC7968892 DOI: 10.1177/1352458520924594] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence for a role of human gut microbiota in multiple sclerosis (MS) risk is mounting, yet large variability is seen across studies. This is, in part, due to the lack of standardization of study protocols, sample collection methods, and sequencing approaches. OBJECTIVE This study aims to address the effect of a household experimental design, sample collection, and sequencing approaches in a gut microbiome study in MS subjects from a multi-city study population. METHODS We analyzed 128 MS patient and cohabiting healthy control pairs from the International MS Microbiome Study (iMSMS). A total of 1005 snap-frozen or desiccated Q-tip stool samples were collected and evaluated using 16S and shallow whole-metagenome shotgun sequencing. RESULTS The intra-individual variance observed by different collection strategies was dramatically lower than inter-individual variance. Shallow shotgun highly correlated with 16S sequencing. Participant house and recruitment site accounted for the two largest sources of microbial variance, while higher microbial similarity was seen in household-matched participants as hypothesized. A significant proportion of the variance in dietary intake was also dominated by geographic distance. CONCLUSION A household pair study largely overcomes common inherent limitations and increases statistical power in population-based microbiome studies.
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