1
|
Loonstra FC, de Ruiter LRJ, Strijbis EMM, de Jong BA, Uitdehaag BMJ. The association between weight during early life and multiple sclerosis onset in a nationwide Dutch birth year cohort. Nutr Neurosci 2024; 27:499-505. [PMID: 37409581 DOI: 10.1080/1028415x.2023.2225271] [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] [Indexed: 07/07/2023]
Abstract
BACKGROUND The relationship between being overweight during early life and disease course in multiple sclerosis (MS) is unresolved. We investigated the association between being overweight or obese during early life (childhood and adolescence) and MS case status, age of first symptom onset and onset type in people with MS (pwMS) of the same birth year. METHODS We enrolled 363 PwMS and 125 healthy controls (HC) from Project Y, a Dutch population-based cross-sectional cohort study including all PwMS born in 1966 and age and sex-matched HC. The associations between weight during childhood and adolescence (non-overweight vs. overweight or obese) and MS, age at symptom onset and onset type (relapsing vs. progressive) were assessed using logistic and linear regressions. In addition, sex-separated associations were explored. RESULTS Being overweight or obese during childhood (OR = 2.82, 95% CI 1.17-6.80) and adolescence (OR = 2.45, 95% CI 1.13-5.34) was associated with developing MS. Furthermore, being overweight or obese during adolescence was associated with a younger age of onset (β = -0.11, p = 0.041). Of all 47 patients with a primary progressive (PP) onset type, only one patient (2.1%) was overweight or obese during childhood, whereas 45 patients with a relapsing remitting (RR) onset (14.3%) were overweight or obese during childhood (PP vs. RR p = 0.017; PP vs. HC p = 0.676; RR vs. HC, p = 0.015). However, using logistic regression analysis we did not find evidence of a significant association. CONCLUSION In a nationwide population-based birth year cohort, being overweight or obese during childhood or adolescence is associated with MS prevalence and an earlier age of onset, but does not seem to associate with the type of onset.
Collapse
Affiliation(s)
- Floor C Loonstra
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lodewijk R J de Ruiter
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brigit A de Jong
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Atolagbe A, Metellus P, Nkemjika S. Capgras Syndrome, Multiple Sclerosis, and COVID-19 Infection: A Case Report. Cureus 2024; 16:e53924. [PMID: 38465171 PMCID: PMC10925012 DOI: 10.7759/cureus.53924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Capgras syndrome is a psychotic illness characterized by an unshaken false belief in having a close family member replaced by an imposter when there is no evidence of such. The patient described in this case report is a 68-year-old Caucasian female who presented with Capgras syndrome in the context of chronic progressive multiple sclerosis (MS) following an acute COVID-19 illness. She was treated with quetiapine with full resolution of symptoms.
Collapse
Affiliation(s)
- Ayodele Atolagbe
- Department of Psychiatry and Behavioral Sciences, Kingsbrook Jewish Medical Center, Brooklyn, USA
| | - Peterson Metellus
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Stanley Nkemjika
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| |
Collapse
|
3
|
van Puijfelik F, Blok KM, Klein Kranenbarg RAM, Rip J, de Beukelaar J, Wierenga-Wolf AF, Wokke B, van Luijn MM, Smolders J. Ocrelizumab associates with reduced cerebrospinal fluid B and CD20 dim CD4 + T cells in primary progressive multiple sclerosis. Brain Commun 2024; 6:fcae021. [PMID: 38385000 PMCID: PMC10881107 DOI: 10.1093/braincomms/fcae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/23/2024] Open
Abstract
