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Viswanathan S, Vijayasingham L, Laurson-Doube J, Quek AML, Tan K, Yeo T, Seinn MMA, Ohnmar O, Estiasari R, Yassin N, Hiew FL, Pasco PM, Hoang NTT, Keosodsay S, Siritho S, Apiwattanakul M, Ros S, Dias de Deus BS, Remli R, Abdullah S, Lim SY. Multi-actor system dynamics in access to disease-modifying treatments for multiple sclerosis in Southeast Asia: A regional survey and suggestions for improvement. Mult Scler Relat Disord 2024; 85:105555. [PMID: 38547547 DOI: 10.1016/j.msard.2024.105555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Despite the global availability of multiple sclerosis (MS) treatments, accessing and financing them in Southeast Asia (SEA) remains a challenge. This descriptive survey-based study aimed to describe the current state of MS treatment access and local access dynamics within this region. METHODS The survey questionnaire, comprising of 15 closed-ended and five open-ended questions, was developed by three neurologists with expertise in MS and routine MS patient management, or had training in neuroimmunology. Questionnaire development was guided by the recent Atlas of MS and in alignment with the Access to Treatment framework, focusing on MS diagnosis and treatment issues in SEA. Fifteen neurologists experienced in managing MS across the region were identified as key informants for this study. RESULTS All fifteen neurologists participated in the survey via email and videoconferencing between January 2020 and February 2023, which included the following countries: Brunei, Cambodia, Indonesia, Malaysia, Myanmar, Lao PDR, Philippines, Singapore, Thailand, Timor-Leste, and Vietnam. All had at least five years of experience in managing MS patients and six had previously completed a neuroimmunology fellowship programme. SEA countries showed disparities in healthcare financing, availability of neurologists, MS treatments, and investigative tools. Access to MS disease-modifying treatments (DMTs) is hindered by high cost, lack of MS specialists, and weak advocacy efforts. On-label DMTs are not listed as essential medicines regionally except for interferon beta1a and teriflunomide in Malaysia. On-label monoclonals are available only in Malaysia, Singapore, and Thailand. Generic on-label DMTs are unavailable due to lack of distributorship and expertise in using them. Off-label DMTs (azathioprine, methotrexate, and rituximab) predominate in most SEA countries. Other challenges include limited access to investigations, education, and knowledge about DMTs among general neurologists, and absence of registries and MS societies. Patient champions, communities, and MS organisations have limited influence on local governments and pharmaceutical companies. Despite its increasing prevalence, there is a lack of concerted priority setting due to MS being perceived as a rare, non-communicable disease. CONCLUSION This study highlights the distinct dynamics, challenges, and research gaps within this region, and provides suggestions to improve MS diagnosis, education, and medicine access.
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Affiliation(s)
| | - Lavanya Vijayasingham
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Amy M L Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Riwanti Estiasari
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Neurology Department, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Norazieda Yassin
- Brunei Neuroscience Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Brunei
| | | | - Paul M Pasco
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Nghia T T Hoang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | | | - Sasitorn Siritho
- Department of Neurology, Bumrungrad International Hospital and Siriraj Hospital, Mahidol, Bangkok, Thailand
| | | | - Sina Ros
- Department of Neurology, Calmette Hospital, Phnom Penh, Cambodia
| | | | - Rabani Remli
- Department of Neurology, National University of Malaysia, Malaysia
| | | | - Su-Yin Lim
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Malaysia.
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2
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Lim GZ, Chan VEY, Yu WY, Tan NCK, Yeo T. FLAIR hyperintense lesions with U-fiber and subcortical enhancement (FUSE) in MOG antibody-associated cerebral cortical encephalitis. Neurol Sci 2024; 45:809-812. [PMID: 37792111 DOI: 10.1007/s10072-023-07092-1] [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] [Received: 07/07/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Gareth Zigui Lim
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Level 3, Clinical Staff Office, Singapore, 308433, Singapore
| | - Vincent Ern Yao Chan
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Nigel Choon Kiat Tan
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Level 3, Clinical Staff Office, Singapore, 308433, Singapore
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Level 3, Clinical Staff Office, Singapore, 308433, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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3
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Ng CC, Poh MQW, Lim SA, Swaminathan SK, Yeo T. Headache and optic disc oedema revealing autoimmune GFAP-astrocytopathy. QJM 2024:hcae007. [PMID: 38229263 DOI: 10.1093/qjmed/hcae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Chai Ching Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Su Ann Lim
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | | | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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4
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Yeo T, Chai JYH, Tan K. Response to Letter to Editor 'increased cases of VGKC-complex observed during current COVID-19 pandemic'. J Neurol Sci 2024; 456:122843. [PMID: 38114361 DOI: 10.1016/j.jns.2023.122843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore
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Ponzini FM, Schultz CW, Leiby BE, Cannaday S, Yeo T, Posey J, Bowne WB, Yeo C, Brody JR, Lavu H, Nevler A. Repurposing the FDA-approved anthelmintic pyrvinium pamoate for pancreatic cancer treatment: study protocol for a phase I clinical trial in early-stage pancreatic ductal adenocarcinoma. BMJ Open 2023; 13:e073839. [PMID: 37848297 PMCID: PMC10582846 DOI: 10.1136/bmjopen-2023-073839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Recent reports of the utilisation of pyrvinium pamoate (PP), an FDA-approved anti-helminth, have shown that it inhibits pancreatic ductal adenocarcinoma (PDAC) cell growth and proliferation in-vitro and in-vivo in preclinical models. Here, we report about an ongoing phase I open-label, single-arm, dose escalation clinical trial to determine the safety and tolerability of PP in PDAC surgical candidates. METHODS AND ANALYSIS In a 3+3 dose design, PP is initiated 3 days prior to surgery. The first three patients will be treated with the initial dose of PP at 5 mg/kg orally for 3 days prior to surgery. Dose doubling will be continued to a reach a maximum of 20 mg/kg orally for 3 days, if the previous two dosages (5 mg/kg and 10 mg/kg) were tolerated. Dose-limiting toxicity grade≥3 is used as the primary endpoint. The pharmacokinetic and pharmacodynamic (PK/PD) profile of PP and bioavailability in humans will be used as the secondary objective. Each participant will be monitored weekly for a total of 30 days from the final dose of PP for any side effects. The purpose of this clinical trial is to examine whether PP is safe and tolerable in patients with pancreatic cancer, as well as assess the drug's PK/PD profile in plasma and fatty tissue. Potential implications include the utilisation of PP in a synergistic manner with chemotherapeutics for the treatment of pancreatic cancer. ETHICS AND DISSEMINATION This study was approved by the Thomas Jefferson Institutional Review Board. The protocol number for this study is 20F.041 (Version 3.1 as of 27 October 2021). The data collected and analysed from this study will be used to present at local and national conferences, as well as, written into peer-reviewed manuscript publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT05055323.
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Affiliation(s)
- Francesca M Ponzini
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Benjamin E Leiby
- Sidney Kimmel Medical College, Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Shawnna Cannaday
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - T Yeo
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - James Posey
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
- Department of Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Wilbur B Bowne
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - Charles Yeo
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jonathan R Brody
- Brenden Colson Center for Pancreatic Care; Departments of Surgery and Cell, Developmental & Cancer Biology, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Harish Lavu
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
| | - Avinoam Nevler
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Pancreatic, Biliary and Related Cancer Center, Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
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6
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Lim GZ, Yap LG, Chuang DF, Yeo T, Tan K. Glial Fibrillary Acidic Protein Astrocytopathy Presenting as Progressive Encephalomyelitis with Rigidity and Myoclonus. Mov Disord Clin Pract 2023; 10:827-829. [PMID: 37205247 PMCID: PMC10186992 DOI: 10.1002/mdc3.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Gareth Zigui Lim
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Leong Gen Yap
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Ding Fang Chuang
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
| | - Tianrong Yeo
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
- Lee Kong Chian School of Medicine, Nanyang Technological UniversitySingaporeSingapore
| | - Kevin Tan
- Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
- Duke‐NUS Medical SchoolSingaporeSingapore
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7
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Yeo T, Siew RWE, Gulam MY, Tye JSN, Aw AYY, Sivalingam T, Peng X, Yong KP, Saffari SE, Chao Y, Tan K. COVID-19 infection after SARS-CoV-2 mRNA vaccination in Multiple Sclerosis, AQP4-antibody NMOSD and MOGAD patients during the Omicron subvariant BA.1/2 wave in Singapore. J Neurol 2023; 270:2817-2825. [PMID: 37027019 PMCID: PMC10080502 DOI: 10.1007/s00415-023-11692-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The SARS-CoV-2 Omicron variant appears to cause milder infections, however, its capacity for immune evasion and high transmissibility despite vaccination remains a concern, particularly in immunosuppressed patients. Herein, we investigate the incidence and risk factors for COVID-19 infection in vaccinated adult patients with Multiple Sclerosis (MS), Aquaporin-4-antibody Neuromyelitis Optica Spectrum Disorder (AQP4-Ab NMOSD), and Myelin Oligodendrocyte Glycoprotein-antibody associated disease (MOGAD) during the Omicron subvariant BA.1/2 wave in Singapore. METHODS This was a prospective observational study conducted at the National Neuroscience Institute, Singapore. Only patients who had at least two doses of mRNA vaccines were included. Data on demographics, disease characteristics, COVID-19 infections and vaccinations, and immunotherapies were collected. SARS-CoV-2 neutralising antibodies were measured at various time points after vaccination. RESULTS Two hundred and one patients were included; 47 had COVID-19 infection during the study period. Multivariable logistic regression revealed that receipt of a third SARS-CoV-2 mRNA vaccination (V3) was protective against COVID-19 infection. No particular immunotherapy group increased the risk of infection, however, Cox proportional-hazards regression showed that patients on anti-CD20s and sphingosine-1-phosphate modulators (S1PRMs) had a shorter time to infection after V3, compared to those on other immunotherapies or not on immunotherapy. CONCLUSIONS The Omicron subvariant BA.1/2 is highly infectious in patients with central nervous system inflammatory diseases; three doses of mRNA vaccination improved protection. However, treatment with anti-CD20s and S1PRMs predisposed patients to earlier infection. Future studies are required to determine the protective efficacy of newer bivalent vaccines that target the Omicron (sub)variant, especially in immunocompromised patients.
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Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Rachel Wan En Siew
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Janis Siew Noi Tye
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Amelia Yun Yi Aw
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Xuejuan Peng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Yong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yinxia Chao
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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8
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Rattanathamsakul N, Siritho S, Viswanathan S, Hiew FL, Apiwattanakul M, Tan K, Thirugnanam UN, Yeo T, Quek AML, Estiasari R, Remli R, Aye SMM, Ohnmar O, Hoang NTT, Pasco PM. Facilities, selection, outcome measurement, and limitations of therapeutic plasma exchange for neuroimmunological disorders: The South East Asian survey study. J Clin Apher 2023. [PMID: 36896493 DOI: 10.1002/jca.22047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an important role in the Southeast Asian region. This study investigates the challenges of performing TPE within the region. METHOD A questionnaire-based survey was conducted and launched to 15 South East Asian Therapeutic Plasma Exchange Consortium (SEATPEC) members from seven countries in January 2021. It included demographics, TPE techniques, indications, challenges, timing, outcome measurement, and access to laboratory testing in each local center. RESULTS A total of 15 neurologists from 12 participating centers were included. They usually perform five sessions of TPE (100.0%), with 1 to 1.5 plasma volume (93.3%), and exchanges via the central catheter (100.0%). Acute relapses of neuromyelitis optica spectrum disorder and myasthenia gravis are the most common indications. They used a combination of normal saline and 5% albumin (60.0%) as replacement fluid. Most (66.7%) used TPE as an add-on treatment in steroid-refractory cases or as first-line treatment for severe attacks. They suggested assessing the TPE efficacy of TPE by the interval to the next attack, post-TPE relapse rates, and TPE-related complications. The major challenges within our region are expense, reimbursibility, and access to TPE. CONCLUSION Although countrywise differences exist, all share similarities regarding methods, indications, timing, obstacles, and challenges of TPE for neuroimmunological conditions. Regional collaboration will be essential to identify strategies to reduce these barriers to access to TPE in the future.
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Affiliation(s)
- Natthapon Rattanathamsakul
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Neurology, Bumrungrad International Hospital, Bangkok, Thailand
| | | | - Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Metha Apiwattanakul
- Department of Neurology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Amy M L Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rabani Remli
- Department of Neurology, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Seinn Mya Mya Aye
- Department of Neurology, Aryu International Hospital, Yangon, Myanmar
| | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Nghia T T Hoang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Paul M Pasco
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
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Probert F, Yeo T, Zhou Y, Sealey M, Arora S, Palace J, Claridge TDW, Hillenbrand R, Oechtering J, Kuhle J, Leppert D, Anthony DC. Corrigendum: Determination of CSF GFAP, CCN5, and vWF levels enhances the diagnostic accuracy of clinically defined MS from non-MS patients with CSF oligoclonal bands. Front Immunol 2022; 13:1095038. [PMID: 36582251 PMCID: PMC9793797 DOI: 10.3389/fimmu.2022.1095038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2021.811351.].
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Affiliation(s)
- Fay Probert
- Department of Chemistry, University of Oxford, Oxford, United Kingdom,*Correspondence: Daniel C. Anthony, ; Fay Probert, fay.probert@p harm.ox.ac.uk
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,Department of Neurology, National Neuroscience Institute, Singapore, Singapore,Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Yifan Zhou
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,Translational Stem Cell Biology Branch, National Institutes of Health, Bethesda, MD, United States,Wellcome Medical Research Council (MRC) Trust Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Megan Sealey
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Siddharth Arora
- Department of Mathematics, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | - Johanna Oechtering
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Leppert
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel C. Anthony
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,*Correspondence: Daniel C. Anthony, ; Fay Probert, fay.probert@p harm.ox.ac.uk
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Lennox B, Xiong W, Waters P, Coles A, Jones PB, Yeo T, May JTM, Yeeles K, Anthony D, Probert F. The serum metabolomic profile of a distinct, inflammatory subtype of acute psychosis. Mol Psychiatry 2022; 27:4722-4730. [PMID: 36131046 PMCID: PMC7613906 DOI: 10.1038/s41380-022-01784-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
A range of studies suggest that a proportion of psychosis may have an autoimmune basis, but this has not translated through into clinical practice-there is no biochemical test able to accurately identify psychosis resulting from an underlying inflammatory cause. Such a test would be an important step towards identifying who might require different treatments and have the potential to improve outcomes for patients. To identify novel subgroups within patients with acute psychosis we measured the serum nuclear magnetic resonance (NMR) metabolite profiles of 75 patients who had identified antibodies (anti-glycine receptor [GlyR], voltage-gated potassium channel [VGKC], Contactin-associated protein-like 2 [CASPR2], leucine-rich glioma inactivated 1 [LGI1], N-methyl-D-aspartate receptor [NMDAR] antibody) and 70 antibody negative patients matched for age, gender, and ethnicity. Clinical symptoms were assessed using the positive and negative syndrome scale (PANSS). Unsupervised principal component analysis identified two distinct biochemical signatures within the cohort. Orthogonal partial least squared discriminatory analysis revealed that the serum metabolomes of NMDAR, LGI1, and CASPR2 antibody psychosis patients were indistinct from the antibody negative control group while VGKC and GlyR antibody patients had significantly decreased lipoprotein fatty acids and increased amino acid concentrations. Furthermore, these patients had more severe presentation with higher PANSS scores than either the antibody negative controls or the NMDAR, LGI1, and CASPR2 antibody groups. These results suggest that a proportion of patients with acute psychosis have a distinct clinical and biochemical phenotype that may indicate an inflammatory subtype.
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Affiliation(s)
- Belinda Lennox
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Wenzheng Xiong
- Department of Pharmacology, University of Oxford, Oxford, UK
- Department of Chemistry, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, UK
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jeanne Tan May May
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ksenija Yeeles
- Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel Anthony
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Fay Probert
- Department of Chemistry, University of Oxford, Oxford, UK
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Affiliation(s)
- J Y Shen
- From the Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - G J Ng
- From the Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - T Yeo
- From the Department of Neurology, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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12
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Yeo T, Bayuangga H, Augusto-Oliveira M, Sealey M, Claridge TDW, Tanner R, Leppert D, Palace J, Kuhle J, Probert F, Anthony DC. Metabolomics detects clinically silent neuroinflammatory lesions earlier than neurofilament-light chain in a focal multiple sclerosis animal model. J Neuroinflammation 2022; 19:252. [PMID: 36210459 PMCID: PMC9549622 DOI: 10.1186/s12974-022-02614-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite widespread searches, there are currently no validated biofluid markers for the detection of subclinical neuroinflammation in multiple sclerosis (MS). The dynamic nature of human metabolism in response to changes in homeostasis, as measured by metabolomics, may allow early identification of clinically silent neuroinflammation. Using the delayed-type hypersensitivity (DTH) MS rat model, we investigated the serum and cerebrospinal fluid (CSF) metabolomics profiles and neurofilament-light chain (NfL) levels, as a putative marker of neuroaxonal damage, arising from focal, clinically silent neuroinflammatory brain lesions and their discriminatory abilities to distinguish DTH animals from controls. Methods 1H nuclear magnetic resonance (NMR) spectroscopy metabolomics and NfL measurements were performed on serum and CSF at days 12, 28 and 60 after DTH lesion initiation. Supervised multivariate analyses were used to determine metabolomics differences between DTH animals and controls. Immunohistochemistry was used to assess the extent of neuroinflammation and tissue damage. Results Serum and CSF metabolomics perturbations were detectable in DTH animals (vs. controls) at all time points, with the greatest change occurring at the earliest time point (day 12) when the neuroinflammatory response was most intense (mean predictive accuracy [SD]—serum: 80.6 [10.7]%, p < 0.0001; CSF: 69.3 [13.5]%, p < 0.0001). The top discriminatory metabolites at day 12 (serum: allantoin, cytidine; CSF: glutamine, glucose) were all reduced in DTH animals compared to controls, and correlated with histological markers of neuroinflammation, particularly astrogliosis (Pearson coefficient, r—allantoin: r = − 0.562, p = 0.004; glutamine: r = − 0.528, p = 0.008). Serum and CSF NfL levels did not distinguish DTH animals from controls at day 12, rather, significant differences were observed at day 28 (mean [SEM]—serum: 38.5 [4.8] vs. 17.4 [2.6] pg/mL, p = 0.002; CSF: 1312.0 [379.1] vs. 475.8 [74.7] pg/mL, p = 0.027). Neither serum nor CSF NfL levels correlated with markers of neuroinflammation; serum NfL did, however, correlate strongly with axonal loss (r = 0.641, p = 0.001), but CSF NfL did not (p = 0.137). Conclusions While NfL levels were elevated later in the pathogenesis of the DTH lesion, serum and CSF metabolomics were able to detect early, clinically silent neuroinflammation and are likely to present sensitive biomarkers for the assessment of subclinical disease activity in patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02614-8.
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Yeo T, Quek AML, Yong KP, Tye JSN, Ratnagopal P, Soon DTL, Tan K. COVID-19 infection after two doses of SARS-CoV-2 mRNA vaccine in multiple sclerosis, AQP4-antibody NMOSD and MOGAD. Mult Scler Relat Disord 2022; 65:104003. [PMID: 35803084 PMCID: PMC9233746 DOI: 10.1016/j.msard.2022.104003] [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: 02/14/2022] [Revised: 05/01/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In pre-vaccinated people with multiple sclerosis (MS), certain disease-modifying therapies (DMTs), particularly the anti-CD20 treatments, appear to be associated with an increased risk of COVID-19 infection and indeed with severe infection. It is still not known if such observations extend to vaccinated individuals and there have been considerably fewer studies in aquaporin-4-antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) patients. In this study, we investigated the rates of symptomatic COVID-19 infection in adult patients with MS, AQP4-NMOSD and MOGAD who had received 2 doses of SARS-CoV-2 mRNA vaccine. METHODS This was a prospective observational study conducted at the 2 main neuroimmunology referral centres in Singapore. Only patients on active follow-up were recruited to ensure robust data collection. Data on demographics, disease history, DMTs and SARS-CoV-2 mRNA vaccinations were recorded, and for those infected with COVID-19, data on COVID-19 infection was collected. RESULTS Nineteen (13 MS, 5 AQP4-NMOSD, 1 MOGAD) out of 365 (231 MS, 106 AQP4-NMOSD, 28 MOGAD) patients had COVID-19 infection despite 2 doses of SARS-CoV-2 mRNA vaccine. Amongst the infected patients, 11 patients were on DMTs (3 rituximab, 2 interferons, 1 azathioprine, 1 mycophenolate, 1 prednisolone, 1 cladribine, 1 alemtuzumab, 1 fingolimod), while 8 patients were untreated. The crude infection rate was calculated using time-at-risk analysis, revealing that rituximab had the highest infection rate amongst all the DMTs. A lower crude infection rate was observed in patients who received a third vaccination. The majority of infections were mild and no patients required oxygen supplementation. CONCLUSION Our findings suggest that patients on rituximab are still at risk of COVID-19 infection after 2 vaccinations and the receipt of a third vaccination may help to prevent infection. Future large scale studies will be required to better delineate the infection risk of different DMTs after the second and subsequent vaccinations.