The anti-CD20 monoclonal antibody ocrelizumab reduces disability progression in primary progressive multiple sclerosis. CD20 is a prototypical B-cell marker; however, subpopulations of CD4+ and CD8+ T cells in peripheral blood and cerebrospinal fluid also express low levels of CD20 (CD20dim). Therefore, direct targeting and depletion of these CD20dim T-cell subpopulations may contribute to the therapeutic effect of ocrelizumab. The aim of this observational cohort study was to compare CD20+ B-cell and CD20dim T-cell distributions between peripheral blood and cerebrospinal fluid of ocrelizumab-treated or ocrelizumab-untreated people with primary progressive multiple sclerosis. Ocrelizumab treatment was associated with depletion of circulating B cells and CD20dim CD4+ and CD20dim CD8+ T cells (P < 0.0001, P = 0.0016 and P = 0.0008, respectively) but, in cerebrospinal fluid, only with lower proportions of B cells and CD20dim memory CD4+ T cells (P < 0.0001 and P = 0.0043, respectively). The proportional prevalence of cerebrospinal fluid CD20dim memory CD8+ T cells was not significantly reduced (P = 0.1333). Only in cerebrospinal fluid, the proportions of CD20dim cells within CD4+ and not CD8+ T cells positive for CCR5, CCR6 and CXCR3 were reduced in ocrelizumab-treated participants. The proportion of CD20dim CD4+ T cells and abundance of CD4+ relative to CD8+ T cells in cerebrospinal fluid correlated positively with age (R = 0.6799, P = 0.0150) and Age-Related Multiple Sclerosis Severity score (R = 0.8087, P = 0.0014), respectively. We conclude that, in contrast to cerebrospinal fluid CD20dim CD8+ T cells, B cells and CD20dim CD4+ T cells are reduced in cerebrospinal fluid of people with primary progressive multiple sclerosis with an ocrelizumab-associated depletion of circulating B cells and CD20dim T cells. Therefore, these cells are likely to contribute to the therapeutic effects of ocrelizumab in people with primary progressive multiple sclerosis.
Collapse
Affiliation(s)
- Fabiënne van Puijfelik
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Katelijn M Blok
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Department of Neurology, Albert Schweitzer Hospital, 3318 AT, Dordrecht, The Netherlands
| | - Romy A M Klein Kranenbarg
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Department of Neurology, Albert Schweitzer Hospital, 3318 AT, Dordrecht, The Netherlands
| | - Jasper Rip
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Janet de Beukelaar
- Department of Neurology, Albert Schweitzer Hospital, 3318 AT, Dordrecht, The Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Marvin M van Luijn
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Joost Smolders
- Department of Immunology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, 1105 BA, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Räuber S, Förster M, Schüller J, Willison A, Golombeck KS, Schroeter CB, Oeztuerk M, Jansen R, Huntemann N, Nelke C, Korsen M, Fischer K, Kerkhoff R, Leven Y, Kirschner P, Kölsche T, Nikolov P, Mehsin M, Marae G, Kokott A, Pul D, Schulten J, Vogel N, Ingwersen J, Ruck T, Pawlitzki M, Meuth SG, Melzer N, Kremer D. The Use of Nitrosative Stress Molecules as Potential Diagnostic Biomarkers in Multiple Sclerosis. Int J Mol Sci 2024; 25:787. [PMID: 38255863 PMCID: PMC10815836 DOI: 10.3390/ijms25020787] [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: 12/02/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) of still unclear etiology. In recent years, the search for biomarkers facilitating its diagnosis, prognosis, therapy response, and other parameters has gained increasing attention. In this regard, in a previous meta-analysis comprising 22 studies, we found that MS is associated with higher nitrite/nitrate (NOx) levels in the cerebrospinal fluid (CSF) compared to patients with non-inflammatory other neurological diseases (NIOND). However, many of the included studies did not distinguish between the different clinical subtypes of MS, included pre-treated patients, and inclusion criteria varied. As a follow-up to our meta-analysis, we therefore aimed to analyze the serum and CSF NOx levels in clinically well-defined cohorts of treatment-naïve MS patients compared to patients with somatic symptom disorder. To this end, we analyzed the serum and CSF levels of NOx in 117 patients (71 relapsing-remitting (RR) MS, 16 primary progressive (PP) MS, and 30 somatic symptom disorder). We found that RRMS and PPMS patients had higher serum NOx levels compared to somatic symptom disorder patients. This difference remained significant in the subgroup of MRZ-negative RRMS patients. In conclusion, the measurement of NOx in the serum might indeed be a valuable tool in supporting MS diagnosis.