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Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kok Pin Yong
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Janis Siew Noi Tye
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore
| | - Pavanni Ratnagopal
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Derek Tuck Loong Soon
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
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Gibbons E, Campgana G, O’Connell K, Yeo T, Whittam D, Karthikeayan VM, Leite MI, Palace J, Jacob A, Huda S. 070 What is seronegative neuromyelitis optica spectrum disorder? J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.107] [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] [Indexed: 11/04/2022]
Abstract
BackgroundMost but not all cases of Neuromyelitis Optica Spectrum Disorder (NMOSD) are associated with Aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG) antibodies.ObjectiveTo determine the clinical characteristics of seronegative NMOSDMethodRetrospective review of seronegative NMOSD in Liverpool and Oxford between January 2010–2020ResultsOf NMOSD=727, 49(7%) were seronegative. The male to female ratio was 1:2.5 and median age at onset was 36(5–57) years. In 2/3 of patients the index presentation was myelitis=22 or myelitis+optic neuritis=11. In 26/33 (79%), longitudinally extensive myelitis was present. Optic neuritis=9 (4 bilateral) and brain involvement=7 were also seen. Relapsing disease was observed in 39/49(80%) of patients. The median annualised attack rate was 0.58 over a median disease duration of 78 (3–258) months. Unmatched CSF oligoclonal bands (CSF-OCBs) were detected in 4/38(11%) and 31/49(63%) fulfilled multiple sclerosis (MS) diagnostic criteria. Immunosuppression (typically Mycophenolate and Rituximab) was used in 34/49(69%). Median last EDSS was 4 (1–10) with death recorded in 5/49 (10%) patients.ConclusionSeronegative NMOSD is uncommon. Longitudinal myelitis with/without optic neuritis is a common initial presentation. Similar to AQP4-IgG, NMOSD disability and mortality rates are high. Absence of unmatched CSF-OCB and typical brain lesions help to distinguish this disease from MS.emily.gibbons@doctors.org.uk
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Larkin JR, Anthony S, Johanssen VA, Yeo T, Sealey M, Yates AG, Smith CF, Claridge TD, Nicholson BD, Moreland JA, Gleeson F, Sibson NR, Anthony DC, Probert F. Metabolomic Biomarkers in Blood Samples Identify Cancers in a Mixed Population of Patients with Nonspecific Symptoms. Clin Cancer Res 2022; 28:1651-1661. [PMID: 34983789 PMCID: PMC7613224 DOI: 10.1158/1078-0432.ccr-21-2855] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/08/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Early diagnosis of cancer is critical for improving patient outcomes, but cancers may be hard to diagnose if patients present with nonspecific signs and symptoms. We have previously shown that nuclear magnetic resonance (NMR) metabolomics analysis can detect cancer in animal models and distinguish between differing metastatic disease burdens. Here, we hypothesized that biomarkers within the blood metabolome could identify cancers within a mixed population of patients referred from primary care with nonspecific symptoms, the so-called "low-risk, but not no-risk" patient group, as well as distinguishing between those with and without metastatic disease. EXPERIMENTAL DESIGN Patients (n = 304 comprising modeling, n = 192, and test, n = 92) were recruited from 2017 to 2018 from the Oxfordshire Suspected CANcer (SCAN) pathway, a multidisciplinary diagnostic center (MDC) referral pathway for patients with nonspecific signs and symptoms. Blood was collected and analyzed by NMR metabolomics. Orthogonal partial least squares discriminatory analysis (OPLS-DA) models separated patients, based upon diagnoses received from the MDC assessment, within 62 days of initial appointment. RESULTS Area under the ROC curve for identifying patients with solid tumors in the independent test set was 0.83 [95% confidence interval (CI): 0.72-0.95]. Maximum sensitivity and specificity were 94% (95% CI: 73-99) and 82% (95% CI: 75-87), respectively. We could also identify patients with metastatic disease in the cohort of patients with cancer with sensitivity and specificity of 94% (95% CI: 72-99) and 88% (95% CI: 53-98), respectively. CONCLUSIONS For a mixed group of patients referred from primary care with nonspecific signs and symptoms, NMR-based metabolomics can assist their diagnosis, and may differentiate both those with malignancies and those with and without metastatic disease. See related commentary by Van Tine and Lyssiotis, p. 1477.
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Affiliation(s)
- James R. Larkin
- Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Susan Anthony
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa A. Johanssen
- Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Tianrong Yeo
- Department of Pharmacology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Neurology, National Neuroscience Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Megan Sealey
- Department of Pharmacology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Abi G. Yates
- Department of Pharmacology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Claire Friedemann Smith
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Brian D. Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julie-Ann Moreland
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Fergus Gleeson
- Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nicola R. Sibson
- Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Daniel C. Anthony
- Department of Pharmacology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Fay Probert
- Department of Pharmacology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Chemistry, University of Oxford, Oxford, United Kingdom
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Probert F, Yeo T, Zhou Y, Sealey M, Arora S, Palace J, Claridge TDW, Hillenbrand R, Oechtering J, Kuhle J, Leppert D, Anthony DC. Determination of CSF GFAP, CCN5, and vWF Levels Enhances the Diagnostic Accuracy of Clinically Defined MS From Non-MS Patients With CSF Oligoclonal Bands. Front Immunol 2022; 12:811351. [PMID: 35185866 PMCID: PMC8855362 DOI: 10.3389/fimmu.2021.811351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/08/2021] [Accepted: 12/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background Inclusion of cerebrospinal fluid (CSF) oligoclonal IgG bands (OCGB) in the revised McDonald criteria increases the sensitivity of diagnosis when dissemination in time (DIT) cannot be proven. While OCGB negative patients are unlikely to develop clinically definite (CD) MS, OCGB positivity may lead to an erroneous diagnosis in conditions that present similarly, such as neuromyelitis optica spectrum disorders (NMOSD) or neurosarcoidosis. Objective To identify specific, OCGB-complementary, biomarkers to improve diagnostic accuracy in OCGB positive patients. Methods We analysed the CSF metabolome and proteome of CDMS (n=41) and confirmed non-MS patients (n=64) comprising a range of CNS conditions routinely encountered in neurology clinics. Results OCGB discriminated between CDMS and non-MS with high sensitivity (85%), but low specificity (67%), as previously described. Machine learning methods revealed CCN5 levels provide greater accuracy, sensitivity, and specificity than OCGB (79%, +5%; 90%, +5%; and 72%, +5% respectively) while glial fibrillary acidic protein (GFAP) identified CDMS with 100% specificity (+33%). A multiomics approach improved accuracy further to 90% (+16%). Conclusion The measurement of a few additional CSF biomarkers could be used to complement OCGB and improve the specificity of MS diagnosis when clinical and radiological evidence of DIT is absent.
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Affiliation(s)
- Fay Probert
- Department of Chemistry, University of Oxford, Oxford, United Kingdom,*Correspondence: Daniel C. Anthony, ; Fay Probert,
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,Department of Neurology, National Neuroscience Institute, Singapore, Singapore,Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Yifan Zhou
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,Translational Stem Cell Biology Branch, National Institutes of Health, Bethesda, MD, United States,Wellcome Medical Research Council (MRC) Trust Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Megan Sealey
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Siddharth Arora
- Department of Mathematics, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | | | - Johanna Oechtering
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Leppert
- Neurologic Clinic and Policlinic, Multiple Sclerosis (MS) Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel C. Anthony
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom,*Correspondence: Daniel C. Anthony, ; Fay Probert,
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Juryńczyk M, Klimiec-Moskal E, Kong Y, Hurley S, Messina S, Yeo T, Jenkinson M, Leite MI, Palace J. Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis. J Neurol 2022; 269:269-279. [PMID: 34043042 PMCID: PMC8738499 DOI: 10.1007/s00415-021-10619-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment. OBJECTIVE In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators. RESULTS Four subgroups were identified. Patients from Group 1 termed "MS-like" (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 ("spinal MS-like", 8) had short-segment myelitis and no MS-like brain lesions. Group 3 ("classic NMO-like", 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 ("NMO-like with brain involvement", 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04). CONCLUSIONS NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients.
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Affiliation(s)
- Maciej Juryńczyk
- Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK. .,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
| | - Elżbieta Klimiec-Moskal
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK ,grid.5522.00000 0001 2162 9631Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Yazhuo Kong
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK ,grid.454868.30000 0004 1797 8574CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101 China ,grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Samuel Hurley
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Messina
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Tianrong Yeo
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Mark Jenkinson
- grid.4991.50000 0004 1936 8948Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- grid.4991.50000 0004 1936 8948Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neuroscienes, University of Oxford, Oxford, UK.
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Yeo T, Probert F, Sealey M, Saldana L, Geraldes R, Höeckner S, Schiffer E, Claridge TDW, Leppert D, DeLuca G, Kuhle J, Palace J, Anthony DC. Objective biomarkers for clinical relapse in multiple sclerosis: a metabolomics approach. Brain Commun 2021; 3:fcab240. [PMID: 34755110 PMCID: PMC8568847 DOI: 10.1093/braincomms/fcab240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
Accurate determination of relapses in multiple sclerosis is important for diagnosis, classification of clinical course and therapeutic decision making. The identification of biofluid markers for multiple sclerosis relapses would add to our current diagnostic armamentarium and increase our understanding of the biology underlying the clinical expression of inflammation in multiple sclerosis. However, there is presently no biofluid marker capable of objectively determining multiple sclerosis relapses although some, in particular neurofilament-light chain, have shown promise. In this study, we sought to determine if metabolic perturbations are present during multiple sclerosis relapses, and, if so, identify candidate metabolite biomarkers and evaluate their discriminatory abilities at both group and individual levels, in comparison with neurofilament-light chain. High-resolution global and targeted 1H nuclear magnetic resonance metabolomics as well as neurofilament-light chain measurements were performed on the serum in four groups of relapsing-remitting multiple sclerosis patients, stratified by time since relapse onset: (i) in relapse (R); (ii) last relapse (LR) ≥ 1 month (M) to < 6 M ago; (iii) LR ≥ 6 M to < 24 M ago; and (iv) LR ≥ 24 M ago. Two hundred and one relapsing-remitting multiple sclerosis patients were recruited: R (n = 38), LR 1–6 M (n = 28), LR 6–24 M (n = 34), LR ≥ 24 M (n = 101). Using supervised multivariate analysis, we found that the global metabolomics profile of R patients was significantly perturbed compared to LR ≥ 24 M patients. Identified discriminatory metabolites were then quantified using targeted metabolomics. Lysine and asparagine (higher in R), as well as, isoleucine and leucine (lower in R), were shortlisted as potential metabolite biomarkers. ANOVA of these metabolites revealed significant differences across the four patient groups, with a clear trend with time since relapse onset. Multivariable receiver operating characteristics analysis of these four metabolites in discriminating R versus LR ≥ 24 M showed an area under the curve of 0.758, while the area under the curve for serum neurofilament-light chain was 0.575. Within individual patients with paired relapse–remission samples, all four metabolites were significantly different in relapse versus remission, with the direction of change consistent with that observed at group level, while neurofilament-light chain was not discriminatory. The perturbations in the identified metabolites point towards energy deficiency and immune activation in multiple sclerosis relapses, and the measurement of these metabolites, either singly or in combination, are useful as biomarkers to differentiate relapse from remission at both group and individual levels.
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Affiliation(s)
- Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK.,Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore.,Duke-NUS Medical School, Singapore 169857, Singapore
| | - Fay Probert
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Megan Sealey
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Luisa Saldana
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | | | | | - Timothy D W Claridge
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, Oxford OX1 3TA, UK
| | - David Leppert
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel CH-4031, Switzerland
| | - Gabriele DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel CH-4031, Switzerland
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
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Viswanathan S, Hiew FL, Siritho S, Apiwattanakul M, Tan K, Quek AML, Estiasari R, Remli R, Bhaskar S, Islam BM, Aye SMM, Ohnmar O, Umapathi T, Keosodsay SS, Hoang NTT, Yeo T, Pasco PM. Impact of Covid-19 on the therapeutic plasma exchange service within the South East Asian region: Consensus recommendations and global perspectives. J Clin Apher 2021; 36:849-863. [PMID: 34694652 PMCID: PMC8646799 DOI: 10.1002/jca.21937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/08/2021] [Accepted: 08/22/2021] [Indexed: 12/03/2022]
Abstract
Introduction Therapeutic plasma exchange (TPE) for neuroimmunological disorders has played an increasingly important role within the Southeast Asian (SEA) region. The South East Asian Therapeutic Plasma exchange Consortium (SEATPEC) was formed in 2018 to promote education and research on TPE within the region. The advent of the Covid‐19 pandemic has produced challenges for the development and expansion of this service. Methodology A qualitative and semi‐quantitative questionnaire‐based survey was conducted by SEATPEC member countries from January to June 2020 (Phase 1) and then from July 2020 to January 2021 in (Phase 2) to assess the impact of Covid‐19 on regional TPE. Objectives The study's main objectives were to explore the challenges experienced and adaptations/adjustments taken by SEATPEC countries in order to continue safe and efficient TPE during the Covid‐19 pandemic. Results The pandemic was found to disrupt the delivery of TPE services in all SEATPEC countries. Contributing factors were multifactorial due to overstretched medical services, staff shortages, quarantines and redeployments, fear of acquiring Covid‐19, movement restriction orders, and patient's psychological fear of attending hospitals/testing for Covid‐19. All SEATPEC countries practiced careful stratification of cases for TPE (electives vs emergencies, Covid‐19 vs non‐Covid‐19 cases). SEATPEC countries had to modify TPE treatment protocols to include careful preprocedure screening of patient's for Covid‐19, use of personal protective equipment (PPE) and post‐TPE sanitization of machines and TPE suites. Conclusion Based on the responses of the survey, SEATPEC countries produced a consensus statement with five recommendations for safe and effective TPE within the region.
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Affiliation(s)
| | - Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Sasitorn Siritho
- Department of Neurology, Bumrungrad International Hospital and Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Metha Apiwattanakul
- Department of Neurology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Amy M L Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Riwanti Estiasari
- Department of Neurology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rabani Remli
- Department of Neurology, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Shalini Bhaskar
- Department of Medicine, Universiti Teknologi MARA, Sg Buloh, Selangor, Malaysia
| | - Badrul M Islam
- Department of Laboratory Sciences and Services Division, The International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Seinn Mya Mya Aye
- Department of Neurology, Aryu International Hospital, Yangon, Myanmar
| | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | | | | | - Nghia T T Hoang
- Department of Neurology, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Paul M Pasco
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
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20
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Soares-Dos-Reis R, Tsz-Ching JL, Kim SH, Jacob A, Whittam D, Berthelot E, Paul F, Nakashima I, Tye JSN, De Seze J, Jitprapaikulsan J, Tan K, Yang L, Elsone L, Leite MI, Mealy MA, Levy M, Fan M, Siebert N, Asgari N, Cabre P, Siritho S, Pittock SJ, Wing-Ho SC, Senger T, Yeo T, Takai Y, Pandit L, Kim HJ, Palace J. Asian and African/Caribbean AQP4-NMOSD patient outcomes according to self-identified race and place of residence. Mult Scler Relat Disord 2021; 53:103080. [PMID: 34171683 DOI: 10.1016/j.msard.2021.103080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy characterized by aquaporin-4 antibodies, whose prognosis is influenced by onset age, race, environmental exposures and immunosuppression. Distinguishing the contribution of environment from genetics is challenging. We aimed to compare neuromyelitis optica spectrum disorder (NMOSD) patient outcomes according to self-identified racial group and place of residence. METHODS This retrospective analysis of prospectively collected data included non-white anti-aquaporin-4 antibody positive NMOSD patients under follow-up from 15 centers [United Kingdom, France, Germany, Denmark, Martinique, United States of America, Japan, South Korea, Singapore, Thailand, China (including Hong Kong) and India]. Racial groups were designated: African/Caribbean; South Asian; East Asian (including Southeast Asia). Patients from these racial groups residing outside Africa/Caribbean or Asia were compared with those living in the Caribbean or the Asian areas. Kaplan-Meier survival curves and Cox models were generated using time to sustained Expanded Disability Status Scale≥6.0 or death; time to sustained Kurtzke Visual Function Score≥3.0 or a composite endpoint of all three. RESULTS Among 821 patients, African/Caribbean patients (n = 206) had the shortest time to immunosuppression and higher visual disability at onset. South Asian patients (n = 65) were younger, had lower visual disability at onset and higher mortality rate. East Asians (n = 550) had the lowest relapse rate and lowest accrued motor disability. Survival analysis of African/Caribbean outside Africa/Caribbean vs those in the Caribbean showed a significant difference in the composite endpoint (p = 0.024,log-rank test), not apparently related to treatment differences. No significant differences between native and those residing outside Asia were found for other racial groups. CONCLUSION This NMOSD study reports the effects of place of residence on the outcomes in different races. Place of residence may not be a significant driver of disability among Asian patients, while it may influence African/Caribbean patient outcomes. Validating these findings could help distinguish between genetic causes and potentially modifiable environmental factors.
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Affiliation(s)
- Ricardo Soares-Dos-Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
| | - Anu Jacob
- Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
| | - Daniel Whittam
- Walton Center NHS Foundation Trust, Liverpool, United Kingdom.
| | - Emeline Berthelot
- Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique.
| | - Friedemann Paul
- NeuroCure Clinical Research, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | | | - Jerôme De Seze
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France.
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore.
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Liene Elsone
- Walton Center NHS Foundation Trust, Liverpool, United Kingdom.
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, United Kingdom.
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Moli Fan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Nadja Siebert
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
| | - Nasrin Asgari
- Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Neurology, Slagelse Hospital, Institute of Regional Health Research, Slagelse, Denmark.
| | - Philippe Cabre
- Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique.
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University, Thailand; Bumrungrad International Hospital, Thailand
| | - Sean J Pittock
- Departments of Laboratory Medicine and Pathology and Neurology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States.
| | | | - Thomas Senger
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France.
| | - Tianrong Yeo
- Department of Pharmacology, Experimental Neuropathology Group, University of Oxford, Mansfield Road OX1 3QT, United Kingdom; Department of Neurology, National Neuroscience Institute, Singapore.
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Lekha Pandit
- Center for Advanced Neurological Research, Nitte University, Mangalore, India
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
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21
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Probert F, Yeo T, Zhou Y, Sealey M, Arora S, Palace J, Claridge TDW, Hillenbrand R, Oechtering J, Leppert D, Kuhle J, Anthony DC. Integrative biochemical, proteomics and metabolomics cerebrospinal fluid biomarkers predict clinical conversion to multiple sclerosis. Brain Commun 2021; 3:fcab084. [PMID: 33997784 PMCID: PMC8111065 DOI: 10.1093/braincomms/fcab084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/23/2022] Open
Abstract
Eighty-five percent of multiple sclerosis cases begin with a discrete attack termed clinically isolated syndrome, but 37% of clinically isolated syndrome patients do not experience a relapse within 20 years of onset. Thus, the identification of biomarkers able to differentiate between individuals who are most likely to have a second clinical attack from those who remain in the clinically isolated syndrome stage is essential to apply a personalized medicine approach. We sought to identify biomarkers from biochemical, metabolic and proteomic screens that predict clinically defined conversion from clinically isolated syndrome to multiple sclerosis and generate a multi-omics-based algorithm with higher prognostic accuracy than any currently available test. An integrative multi-variate approach was applied to the analysis of cerebrospinal fluid samples taken from 54 individuals at the point of clinically isolated syndrome with 2-10 years of subsequent follow-up enabling stratification into clinical converters and non-converters. Leukocyte counts were significantly elevated at onset in the clinical converters and predict the occurrence of a second attack with 70% accuracy. Myo-inositol levels were significantly increased in clinical converters while glucose levels were decreased, predicting transition to multiple sclerosis with accuracies of 72% and 63%, respectively. Proteomics analysis identified 89 novel gene products related to conversion. The identified biochemical and protein biomarkers were combined to produce an algorithm with predictive accuracy of 83% for the transition to clinically defined multiple sclerosis, outperforming any individual biomarker in isolation including oligoclonal bands. The identified protein biomarkers are consistent with an exaggerated immune response, perturbed energy metabolism and multiple sclerosis pathology in the clinical converter group. The new biomarkers presented provide novel insight into the molecular pathways promoting disease while the multi-omics algorithm provides a means to more accurately predict whether an individual is likely to convert to clinically defined multiple sclerosis.
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Affiliation(s)
- Fay Probert
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK.,Department of Chemistry, University of Oxford, Oxford OX1 3TA, UK
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK.,Department of Neurology, National Neuroscience Institute, Singapore 308437, Singapore
| | - Yifan Zhou
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Megan Sealey
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Siddharth Arora
- Mathematical Institute, University of Oxford, Oxford OX2 6GG, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | | | | | - Johanna Oechtering
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel CH-4031, Switzerland
| | - David Leppert
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel CH-4031, Switzerland
| | - Jens Kuhle
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel, University of Basel, Basel CH-4031, Switzerland
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
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22
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Roca-Fernández A, Oertel FC, Yeo T, Motamedi S, Probert F, Craner MJ, Sastre-Garriga J, Zimmermann HG, Asseyer S, Kuchling J, Bellmann-Strobl J, Ruprecht K, Leite MI, Paul F, Brandt AU, Palace J. Foveal changes in aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder are independent of optic neuritis and not overtly progressive. Eur J Neurol 2021; 28:2280-2293. [PMID: 33547839 DOI: 10.1111/ene.14766] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/18/2020] [Accepted: 01/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Foveal changes were reported in aquaporin-4 antibody (AQP4-Ab) seropositive neuromyelitis optica spectrum disorder (NMOSD) patients; however, it is unclear whether they are independent of optic neuritis (ON), stem from subclinical ON or crossover from ON in fellow eyes. Fovea morphometry and a statistical classification approach were used to investigate if foveal changes in NMOSD are independent of ON and progressive. METHODS This was a retrospective longitudinal study of 27 AQP4-IgG + NMOSD patients (49 eyes; 15 ON eyes and 34 eyes without a history of ON [NON eyes]), follow-up median (first and third quartile) 2.32 (1.33-3.28), and 38 healthy controls (HCs) (76 eyes), follow-up median (first and third quartile) 1.95 (1.83-2.54). The peripapillary retinal nerve fibre layer thickness and the volume of combined ganglion cell and inner plexiform layer as measures of neuroaxonal damage from ON were determined by optical coherence tomography. Nineteen foveal morphometry parameters were extracted from macular optical coherence tomography volume scans. Data were analysed using orthogonal partial least squares discriminant analysis and linear mixed effects models. RESULTS At baseline, foveal shape was significantly altered in ON eyes and NON eyes compared to HCs. Discriminatory analysis showed 81% accuracy distinguishing ON vs. HCs and 68% accuracy in NON vs. HCs. NON eyes were distinguished from HCs by foveal shape parameters indicating widening. Orthogonal partial least squares discriminant analysis discriminated ON vs. NON with 76% accuracy. In a follow-up of 2.4 (20.85) years, no significant time-dependent foveal changes were found. CONCLUSION The parafoveal area is altered in AQP4-Ab seropositive NMOSD patients suggesting independent neuroaxonal damage from subclinical ON. Longer follow-ups are needed to confirm the stability of the parafoveal structure over time.