Collapse
Affiliation(s)
- Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Moritz Förster
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology, Kliniken Maria Hilf GmbH, Academic Teaching Hospital of the RWTH Aachen University Hospital, 41063 Moenchengladbach, Germany
| | - Julia Schüller
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Alice Willison
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Kristin S. Golombeck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Christina B. Schroeter
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Menekse Oeztuerk
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Robin Jansen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Niklas Huntemann
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Christopher Nelke
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Melanie Korsen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Katinka Fischer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Ruth Kerkhoff
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology, Kliniken Maria Hilf GmbH, Academic Teaching Hospital of the RWTH Aachen University Hospital, 41063 Moenchengladbach, Germany
| | - Yana Leven
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Patricia Kirschner
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Tristan Kölsche
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Petyo Nikolov
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Mohammed Mehsin
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Gelenar Marae
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Alma Kokott
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Duygu Pul
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Julius Schulten
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Niklas Vogel
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Jens Ingwersen
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Tobias Ruck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - Nico Melzer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
| | - David Kremer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany; (S.R.); (M.F.); (J.S.); (A.W.); (K.S.G.); (C.B.S.); (M.O.); (R.J.); (N.H.); (C.N.); (M.K.); (K.F.); (R.K.); (Y.L.); (P.K.); (T.K.); (P.N.); (G.M.); (A.K.); (D.P.); (J.S.); (N.V.); (J.I.); (T.R.); (M.P.); (S.G.M.); (N.M.)
- Department of Neurology and Neurorehabilitation, Hospital Zum Heiligen Geist, Academic Teaching Hospital of the Heinrich Heine University Düsseldorf, 47906 Kempen, Germany
| |
Collapse
|
5
|
van den Berg R, Blok K, Tebayna N, van Dijk M, van Rosmalen J, de Beukelaar J. Reasons Patients With Primary Progressive Multiple Sclerosis Contact Their Specialist Nurses. Int J MS Care 2024; 26:30-35. [PMID: 38213677 PMCID: PMC10779713 DOI: 10.7224/1537-2073.2022-056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Questions asked by patients with primary progressive multiple sclerosis (PPMS) during patient-initiated MS nurse consultations may contain salient information that can help health care providers understand their needs, which, in turn, can help tailor counseling and treatment. METHODS Records of all patients with PPMS visiting the MS center of a large teaching hospital in the Netherlands between January 2007 and January 2021 were studied retrospectively. Number and type (scheduled or patient initiated) of MS nurse consultations, reasons for consultations (in prespecified categories), and frequency of subsequent referrals were registered. Association between factors (living with partner, Expanded Disability Status Scale score, comorbidities, age, sex) and number of patient-initiated consultations was studied using negative binomial regression analysis. RESULTS In total, 98 patients with PPMS were included, with 720 MS nurse consultations during follow-up (median duration, 8.1 years), of which 274 (38%) were patient initiated. Patients had a broad spectrum of reasons to contact MS nurses. The most common categories were treatment (36%) and micturition and defecation (31%). Patients living without a partner (incidence rate ratio, 2.340; 95% CI, 1.057-5.178) and male patients (incidence rate ratio, 1.890; 95% CI, 0.925-3.861) consulted MS nurses more frequently. The MS nurses made 146 referrals (20% of all contacts); 59 were after patient-initiated consultation (22%). The most frequent referrals were to neurologists, urologists, and rehabilitation specialists. CONCLUSIONS Multiple sclerosis nurses have a pivotal role in PPMS care, especially for patients living without a partner and male patients. Recurring questions about (new) treatment options illustrate the pressing need for highly effective treatment. Micturition and defecation problems are also a considerable concern and warrant close monitoring.
Collapse
Affiliation(s)
- Rosaline van den Berg
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Katelijn Blok
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
- Multiple Sclerosis Center ErasMS of the Department of Neurology (KB)
| | - Nura Tebayna
- From the Department of Neurology, Multiple Sclerosis Center (RvdB, KB, NT, JdB) and the Science Office (RvdB), Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Monique van Dijk
- Nursing Science Section of the Department of Internal Medicine (MvD)
| | | | | |
Collapse
|
6
|
Calvi A, Mendelsohn Z, Hamed W, Chard D, Tur C, Stutters J, MacManus D, Kanber B, Wheeler-Kingshott CAMG, Barkhof F, Prados F. Treatment reduces the incidence of newly appearing multiple sclerosis lesions evolving into chronic active, slowly expanding lesions: A retrospective analysis. Eur J Neurol 2024; 31:e16092. [PMID: 37823722 DOI: 10.1111/ene.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Newly appearing lesions in multiple sclerosis (MS) may evolve into chronically active, slowly expanding lesions (SELs), leading to sustained disability progression. The aim of this study was to evaluate the incidence of newly appearing lesions developing into SELs, and their correlation to clinical evolution and treatment. METHODS A retrospective analysis of a fingolimod trial in primary progressive MS (PPMS; INFORMS, NCT00731692) was undertaken. Data were available from 324 patients with magnetic resonance imaging scans up to 3 years after screening. New lesions at year 1 were identified with convolutional neural networks, and SELs obtained through a deformation-based method. Clinical disability was assessed annually by Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test, Timed 25-Foot Walk, and Paced Auditory Serial Addition Test. Linear, logistic, and mixed-effect models were used to assess the relationship between the Jacobian expansion in new lesions and SELs, disability scores, and treatment status. RESULTS One hundred seventy patients had ≥1 new lesions at year 1 and had a higher lesion count at screening compared to patients with no new lesions (median = 27 vs. 22, p = 0.007). Among the new lesions (median = 2 per patient), 37% evolved into definite or possible SELs. Higher SEL volume and count were associated with EDSS worsening and confirmed disability progression. Treated patients had lower volume and count of definite SELs (β = -0.04, 95% confidence interval [CI] = -0.07 to -0.01, p = 0.015; β = -0.36, 95% CI = -0.67 to -0.06, p = 0.019, respectively). CONCLUSIONS Incident chronic active lesions are common in PPMS, and fingolimod treatment can reduce their number.
Collapse
Affiliation(s)
- Alberto Calvi
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, Fundació Clinic per a la Recerca Biomèdica, Barcelona, Spain
| | - Zoe Mendelsohn
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Weaam Hamed
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Radiology, Mansoura University Hospital, Mansoura, Egypt
| | - Declan Chard
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | - Carmen Tur
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Jon Stutters
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - David MacManus
- NMR Research Unit, Institute of Neurology, University College London, London, UK
| | - Baris Kanber
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Frederik Barkhof
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- Radiology and Nuclear Medicine, Amsterdam University Medical Centers (UMC), Vrije Universiteit, Amsterdam, the Netherlands
| | - Ferran Prados
- NMR Research Unit, Institute of Neurology, University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing, University College London, London, UK
- e-Health Centre, Universitat Oberta de Catalunya, Barcelona, Spain
| |
Collapse
|
7
|
Zanghì A, Ferraro D, Callari G, Valentino P, Granella F, Patti F, Lus G, Bonavita S, Moretti MC, Avolio C, D’Amico E. Ocrelizumab Extended Interval Dosing in Primary Progressive Multiple Sclerosis: An Italian Experience. Curr Neuropharmacol 2024; 22:339-345. [PMID: 37876043 PMCID: PMC10788893 DOI: 10.2174/1570159x22666231002142709] [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: 04/07/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The intervals between two courses of anti CD20 therapies in the COVID19 pandemic era provided the opportunity to individually delay therapy, known as extended interval dosing (EID). METHODS We collect real-world data on patients with primary progressive MS (PPMS) treated with Ocrelizumab (OCR) during the COVID'19 pandemic. The observation period in which the standard interval dosing (SID) or EID occurred (always a maintenance cycle, 600 mg) was from January 2020 to June 2021. All patients had two infusions during the observation period. Our first aim was to compare confirmed disability progression (CDP) between SID and EID patients. RESULTS From a total cohort of 410 patients treated with OCR, 96 patients fulfilled the inclusion criteria. All patients received two infusions during the index window, 71 received only SID infusions whilst 25 received at least one EID infusion throughout the entire follow-up. During the entire available follow-up (median 10 months, IQR 7-11), CDP was recorded in 5 patients (3/71, 4.2% SID and 2/25, 8% EID, V-Cramer = 0.141, p-value = 0.167). EID regimen did not influence the risk of CDP during the investigated follow up. CONCLUSION In our multicentre real-world cohort, the EID regimen in PPMS patients did not result in increased CDP during the available follow-up.