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Affiliation(s)
- Adriana Roca-Fernández
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, UK.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Seyedamirhosein Motamedi
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Fay Probert
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Matthew J Craner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jaume Sastre-Garriga
- Department of Neurology/Neuroimmunology, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joseph Kuchling
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Ulrich Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California Irvine, Irvine, CA, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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23
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Neo S, Yeo T, Chen Z, Ngiam NHW, Lim ETX, Tan K, Lim TCC. Acute radiological features facilitate diagnosis and prognosis of anti-N-methyl-d-aspartate receptor (NMDAR) and anti-voltage-gated potassium channel (VGKC) encephalitis in adults. J Neurol Sci 2020; 419:117216. [PMID: 33171389 DOI: 10.1016/j.jns.2020.117216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anti-N-methyl-d-aspartate receptor (NMDAR) and anti-voltage-gated potassium channel (VGKC) encephalitis are the commonest antibody-associated autoimmune encephalitides (AIE). Acute clinical features have been well-described, but data on the role of radiological findings in diagnosis and prognosis of AIE are limited. METHODS Anti-NMDAR and anti-VGKC encephalitis patients from the National Neuroscience Institute were identified. We compared clinical and paraclinical features, at acute presentation and on follow-up between and within groups. RESULTS Twenty-six anti-NMDAR and 11 anti-VGKC encephalitis patients were reviewed. At acute presentation, dysautonomia (57.7%) and impairment of consciousness (84.6%) occurred exclusively in anti-NMDAR encephalitis. Cerebrospinal fluid pleocytosis was more common in anti-NMDAR encephalitis (88.5% vs 20.0%, p = 0.003), while ictal electroencephalography abnormalities were more frequent in anti-VGKC encephalitis (11.5% vs 45.5%, p = 0.022). On acute imaging, leptomeningeal enhancement was seen only in anti-NMDAR encephalitis (37.5%), while hippocampal T2 hyperintensities supported the diagnosis of anti-VGKC encephalitis (63.6% vs 12.5%, p = 0.002). At follow-up (median 53.0 months, range 13.0-119.0), anti-NMDAR encephalitis patients had better modified Rankin scale scores (median 0.0 vs 3.0, p = 0.023). Relapses occurred equally in both groups. Anti-VGKC encephalitis patients with abnormal acute MRI were more likely to have poor outcomes compared to those with normal imaging (100% vs 25%, p = 0.008), whereas acute imaging features in anti-NMDAR encephalitis did not predict long-term outcomes. CONCLUSIONS Acute MRI findings can aid in early diagnosis and prognostication in suspected AIE. Leptomeningeal enhancement in anti-NMDAR encephalitis and hippocampal lesions in anti-VGKC encephalitis, together with typical clinical features, may allow distinction between these antibody subtypes, and specific abnormal imaging features in anti-VGKC encephalitis may be used as a prognostic marker.
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Affiliation(s)
- Shermyn Neo
- Department of Neurology, National Neuroscience Institute, Singapore.
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Zhiyong Chen
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Ethanyn Tyen-Xin Lim
- Department of Diagnostic Radiology, National University Health System, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore
| | - Tchoyoson Choie Cheio Lim
- Duke-NUS Medical School, Singapore; Department of Neuroradiology, National Neuroscience Institute, Singapore
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24
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Ramberger M, Berretta A, Tan JMM, Sun B, Michael S, Yeo T, Theorell J, Bashford-Rogers R, Paneva S, O’Dowd V, Dedi N, Topia S, Griffin R, Ramirez-Franco J, El Far O, Baulac S, Leite MI, Sen A, Jeans A, McMillan D, Marshall D, Anthony D, Lightwood D, Waters P, Irani SR. Distinctive binding properties of human monoclonal LGI1 autoantibodies determine pathogenic mechanisms. Brain 2020; 143:1731-1745. [PMID: 32437528 PMCID: PMC7296845 DOI: 10.1093/brain/awaa104] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 09/07/2019] [Revised: 02/10/2020] [Accepted: 03/01/2020] [Indexed: 12/20/2022] Open
Abstract
Autoantibodies against leucine-rich glioma inactivated 1 (LGI1) are found in patients with limbic encephalitis and focal seizures. Here, we generate patient-derived monoclonal antibodies (mAbs) against LGI1. We explore their sequences and binding characteristics, plus their pathogenic potential using transfected HEK293T cells, rodent neuronal preparations, and behavioural and electrophysiological assessments in vivo after mAb injections into the rodent hippocampus. In live cell-based assays, LGI1 epitope recognition was examined with patient sera (n = 31), CSFs (n = 11), longitudinal serum samples (n = 15), and using mAbs (n = 14) generated from peripheral B cells of two patients. All sera and 9/11 CSFs bound both the leucine-rich repeat (LRR) and the epitempin repeat (EPTP) domains of LGI1, with stable ratios of LRR:EPTP antibody levels over time. By contrast, the mAbs derived from both patients recognized either the LRR or EPTP domain. mAbs against both domain specificities showed varied binding strengths, and marked genetic heterogeneity, with high mutation frequencies. LRR-specific mAbs recognized LGI1 docked to its interaction partners, ADAM22 and ADAM23, bound to rodent brain sections, and induced internalization of the LGI1-ADAM22/23 complex in both HEK293T cells and live hippocampal neurons. By contrast, few EPTP-specific mAbs bound to rodent brain sections or ADAM22/23-docked LGI1, but all inhibited the docking of LGI1 to ADAM22/23. After intrahippocampal injection, and by contrast to the LRR-directed mAbs, the EPTP-directed mAbs showed far less avid binding to brain tissue and were consistently detected in the serum. Post-injection, both domain-specific mAbs abrogated long-term potentiation induction, and LRR-directed antibodies with higher binding strengths induced memory impairment. Taken together, two largely dichotomous populations of LGI1 mAbs with distinct domain binding characteristics exist in the affinity matured peripheral autoantigen-specific memory pools of individuals, both of which have pathogenic potential. In human autoantibody-mediated diseases, the detailed characterization of patient mAbs provides a valuable method to dissect the molecular mechanisms within polyclonal populations.
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Affiliation(s)
- Melanie Ramberger
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Antonio Berretta
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jeanne M M Tan
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Experimental Neuropathology Group, Department of Pharmacology, University of Oxford, Oxford, UK
| | - Bo Sun
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Sophia Michael
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Experimental Neuropathology Group, Department of Pharmacology, University of Oxford, Oxford, UK
| | - Jakob Theorell
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Sofija Paneva
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Neesha Dedi
- UCB Pharma, 208-216 Bath Road, Berkshire, UK
| | | | | | - Jorge Ramirez-Franco
- Unité de Neurobiologie des Canaux Ioniques et de la Synapse, INSERM UMR_S 1072, Aix Marseille Université, Marseille, France
| | - Oussama El Far
- Unité de Neurobiologie des Canaux Ioniques et de la Synapse, INSERM UMR_S 1072, Aix Marseille Université, Marseille, France
| | - Stéphanie Baulac
- Sorbonne Université, UPMC Univ Paris 06, UMR S 1127, INSERM, U1127, CNRS, UMR 7225, Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Pitié-Salpêtrière, Paris, France
| | - Maria I Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Arjune Sen
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
- Oxford Epilepsy Research Group, University of Oxford, Oxford, UK
| | - Alexander Jeans
- Experimental Neuropathology Group, Department of Pharmacology, University of Oxford, Oxford, UK
| | | | | | - Daniel Anthony
- Experimental Neuropathology Group, Department of Pharmacology, University of Oxford, Oxford, UK
| | | | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
- Oxford Epilepsy Research Group, University of Oxford, Oxford, UK
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25
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Yeo T, Dos Passos GR, Muhammed L, Everett R, Reeve S, Messina S, Probert F, Leite MI, Palace J. Factors associated with fatigue in CNS inflammatory diseases with AQP4 and MOG antibodies. Ann Clin Transl Neurol 2020; 7:375-383. [PMID: 32187851 PMCID: PMC7086003 DOI: 10.1002/acn3.51008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/14/2020] [Accepted: 02/14/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Fatigue is a common and disabling symptom amongst people with multiple sclerosis, however it has not been compared across the central nervous system (CNS) inflammatory diseases associated with aquaporin‐4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). We explored the factors associated with fatigue within and across the two diseases, and compared fatigue levels between them. Methods We performed a cross‐sectional study of 90 AQP4‐Ab and 44 MOG‐Ab patients. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS). Clinical, demographic, and psychometric (anxiety, depression, pain) data were used as independent variables. Multivariable linear regression was used to identify significant independent variables associated with fatigue within and across the two diseases. Results Within AQP4‐Ab patients, age (P = 0.002), disease duration (P = 0.004), number of clinical attacks (P = 0.001), disability (P = 0.007), pain interference (P < 0.001), anxiety (P = 0.026), and depression (P < 0.001) were significant independent variables. Interestingly, disease duration had a negative association with fatigue (P = 0.004). Within MOG‐Ab patients, pain interference score (P < 0.001) and anxiety (P = 0.001) were significant independent variables. Although fatigue was worse in AQP4‐Ab patients compared to MOG‐Ab patients (P = 0.008) in all patients as well as in those who ever had transverse myelitis (P = 0.023), this was driven by the differences in age, disability and pain interference rather than antibody subtype itself. Interpretation Multiple factors, but not the antibody specificity, appear to contribute to fatigue in antibody positive CNS inflammatory diseases. A multifaceted treatment approach is needed to better manage the physical, cognitive, and psychosocial aspects of fatigue in these patients.
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Affiliation(s)
- Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, UK.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Giordani Rodrigues Dos Passos
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Neurology, Sao Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rosie Everett
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Sandra Reeve
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Fay Probert
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
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Bagi Z, Couch Y, Broskova Z, Perez-Balderas F, Yeo T, Davis S, Fischer R, Sibson NR, Davis BG, Anthony DC. Extracellular vesicle integrins act as a nexus for platelet adhesion in cerebral microvessels. Sci Rep 2019; 9:15847. [PMID: 31676801 PMCID: PMC6825169 DOI: 10.1038/s41598-019-52127-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/14/2019] [Indexed: 01/13/2023] Open
Abstract
Circulating extracellular vesicles (EVs) regulate signaling pathways via receptor-ligand interactions and content delivery, after attachment or internalization by endothelial cells. However, they originate from diverse cell populations and are heterogeneous in composition. To determine the effects of specific surface molecules, the use of synthetic EV mimetics permits the study of specific EV receptor-ligand interactions. Here, we used endogenous EVs derived from the circulation of rats, as well as ligand-decorated synthetic microparticles (MPs) to examine the role of integrin αvβ3 in platelet adhesion under flow in structurally intact cerebral arteries. At an intraluminal pressure of 50 mmHg and flow rate of 10 µl/min, platelets were delivered to the artery lumen and imaged with whole-field fluorescent microscopy. Under basal conditions very few platelets bound to the endothelium. However, adhesion events were markedly increased following the introduction of arginine-glycine-aspartate (RGD)-labelled synthetic MPs or endogenously-derived EVs from experimental stroke animals carrying excess RGD proteins, including vitronectin, CD40-ligand and thrombospondin-1. These data, which were generated in a dynamic and physiologically relevant system, demonstrate the importance of vesicle-carried RGD ligands in platelet adherence to the cerebrovascular endothelium and highlight the ability of synthetic EVs to isolate and identify key components of the molecular handshake between EVs and their targets.
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Affiliation(s)
- Zsolt Bagi
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, United Kingdom.
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Yvonne Couch
- RDM-Investigative Medicine, University of Oxford, Oxford, OX3 7LJ, United Kingdom
| | - Zuzana Broskova
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, United Kingdom
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA
| | - Francisco Perez-Balderas
- Chemistry Research Laboratory, University of Oxford, Oxford, OX1 3TA, United Kingdom
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, United Kingdom
| | - Simon Davis
- TDI Mass Spectrometry Laboratory, Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Roman Fischer
- TDI Mass Spectrometry Laboratory, Target Discovery Institute, Nuffield Department of Medicine, University of Oxford, Roosevelt Drive, Oxford, OX3 7FZ, UK
| | - Nicola R Sibson
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, OX3 7DQ, United Kingdom
| | - Benjamin G Davis
- Chemistry Research Laboratory, University of Oxford, Oxford, OX1 3TA, United Kingdom
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Oxford, OX1 3QT, United Kingdom.
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Yeo T, Probert F, Jurynczyk M, Sealey M, Cavey A, Claridge TDW, Woodhall M, Waters P, Leite MI, Anthony DC, Palace J. Classifying the antibody-negative NMO syndromes: Clinical, imaging, and metabolomic modeling. Neurol Neuroimmunol Neuroinflamm 2019; 6:e626. [PMID: 31659123 PMCID: PMC6865851 DOI: 10.1212/nxi.0000000000000626] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
Objective To determine whether unsupervised principal component analysis (PCA) of comprehensive clinico-radiologic data can identify phenotypic subgroups within antibody-negative patients with overlapping features of multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSDs), and to validate the phenotypic classifications using high-resolution nuclear magnetic resonance (NMR) plasma metabolomics with inference to underlying pathologies. Methods Forty-one antibody-negative patients were recruited from the Oxford NMO Service. Thirty-six clinico-radiologic parameters, focusing on features known to distinguish NMOSD and MS, were collected to build an unbiased PCA model identifying phenotypic subgroups within antibody-negative patients. Metabolomics data from patients with relapsing-remitting MS (RRMS) (n = 34) and antibody-positive NMOSD (Ab-NMOSD) (aquaporin-4 antibody n = 54, myelin oligodendrocyte glycoprotein antibody n = 20) were used to identify discriminatory plasma metabolites separating RRMS and Ab-NMOSD. Results PCA of the 36 clinico-radiologic parameters revealed 3 phenotypic subgroups within antibody-negative patients: an MS-like subgroup, an NMOSD-like subgroup, and a low brain lesion subgroup. Supervised multivariate analysis of metabolomics data from patients with RRMS and Ab-NMOSD identified myoinositol and formate as the most discriminatory metabolites (both higher in RRMS). Within antibody-negative patients, myoinositol and formate were significantly higher in the MS-like vs NMOSD-like subgroup; myoinositol (mean [SD], 0.0023 [0.0002] vs 0.0019 [0.0003] arbitrary units [AU]; p = 0.041); formate (0.0027 [0.0006] vs 0.0019 [0.0006] AU; p = 0.010) (AU). Conclusions PCA identifies 3 phenotypic subgroups within antibody-negative patients and that the metabolite discriminators of RRMS and Ab-NMOSD suggest that these groupings have some pathogenic meaning. Thus, the identified clinico-radiologic discriminators may provide useful diagnostic clues when seeing antibody-negative patients in the clinic.
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Affiliation(s)
- Tianrong Yeo
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Fay Probert
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Maciej Jurynczyk
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Megan Sealey
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Ana Cavey
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Timothy D W Claridge
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Mark Woodhall
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Patrick Waters
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Maria Isabel Leite
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Daniel C Anthony
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK.
| | - Jacqueline Palace
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK.
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Probert F, Walsh A, Jagielowicz M, Yeo T, Claridge TDW, Simmons A, Travis S, Anthony DC. Plasma Nuclear Magnetic Resonance Metabolomics Discriminates Between High and Low Endoscopic Activity and Predicts Progression in a Prospective Cohort of Patients With Ulcerative Colitis. J Crohns Colitis 2018; 12:1326-1337. [PMID: 30016408 PMCID: PMC6403054 DOI: 10.1093/ecco-jcc/jjy101] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic assessment of ulcerative colitis [UC] is one of the most accurate measures of disease activity, but frequent endoscopic investigations are disliked by patients and expensive for the healthcare system. A minimally invasive test that provides a surrogate measure of endoscopic activity is required. METHODS Plasma nuclear magnetic resonance [NMR] spectra from 40 patients with UC followed prospectively over 6 months were analysed with multivariate statistics. NMR metabolite profiles were compared with endoscopic [Ulcerative Colitis Endoscopic Index of Severity: UCEIS], histological [Nancy Index] and clinical [Simple Clinical Colitis Activity Index: SCCAI] severity indices, along with routine blood measurements. RESULTS A blinded principal component analysis spontaneously separated metabolite profiles of patients with low [≤3] and high [>3] UCEIS. Orthogonal partial least squares discrimination analysis identified low and high UCEIS metabolite profiles with an accuracy of 77 ± 5%. Plasma metabolites driving discrimination included decreases in lipoproteins and increases in isoleucine, valine, glucose and myo-inositol in high compared to low UCEIS. This same metabolite profile distinguished between low [Nancy 0-1] and high histological activity [Nancy 3-4] with a modest although significant accuracy [65 ± 6%] but was independent of SCCAI and all blood parameters measured. A different metabolite profile, dominated by changes in lysine, histidine, phenylalanine and tyrosine, distinguished between improvement in UCEIS [decrease ≥1] and worsening [increase ≥1] over 6 months with an accuracy of 74 ± 4%. CONCLUSION Plasma NMR metabolite analysis has the potential to provide a low-cost, minimally invasive technique that may be a surrogate for endoscopic assessment, with predictive capacity.
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Affiliation(s)
- Fay Probert
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Alissa Walsh
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Marta Jagielowicz
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, and Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Oxford, UK,Department of Neurology, National Neuroscience Institute, Jalan Tan Tock Seng, Singapore
| | - Timothy D W Claridge
- Department of Chemistry, University of Oxford, Chemistry Research Laboratory, Oxford, UK
| | - Alison Simmons
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, and Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK,Corresponding author: Clinical: Simon Travis, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. ; Analysis and interpretation: Daniel Anthony, Department of Pharmacology, University of Oxford, Oxford, UK.
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Oxford, UK,Corresponding author: Clinical: Simon Travis, Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. ; Analysis and interpretation: Daniel Anthony, Department of Pharmacology, University of Oxford, Oxford, UK.
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Jurynczyk M, Probert F, Yeo T, Tackley G, Claridge TDW, Cavey A, Woodhall MR, Arora S, Winkler T, Schiffer E, Vincent A, DeLuca G, Sibson NR, Isabel Leite M, Waters P, Anthony DC, Palace J. Metabolomics reveals distinct, antibody-independent, molecular signatures of MS, AQP4-antibody and MOG-antibody disease. Acta Neuropathol Commun 2017; 5:95. [PMID: 29208041 PMCID: PMC5718082 DOI: 10.1186/s40478-017-0495-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 11/11/2022] Open
Abstract
The overlapping clinical features of relapsing remitting multiple sclerosis (RRMS), aquaporin-4 (AQP4)-antibody (Ab) neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG)-Ab disease mean that detection of disease specific serum antibodies is the gold standard in diagnostics. However, antibody levels are not prognostic and may become undetectable after treatment or during remission. Therefore, there is still a need to discover antibody-independent biomarkers. We sought to discover whether plasma metabolic profiling could provide biomarkers of these three diseases and explore if the metabolic differences are independent of antibody titre. Plasma samples from 108 patients (34 RRMS, 54 AQP4-Ab NMOSD, and 20 MOG-Ab disease) were analysed by nuclear magnetic resonance spectroscopy followed by lipoprotein profiling. Orthogonal partial-least squares discriminatory analysis (OPLS-DA) was used to identify significant differences in the plasma metabolite concentrations and produce models (mathematical algorithms) capable of identifying these diseases. In all instances, the models were highly discriminatory, with a distinct metabolite pattern identified for each disease. In addition, OPLS-DA identified AQP4-Ab NMOSD patient samples with low/undetectable antibody levels with an accuracy of 92%. The AQP4-Ab NMOSD metabolic profile was characterised by decreased levels of scyllo-inositol and small high density lipoprotein particles along with an increase in large low density lipoprotein particles relative to both RRMS and MOG-Ab disease. RRMS plasma exhibited increased histidine and glucose, along with decreased lactate, alanine, and large high density lipoproteins while MOG-Ab disease plasma was defined by increases in formate and leucine coupled with decreased myo-inositol. Despite overlap in clinical measures in these three diseases, the distinct plasma metabolic patterns support their distinct serological profiles and confirm that these conditions are indeed different at a molecular level. The metabolites identified provide a molecular signature of each condition which is independent of antibody titre and EDSS, with potential use for disease monitoring and diagnosis.
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Affiliation(s)
- Maciej Jurynczyk
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Fay Probert
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK.
| | - Tianrong Yeo
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - George Tackley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Tim D W Claridge
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, Mansfield Road, Oxford, OX1 3TA, UK
| | - Ana Cavey
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Mark R Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Siddharth Arora
- Mathematical Institute, University of Oxford, Woodstock Rd, Oxford, OX2 6GC, UK
| | | | - Eric Schiffer
- Numares AG, Am Biopark 9, 93053, Regensburg, Germany
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Gabriele DeLuca
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Nicola R Sibson
- Cancer Research UK & Medical Research Council Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, OX37DQ, Oxford, UK
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK.
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Level 3, West Wing, Headley Way, Oxford, OX3 9DU, UK.
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Yeo T, Tan LC. 'Hummingbird' Sign in a Patient with Guam Parkinsonism-Dementia Complex. J Mov Disord 2017; 10:145-148. [PMID: 28782342 PMCID: PMC5615172 DOI: 10.14802/jmd.17025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/31/2017] [Accepted: 06/16/2017] [Indexed: 12/12/2022] Open
Abstract
We present a case of a 71-year-old male Chamorro patient from Guam who presented with progressive supranuclear palsy (PSP)-Richardson's syndrome. Considering his strong family history of parkinsonism and a PSP phenotype, he was clinically diagnosed with Guam parkinsonism-dementia complex (PDC). Magnetic resonance imaging (MRI) of the brain revealed prominent midbrain atrophy with preserved pontine volume, forming the 'hummingbird' sign, which has not been described before in Guam PDC. Molecular analysis of the chromosome 9 open reading frame 72 gene (C9orf72) showed only 6 GGGGCC repeats. We discuss the clinico-pathological similarities and differences between PSP and Guam PDC, and highlight the topography of neuropathological changes seen in Guam PDC to explain the appearance of the 'hummingbird' sign on MRI.
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Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Louis Cs Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
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31
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Yeo T, Chen Z, Chai J, Tan K. Detection of LGI1 and CASPR2 antibodies with a commercial cell-based assay in patients with very high VGKC-complex antibody levels. J Neurol Sci 2017; 378:85-90. [DOI: 10.1016/j.jns.2017.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/26/2017] [Accepted: 04/25/2017] [Indexed: 01/17/2023]
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Xu Z, Prasad K, Yeo T. Progressive Encephalomyelitis with Rigidity and Myoclonus in an Intellectually Disabled Patient Mimicking Neuroleptic Malignant Syndrome. J Mov Disord 2017; 10:99-101. [PMID: 28352055 PMCID: PMC5435832 DOI: 10.14802/jmd.16058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/20/2017] [Accepted: 02/17/2017] [Indexed: 01/24/2023] Open
Abstract
We present a case of 32-year-old male with profound mental retardation and autism spectrum disorder who had presented with seizures, rigidity and elevated creatine kinase and was initially diagnosed as neuroleptic malignant syndrome (NMS). The patient subsequently had a complicated clinical course, developing refractory status epilepticus, which lead to the eventual diagnosis of progressive encephalomyelitis with rigidity and myoclonus (PERM). We discuss the clinical similarities and differences between NMS and PERM, and highlight the need to consider alternative diagnoses when the clinical picture of NMS is atypical, particularly in this patient group where the history and clinical examination may be challenging.