Collapse
Affiliation(s)
- Aurora Zanghì
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Moderna, Emilia-Ronagna, Italy
| | | | - Paola Valentino
- Azienda Ospedaliera Universitaria “Mater Domini”, Catanzaro, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy and Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Francesco Patti
- Department “G.F. Ingrassia”, MS Center University of Catania, Catania, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138 Naples, Italy
| | | | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Emanuele D’Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
8
|
Blok KM, Smolders J, van Rosmalen J, Martins Jarnalo CO, Wokke B, de Beukelaar J. Real-world challenges in the diagnosis of primary progressive multiple sclerosis. Eur J Neurol 2023; 30:3799-3808. [PMID: 37578087 DOI: 10.1111/ene.16042] [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: 08/16/2022] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND AND PURPOSE Despite the 2017 revisions to the McDonald criteria, diagnosing primary progressive multiple sclerosis (PPMS) remains challenging. To improve clinical practice, the aim was to identify frequent diagnostic challenges in a real-world setting and associate these with the performance of the 2010 and 2017 PPMS diagnostic McDonald criteria. METHODS Clinical, radiological and laboratory characteristics at the time of diagnosis were retrospectively recorded from designated PPMS patient files. Possible complicating factors were recorded such as confounding comorbidity, signs indicative of alternative diagnoses, possible earlier relapses and/or incomplete diagnostic work-up (no cerebrospinal fluid examination and/or magnetic resonance imaging brain and spinal cord). The percentages of patients fulfilling the 2010 and 2017 McDonald criteria were calculated after censoring patients with these complicating factors. RESULTS A total of 322 designated PPMS patients were included. Of all participants, it was found that n = 28/322 had confounding comorbidity and/or signs indicative of alternative diagnoses, n = 103/294 had possible initial relapsing and/or uncertainly progressive phenotypes and n = 73/191 received an incomplete diagnostic work-up. When applying the 2010 and 2017 diagnostic PPMS McDonald criteria on n = 118 cases with a full diagnostic work-up and a primary progressive disease course without a better alternative explanation, these were met by 104/118 (88.1%) and 98/118 remaining patients (83.1%), respectively (p = 0.15). CONCLUSION Accurate interpretation of the initial clinical course, consideration of alternative diagnoses and a full diagnostic work-up are the cornerstones of a PPMS diagnosis. When these conditions are met, the 2010 and 2017 McDonald criteria for PPMS perform similarly, emphasizing the importance of their appropriate application in clinical practice.
Collapse
Affiliation(s)
- Katelijn M Blok
- Department of Neurology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
- Neuroimmunology Research Group, Netherlands Institute for Neurosciences, Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carine O Martins Jarnalo
- Department of Radiology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janet de Beukelaar
- Department of Neurology, MS Center of the Albert Schweitzer Hospital, Dordrecht, The Netherlands
| |
Collapse
|
9
|
Blok KM, van Rosmalen J, Tebayna N, Smolders J, Wokke B, de Beukelaar J. Disease activity in primary progressive multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2023; 14:1277477. [PMID: 38020591 PMCID: PMC10661414 DOI: 10.3389/fneur.2023.1277477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Disease activity in multiple sclerosis (MS) is defined as presence of relapses, gadolinium enhancing lesions and/or new or enlarging lesions on MRI. It is associated with efficacy of immunomodulating therapies (IMTs) in primary progressive MS (PPMS). However, a thorough review on disease activity in PPMS is lacking. In relapsing remitting MS, the prevalence of activity decreases in more contemporary cohorts. For PPMS, this is unknown. Aim To review disease activity in PPMS cohorts and identify its predictors. Methods A systematic search in EMBASE, MEDLINE, Web of science Core Collection, COCHRANE CENTRAL register of trials, and GOOGLE SCHOLAR was performed. Keywords included PPMS, inflammation, and synonyms. We included original studies with predefined available data, extracted cohort characteristics and disease activity outcomes and performed meta-regression analyses. Results We included 34 articles describing 7,109 people with PPMS (pwPPMS). The weighted estimated proportion of pwPPMS with overall disease activity was 26.8% (95% CI 20.6-34.0%). A lower age at inclusion predicted higher disease activity (OR 0.91, p = 0.031). Radiological activity (31.9%) was more frequent than relapses (9.2%), and was predicted by longer follow-up duration (OR 1.27, p = 0.033). Year of publication was not correlated with disease activity. Conclusion Inflammatory disease activity is common in PPMS and has remained stable over the last decades. Age and follow-up duration predict disease activity, advocating prolonged monitoring of young pwPPMS to evaluate potential IMT benefits.
Collapse
Affiliation(s)
- Katelijn M. Blok
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nura Tebayna
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Neuroimmunology Researchgroup, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janet de Beukelaar
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| |
Collapse
|
10
|
Msheik A, Assi F, Hamed F, Jibbawi A, Nakhl AM, Khoury A, Mohanna R, Gerges T, Atat R. Stem Cell Transplantation for Multiple Sclerosis: A 2023 Review of Published Studies. Cureus 2023; 15:e47972. [PMID: 38034162 PMCID: PMC10686127 DOI: 10.7759/cureus.47972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
This comprehensive literature review underscores the potential of stem cell transplantation (SCT) as a therapeutic intervention for multiple sclerosis (MS). By amalgamating evidence from various sources, including randomized controlled trials (RCTs), observational, retrospective, and comparative studies, this review offers a holistic understanding of SCT's effectiveness, safety, and feasibility in diverse contexts of MS management. SCT has shown promise in mitigating disease activity and progression, particularly in relapsing-remitting MS (RRMS). RCTs like the high dose immunoablation and autologous hematopoietic stem cell transplantation in MS (ASTIMS) versus mitoxantrone therapy in severe multiple sclerosis and multiple sclerosis international stem cell transplant (MIST) trials reveal SCT's capacity to reduce new lesion occurrences and inflammatory activity. However, variability exists in disability score improvements among these studies. Observational and retrospective investigations further affirm SCT's potential, highlighting decreased relapse rates, enhanced expanded disability status scale (EDSS) scores, and a noteworthy proportion of patients achieving no evidence of disease activity (NEDA). The initial literature search using all of the search items produced a total of 3,636 articles. After title, abstract, and article type screening and article retrieving, 147 articles were assessed for eligibility using the inclusion criteria. At the end of the literature search, 37 articles met the eligibility criteria. They were included in our review according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Patients treated with hematopoietic stem cell transplantation (HSCT) present lower progression and relapse rates, suppression of inflammatory activity, and a greater reduction in T2 lesions on MRI than those treated with disease-modifying therapies (DMTs). In summary, while SCT presents promise as a therapeutic option for MS, its deployment should be tailored to individual patient characteristics, disease stages, and responses.
Collapse
Affiliation(s)
- Ali Msheik
- Neurological Surgery, Faculty of Medicine Lebanese University, Hadath, LBN
| | - Farah Assi
- Infectious Diseases, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Faten Hamed
- Pharmacology, Lebanese International University, Beirut, LBN
| | - Ali Jibbawi
- Pediatric Medicine, Saint Georges Hospital, Beirut, LBN
| | - Anna-Marina Nakhl
- Medicine and Surgery, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Anthony Khoury
- Medicine and Surgery, Faculty of Medicine Lebanese University, Beirut, LBN
| | - Rami Mohanna
- Medicine and Surgery, Faculty of Medicine Saint-Joseph University, Beirut, LBN
| | - Teddy Gerges
- Anesthesia, Winchester Anesthesia Associates, Boston, USA
| | - Rami Atat
- Neurology, Faculty of Medical Sciences Lebanese University, Beirut, LBN
- Neurology, Al Zahraa University Medical Center, Beirut, LBN
| |
Collapse
|
11
|
Franks C, Eylon A, Carrion A, Bassa R. An Atypical Presentation of Progressive Multiple Sclerosis in a Young Black Male. Cureus 2023; 15:e45496. [PMID: 37727844 PMCID: PMC10506862 DOI: 10.7759/cureus.45496] [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] [Accepted: 09/18/2023] [Indexed: 09/21/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease primarily affecting the central nervous system, commonly diagnosed in women and individuals of European ancestry. It most commonly presents in the form of relapsing-remitting MS, which is characterized by exacerbations with partial to complete recovery. Far less common is the primary progressive form of MS, which involves the progression of neurological symptoms that gradually worsen with time. We present an atypical case of progressive MS in a 26-year-old incarcerated Black male. Initially diagnosed in 2019, he experienced bilateral upper extremity weakness and phasic spasticity, with subsequent worsening of symptoms including lower extremity spasticity, vision impairment, and difficulties with mobility and writing. With progressing symptoms, unintentional weight loss, and declining motor function, he was admitted to the hospital in March 2023. This case emphasizes the importance of considering MS as a differential diagnosis in any patient with progressive neurological dysfunction because, unlike the more prevalent relapsing-remitting type of MS, primary progressive MS has a more insidious onset with no recovery between exacerbations. It addresses the patient's symptom history, medication compliance challenges, and the need for improved education and awareness of MS in diverse patient populations.