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Affiliation(s)
- Zheyu Xu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kalpana Prasad
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Tianrong Yeo
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
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Lilleker JB, Yeo T, van Sonderen A, Jones MS, Mohanraj R, Chai JY, Tan K, Schreurs MW, de Bruijn MA, Sillevis Smitt PA, Titulaer MJ. The relevance of VGKC positivity in the absence of LGI1 and Caspr2 antibodiesAuthor Response. Neurology 2016; 87:1848-1849. [DOI: 10.1212/wnl.0000000000003300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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34
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Tay MRJ, Yeo T, Chen Z, Au WL, Tan K. Movement Disorders in an Adult Patient with anti-NMDAR Encephalitis After Herpes Simplex Encephalitis. Mov Disord Clin Pract 2016; 4:460-462. [PMID: 30838281 DOI: 10.1002/mdc3.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/22/2016] [Accepted: 07/24/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Tianrong Yeo
- Department of Neurology National Neuroscience Institute Singapore
| | - Zhiyong Chen
- Department of Neurology National Neuroscience Institute Singapore
| | - Wing Lok Au
- Department of Neurology National Neuroscience Institute Singapore
| | - Kevin Tan
- Department of Neurology National Neuroscience Institute Singapore
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Lee R, Rogers S, Caress A, Molassiotis A, Edwards R, Ryder D, Sanghera P, Lunt C, Yeo T, Slevin N. PO-0637: RCT pilot study of Therabite vs wooden spatula in amelioration of trismus in H&N cancer patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31887-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tong L, Huang C, Ramalli A, Tortoli P, Luo J, D'hooge J, Tzemos N, Mordi I, Bishay T, Bishay T, Negishi T, Hristova K, Kurosawa K, Bansal M, Thavendiranathan P, Yuda S, Popescu B, Vinereanu D, Penicka M, Marwick T, Hamed W, Kamel M, Yaseen R, El-Barbary H, Nemes A, Kis O, Gavaller H, Kanyo E, Forster T, Angelis A, Vlachopoulos C, Ioakimidis N, Felekos I, Chrysohoou C, Aznaouridis K, Abdelrasoul M, Terentes D, Ageli K, Stefanadis C, Kurnicka K, Domienik-Karlowicz J, Lichodziejewska B, Goliszek S, Grudzka K, Krupa M, Dzikowska-Diduch O, Ciurzynski M, Pruszczyk P, Gual Capllonch F, Lopez Ayerbe J, Teis A, Ferrer E, Vallejo N, Junca G, Pla R, Bayes-Genis A, Schwaiger J, Knight D, Gallimore A, Schreiber B, Handler C, Coghlan J, Bruno RM, Giardini G, Malacrida S, Catuzzo B, Armenia S, Brustia R, Ghiadoni L, Cauchy E, Pratali L, Kim K, Lee K, Cho J, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Cho S, Nastase O, Enache R, Mateescu A, Botezatu D, Popescu B, Ginghina C, Gu H, Sinha M, Simpson J, Chowienczyk P, Fazlinezhad A, Tashakori Behesthi A, Homaei F, Mostafavi H, Hosseini G, Bakaeiyan M, Boutsikou M, Petrou E, Dimopoulos A, Dritsas A, Leontiadis E, Karatasakis G, Sahin ST, Yurdakul S, Yilmaz N, Cengiz B, Cagatay Y, Aytekin S, Yavuz S, Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T, Brunvand H, Nasr G, Nasr A, Eleraki A, Elrefai S, Mordi I, Sonecki P, Tzemos N, Gustafsson U, Naar J, Stahlberg M, Cerne A, Capotosto L, Rosato E, D'angeli I, Azzano A, Truscelli G, De Maio M, Salsano F, Terzano C, Mangieri E, Vitarelli A, Renard S, Najih H, Mancini J, Jacquier A, Haentjens J, Gaubert J, Habib G, Caminiti G, D'antoni V, D'antoni V, Cardaci V, Cardaci V, Conti V, Conti V, Volterrani M, Volterrani M, Ahn J, Kim D, Lee H, Iliuta L, Lo Iudice F, Esposito R, Lembo M, Santoro C, Ballo P, Mondillo S, De Simone G, Galderisi M, Hwang Y, Kim J, Kim J, Moon K, Yoo K, Kim C, Tagliamonte E, Rigo F, Cirillo T, Caruso A, Astarita C, Cice G, Quaranta G, Romano C, Capuano N, Calabro' R, Zagatina A, Zhuravskaya N, Guseva O, Huttin O, Benichou M, Voilliot D, Venner C, Micard E, Girerd N, Sadoul N, Moulin F, Juilliere Y, Selton-Suty C, Baron T, Christersson C, Johansson K, Flachskampf F, Lee S, Lee J, Hur S, Park J, Yun J, Song S, Kim W, Ko J, Nyktari E, Bilal S, Ali S, Izgi C, Prasad S, Aly M, Kleijn S, Kandil H, Kamp O, Beladan C, Calin A, Rosca M, Craciun A, Gurzun M, Calin C, Enache R, Mateescu A, Ginghina C, Popescu B, Mornos C, Mornos A, Ionac A, Cozma D, Crisan S, Popescu I, Ionescu G, Petrescu L, Camacho S, Gamaza Chulian S, Carmona R, Diaz E, Giraldez A, Gutierrez A, Toro R, Benezet J, Antonini-Canterin F, Vriz O, La Carrubba S, Poli S, Leiballi E, Zito C, Careri S, Caruso R, Pellegrinet M, Nicolosi G, Kong W, Kyu K, Wong R, Tay E, Yip J, Yeo T, Poh K, Correia M, Delgado A, Marmelo B, Correia E, Abreu L, Cabral C, Gama P, Santos O, Rahman M, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Okura H, Kanai M, Murata E, Kataoka T, Stoebe S, Tarr A, Pfeiffer D, Hagendorff A, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Carigi S, Baldazzi F, Bologna F, Amati S, Venturi P, Grosseto D, Biagetti C, Fabbri E, Arlotti M, Piovaccari G, Rahbi H, Bin Abdulhaq A, Tleyjeh I, Santoro C, Galderisi M, Costantino M, Tarsia G, Innelli P, Dores E, Esposito G, Matera A, De Simone G, Trimarco B, Capotosto L, Azzano A, Mukred K, Ashurov R, Tanzilli G, Mangieri E, Vitarelli A, Merlo M, Gigli M, Stolfo D, Pinamonti B, Antonini Canterin F, Muca M, D'angelo G, Scapol S, Di Nucci M, Sinagra G, Behaghel A, Feneon D, Fournet M, Thebault C, Martins R, Mabo P, Leclercq C, Daubert C, Donal E, Davinder Pal S, Prakash Chand N, Sanjeev A, Rajeev M, Ankur D, Ram Gopal S, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Demkina A, Hashieva F, Krylova N, Kovalevskaya E, Potehkina N, Zaroui A, Ben Said R, Smaali S, Rekik B, Ben Hlima M, Mizouni H, Mechmeche R, Mourali M, Malhotra A, Sheikh N, Dhutia H, Siva A, Narain R, Merghani A, Millar L, Walker M, Sharma S, Papadakis M, Siam-Tsieu V, Mansencal N, Arslan M, Deblaise J, Dubourg O, Zaroui A, Rekik B, Ben Said R, Boudiche S, Larbi N, Tababi N, Hannachi S, Mechmeche R, Mourali M, Mechmeche R, Zaroui A, Chalbia T, Ben Halima M, Rekik B, Boussada R, Mourali M, Lipari P, Bonapace S, Valbusa F, Rossi A, Zenari L, Lanzoni L, Targher G, Canali G, Molon G, Barbieri E, Novo G, Giambanco S, Sutera M, Bonomo V, Giambanco F, Rotolo A, Evola S, Assennato P, Novo S, Budnik M, Piatkowski R, Kochanowski J, Opolski G, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Maragoudakis F, Papadaki H, Vardas P, Rodrigues A, Perandini L, Souza T, Sa-Pinto A, Borba E, Arruda A, Furtado M, Carvalho F, Bonfa E, Andrade J, Hlubocka Z, Malinova V, Palecek T, Danzig V, Kuchynka P, Dostalova G, Zeman J, Linhart A, Chatzistamatiou E, Konstantinidis D, Memo G, Mpampatzeva Vagena I, Moustakas G, Manakos K, Trachanas K, Vergi N, Feretou A, Kallikazaros I, Corut H, Sade L, Ozin B, Atar I, Turgay O, Muderrisoglu H, Ledakowicz-Polak A, Polak L, Krauza G, Zielinska M, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nogueira M, Branco L, Agapito A, Galrinho A, Borba A, Teixeira P, Monteiro A, Ramos R, Cacela D, Cruz Ferreira R, Guala A, Camporeale C, Tosello F, Canuto C, Ridolfi L, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Hristova K, Marinov R, Stamenov G, Mihova M, Persenska S, Racheva A, Plaskota K, Trojnarska O, Bartczak A, Grajek S, Ramush Bejiqi R, Retkoceri R, Bejiqi H, Beha A, Surdulli S, Dreyfus J, Durand-Viel G, Cimadevilla C, Brochet E, Vahanian A, Messika-Zeitoun D, Jin C, Fang F, Meng F, Kam K, Sun J, Tsui G, Wong K, Wan S, Yu C, Lee A, Cho IJ, Chung H, Heo R, Ha S, Hong G, Shim C, Chang H, Ha J, Chung N, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Alexopoulos A, Dawson D, Nihoyannopoulos P, Zainal Abidin HA, Ismail J, Arshad K, Ibrahim Z, Lim C, Abd Rahman E, Kasim S, Peteiro J, Barrio A, Escudero A, Bouzas-Mosquera A, Yanez J, Martinez D, Castro-Beiras A, Scali M, Simioniuc A, Mandoli G, Lombardo A, Massaro F, Di Bello V, Marzilli M, Dini F, Adachi H, Tomono J, Oshima S, Merchan Ortega G, Bravo Bustos D, Lazaro Garcia R, Sanchez Espino A, Macancela Quinones J, Ikuta I, Ruiz Lopez M, Valencia Serrano F, Bonaque Gonzalez J, Gomez Recio M, Romano G, D'ancona G, Pilato G, Di Gesaro G, Clemenza F, Raffa G, Scardulla C, Sciacca S, Lancellotti P, Pilato M, Addetia K, Takeuchi M, Maffessanti F, Weinert L, Hamilton J, Mor-Avi V, Lang R, Sugano A, Seo Y, Watabe H, Kakefuda Y, Aihara H, Nishina H, Ishizu T, Fumikura Y, Noguchi Y, Aonuma K, Luo X, Fang F, Lee A, Shang Q, Yu C, Sammut EC, Chabinok R, Jackson T, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Byrne D, Walsh J, Ellis L, Mckiernan S, Norris S, King G, Murphy R, Hristova K, Katova T, Simova I, Kostova V, Shuie I, Ferferieva V, Bogdanova V, Castelon X, Nemes A, Sasi V, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Grapsa J, Demir O, Dawson D, Sharma R, Senior R, Nihoyannopoulos P, Pilichowska E, Zaborska B, Baran J, Stec S, Kulakowski P, Budaj A, Kosmala W, Kaye G, Saito M, Negishi K, Marwick T, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Dulai RS, Taylor A, Gupta S. Poster session 1: Wednesday 3 December 2014, 09:00-16:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014; 15:ii25-ii51. [DOI: 10.1093/ehjci/jeu248] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Karlsson B, Hanssens PEJ, Yamamoto M, Beute G, Kawabe T, Watanabe S, Soderman M, LIm K, Yeo T. P08.12 * WHOLE BRAIN RADIATION THERAPY OR GAMMA KNIFE RADIOSURGERY IN PATIENTS WITH >=3 BRAIN METASTASES? RESULTS BASED ON A STUDY OF MORE THAN 600 DUTCH PATIENTS AND A REVIEW OF THE LITERATURE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chow WC, Chong R, Guan R, Ho KYL, Leo YS, Loy KL, Lui HF, Ng HS, Siew WF, Teo EK, Yeo T. Ministry of Health clinical practice guidelines: Chronic Hepatitis B Infection. Singapore Med J 2011; 52:307-313. [PMID: 21552794] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Ministry of Health (MOH) publishes clinical practice guidelines on Chronic Hepatitis B Infection to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Chronic Hepatitis B Infection, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=26108). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
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Tu A, Yeo T, Steinke D, Resch L, Mehta V. Chordoid glioma: imaging pearls of a unique third ventricular tumor. Can J Neurol Sci 2010; 37:677-680. [PMID: 21059517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- A Tu
- Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Davis JS, Thomas J, McMillan M, Yeo T, Celermajer D, Stephens D, Anstey NM. Finger reactive hyperaemia to measure endothelial function in sepsis and health (the FRESH study). Crit Care 2008. [PMCID: PMC4088435 DOI: 10.1186/cc6285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bhagat YA, Emery DJ, Naik S, Yeo T, Beaulieu C. Comparison of generalized autocalibrating partially parallel acquisitions and modified sensitivity encoding for diffusion tensor imaging. AJNR Am J Neuroradiol 2007; 28:293-8. [PMID: 17296998 PMCID: PMC7977396] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Diffusion tensor magnetic resonance imaging (DTI) of the brain is usually acquired with single-shot echo-planar imaging, which is associated with localized signal loss, geometric distortions, and blurring. Parallel imaging can lessen these artifacts by shortening the length of the echo-train acquisition. The self-calibrating parallel acquisition techniques, image domain-based modified sensitivity encoding (mSENSE) and k-space-based generalized autocalibrating partially parallel acquisitions (GRAPPA), were evaluated with DTI of the brain in 5 healthy subjects. METHODS GRAPPA and mSENSE with higher acceleration factors (R) up to 4 were compared with conventional DTI (with and without phase partial Fourier, another method of reducing the echo-train length) on a 1.5T Sonata scanner (Siemens, Erlangen, Germany). The resulting images and diffusion maps were evaluated qualitatively and quantitatively. Qualitative analysis was performed by 3 reviewers blinded to the technique using image sharpness and the level of artifacts as characteristics for scoring each set of images. Quantitative comparisons encompassed measuring signal-to-noise ratio, Trace/3 apparent diffusion coefficient (ADC), and fractional anisotropy (FA) in 6 white-matter (WM) and gray-matter (GM) regions. RESULTS Reviewers scored the GRAPPA and mSENSE R = 2 images better than images acquired with conventional techniques. FA contrast was improved at the GM/WM junction in peripheral brain areas. Trace/3 ADC and FA measurements were consistent for all methods. However, R = 3,4 images suffered from reconstruction-related artifacts. CONCLUSIONS GRAPPA and mSENSE (R = 2) minimized the susceptibility and off-resonance effects associated with conventional DTI methods, yielding high-quality images and reproducible quantitative diffusion measurements.
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Affiliation(s)
- Y A Bhagat
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Hensiek AE, Roxburgh R, Meranian M, Seaman S, Yeo T, Compston DAS, Sawcer SJ. Osteopontin gene and clinical severity of multiple sclerosis. J Neurol 2003; 250:943-7. [PMID: 12928913 DOI: 10.1007/s00415-003-1120-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Revised: 02/17/2003] [Accepted: 03/11/2003] [Indexed: 10/26/2022]
Abstract
Osteopontin transcription is increased in the central nervous system of patients with multiple sclerosis and rats with experimental allergic encephalomyelitis; where expression correlates with disease severity. We typed four single nucleotide polymorphisms located in exons 6 and 7 of the osteopontin gene in a large cohort of 1056 multiple sclerosis patients and 325 controls. We did not find significant allelic differences of the screened polymorphisms between the cases and controls and there was no allelic association with disease severity. Despite strong theoretical reasons to consider osteopontin as a potential candidate, the results of our study argue against the gene being a susceptibility locus for either the development or clinical severity of MS.
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Affiliation(s)
- A E Hensiek
- University of Cambridge Neurology unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, UK
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Abstract
The influence of polyvinylpyrrolidone (PVP), a commonly used binder and adhesive, on the aggregation of spheroids coated with hydroxypropylmethylcellulose (HPMC) was studied. The aggregation propensities of spheroids coated by HPMC alone and by HPMC with polyethylene glycol (PEG) were compared with those coated by HPMC with PVP and the viscosity of the coating solutions determined. The coating was conducted at a maximum spray rate of 11 g/min to avoid premature termination of the coating process at higher spray rates due to uncontrollable aggregation of spheroids. PVP was able to reduce the extent of aggregation of spheroids. It was more effective in reducing spheroid aggregation than PEG. The reduction in spheroid aggregation propensity was ascribed to viscosity lowering effects of PVP. The viscosity of the coating solutions determined over the temperature range of 28-58 degrees C was found to increase in the following order: HPMC-PVP<HPMC-PEG<HPMC.
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Affiliation(s)
- T Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, S117543, Singapore, Singapore
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Aye D, Brouh Y, Soro L, Amonkou A, Yeo T, Kouame KE, Coffi S, Bondurand A. Rupture spontanée de rate au cours d'un paludisme à Plasmodium falciparum chez un sujet immun. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0923-2524(97)84088-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brooks S, Burrin J, Cheetham ME, Hall GM, Yeo T, Williams C. The responses of the catecholamines and beta-endorphin to brief maximal exercise in man. Eur J Appl Physiol Occup Physiol 1988; 57:230-4. [PMID: 2965009 DOI: 10.1007/bf00640668] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The responses to brief maximal exercise of 10 male subjects have been studied. During 30 s of exercise on a non-motorized treadmill, the mean power output (mean +/- SD) was 424.8 +/- 41.9 W, peak power 653.3 +/- 103.0 W and the distance covered was 167.3 +/- 9.7 m. In response to the exercise blood lactate concentrations increased from 0.60 +/- 0.26 to 13.46 +/- 1.71 mmol.l-1 (p less than 0.001) and blood glucose concentrations from 4.25 +/- 0.45 to 5.59 +/- 0.67 mmol.l-1 (p less than 0.001). The severe nature of the exercise is indicated by the fall in blood pH from 7.38 +/- 0.02 to 7.16 +/- 0.07 (p less than 0.001) and the estimated decrease in plasma volume of 11.5 +/- 3.4% (p less than 0.001). The plasma catecholamine concentrations increased from 2.2 +/- 0.6 to 13.4 +/- 6.4 nmol.l-1 (p less than 0.001) and 0.2 +/- 0.2 to 1.4 +/- 0.6 nmol.l-1 (p less than 0.001) for noradrenaline (NA) and adrenaline (AD) respectively. The plasma concentration of the opioid beta-endorphin increased in response to the exercise from less than 5.0 to 10.2 +/- 3.9 p mol.l-1. The post-exercise AD concentrations correlated with those for lactate as well as with changes in pH and the decrease in plasma volume. Post-exercise beta-endorphin levels correlated with the peak speed attained during the sprint and the subjects peak power to weight ratio. These results suggest that the increases in plasma adrenaline are related to those factors that reflect the stress of the exercise and the contribution of anaerobic metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Brooks
- Department of Physical Education and Sports Science, University of Technology, Loughborough, Leicestershire, Great Britain
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Impallomeni M, Yeo T, Rudd A, Carr D, Aber V. Investigation of anterior pituitary function in elderly in-patients over the age of 75. Q J Med 1987; 63:505-15. [PMID: 3659265] [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] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Dynamic pituitary function tests were carried out on 50 randomly selected in-patients, (30 women and 20 men) over the age of 75 during early convalescence. Twenty-five subjects also had CT scans of the pituitary fossa. One male patient had hypogonadotrophic hypogonadism; another had a large prolactinoma and hypothyroidism; these were excluded from the analysis. Of the remaining 48 subjects, 14 (29 per cent) had reduced TSH responses to TRH and 28 (64 per cent) decreased GH responses to L-dopa compared with our laboratory's reference ranges. Fifteen women (51 per cent) had low basal gonadotrophin levels of which 10 (34 per cent) gave a poor LH response to LHRH and eight (27 per cent) a poor FSH response. Forty-three subjects (93 per cent) gave a good ACTH response to metyrapone. Only six subjects (24 per cent) had an apparently normal pituitary fossa; 16 (64 per cent) had partially or completely empty fossas. There was no significant correlation between the diminished pituitary responses. Only one patient had responses which suggested panhypopituitarism. There was also no significant correlation between the appearance on CT scan of the pituitary fossa and the results of the dynamic tests. It is suggested that laboratory reference range for pituitary function which have been derived from young ambulatory subjects are not appropriate for hospital in-patients over the age of 75. A series of reference ranges for such subjects is proposed.
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Affiliation(s)
- M Impallomeni
- Geriatric Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London
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Wilson CA, McNeilly AS, Yeo T. Mechanisms by which 5HT stimulates ovulation in the immature rat treated with pregnant mare serum gonadotrophin. Acta Endocrinol (Copenh) 1986; 111:235-40. [PMID: 3082099 DOI: 10.1530/acta.0.1110235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pregnant mare serum gonadotrophin (PMS) normally induces a pre-ovulatory immunoreactive LH surge followed by ovulation in 27 day old rats provided they weigh more than 60 g; ovulation does not occur in the lighter rats although a pre-ovulatory LH surge can still be measured. 5HT injected into the paraventricular nucleus (PVN) can induce ovulation in these smaller rats treated with PMS and does so without appearing to stimulate extra immunoreactive LH. The LH secreted in the under 60 g PMS-treated rats is a pleiomorphic form since it cannot be detected by cytochemical bioassay, indicating abnormal biological activity, which may account for its failure to induce ovulation. After unilateral injection of 5HT into PVN, the LH was detectable by the bioassay. Injection of 5HT also stimulated the release of growth hormone and prolactin but had no significant effect on the plasma concentration of the gonadotrophins or corticosterone. Since an injection of exogenous GH converted the LH to a fully bioactive form it is suggested that GH is important in inducing the secretion of an "adult' form of LH in the peripubertal rat necessary for first ovulation and that 5HT exerts its ovulatory effect via stimulating the release of this hormone.
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Williams G, Kerle DJ, Ware H, Doble A, Dunlop H, Smith C, Allen J, Yeo T, Bloom SR. Objective responses to ketoconazole therapy in patients with relapsed progressive prostatic cancer. Br J Urol 1986; 58:45-51. [PMID: 3947856 DOI: 10.1111/j.1464-410x.1986.tb05426.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The contribution of adrenal androgens to the maintenance and progression of so-called hormone-unresponsive prostatic carcinoma was studied in 20 patients with advanced relapsed disease. The role played by testicular androgens had been negated by prior orchiectomy or concurrent LHRH analogue therapy. Ketoconazole, an antifungal agent which inhibits adrenal and testicular androgenesis, administered in a dose of 400 mg 8-hourly, resulted in optimal suppression of adrenal androgens. The mean serum androstenedione concentration fell from 8.01 +/- 0.84 nMol/l to 1.55 +/- 0.25 nMol/l, P less than 0.001, and serum testosterone from 1.25 +/- 0.14 nMol/l to 0.36 +/- 0.06 nMol/l, P less than 0.01, after 6 months treatment. There was, however, no significant difference between patients receiving 400 and those receiving 200 mg. Androgen suppression resulted in six objective and ten subjective clinical responses. Ablation of both testicular and adrenal androgens can now be achieved using ketoconazole in combination with orchiectomy or LHRH analogues, but the high incidence of side effects may preclude its use in all patients with prostatic cancer. The results of this study support the concept of "total androgen ablation" as primary therapy in advanced prostatic cancer as a possible means of improving survival in this common malignancy.
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