Collapse
Affiliation(s)
- Charles Franks
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Adi Eylon
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Arturo Carrion
- Internal Medicine, Reception and Medical Center, Lake Butler, USA
| | - Ramon Bassa
- Internal Medicine, Reception and Medical Center, Lake Butler, USA
| |
Collapse
|
12
|
Koch MW, Repovic P, Mostert J, Bowen JD, Comtois J, Strijbis E, Uitdehaag B, Cutter G. Threshold definitions for significant change on the timed 25-foot walk and nine-hole peg test in primary progressive multiple sclerosis. Eur J Neurol 2023; 30:2761-2768. [PMID: 37306560 DOI: 10.1111/ene.15920] [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: 02/14/2023] [Revised: 04/11/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE The timed 25-foot walk (T25FW) and nine-hole peg test (NHPT) exhibit random variability in the short term. A threshold of ≥20% change from baseline has been used to indicate true disability change, but other threshold definitions may be better suited to exclude false and include true change events. The aim of this study was to use patient-level original trial data to investigate the short-term variation in T25FW and NHPT, and to compare its extent with disability change at 12-month follow-up in people with primary progressive multiple sclerosis (PPMS). METHODS We used original patient-level data from PROMISE, a large PPMS trial. In this trial, three separate T25FW and NHPT measurements were performed 1 week apart during screening. We used these repeated measures to describe the extent of short-term variation. We used binary logistic regression models to investigate the association between screening characteristics and unacceptable short-term variation. RESULTS The traditional 20% threshold excluded a reasonable number of false change events, while also yielding a large number of change events at follow-up. Increasing index values on the T25FW and NHPT were associated with higher short-term variation. CONCLUSIONS The traditional ≥20% change threshold for the T25FW and NHPT represents a reasonable compromise between reducing the number of false change events and achieving the largest number of change events in people with PPMS. Our analyses inform the design of clinical trials in PPMS.
Collapse
Affiliation(s)
- Marcus W Koch
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - James D Bowen
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Jacynthe Comtois
- Department of Medicine, Neurology service, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
- Département de neurosciences, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Eva Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bernard Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
13
|
Kiselev IS, Kulakova OG, Baturina OA, Kabilov MR, Boyko AN, Favorova OO. [DNA Methylation Profile of CD14+ Monocytes Changes in Primary Progressive Multiple Sclerosis]. Mol Biol (Mosk) 2023; 57:819-826. [PMID: 37752647 DOI: 10.31857/s002689842305004x, edn: gvhyat] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 09/28/2023]
Abstract
Multiple sclerosis (MS) is a chronic autoimmune inflammatory and neurodegenerative disease of the central nervous system, which is characterized by significant clinical heterogeneity. Primary progressive MS (PPMS) develops in 10-15% of patients. Unlike the most common relapsing-remitting form of MS, PPMS involves steady progress of neurodegeneration and, as a consequence, a persistent gradual increase in neurological symptoms. The peculiarities of epigenetic regulation of gene expression may be one of the reasons for the differences in the pathogenesis of the two MS forms. DNA methylation is one of the key epigenetic mechanisms, which remains almost unexplored in different cell populations of PPMS patients. The goal of this work was to identify differential methylation profiles of the CpG sites in the CD14+ monocyte DNA, which characterize PPMS. A genome-wide analysis of DNA methylation in PPMS patients and healthy individuals has identified 169 differentially methylated positions (DMPs), 90.5% of which were hypermethylated in PPMS patients. More than half of all DMPs are located in/near known genes and within CpG islands and their neighboring regions, which indicates their high functional significance. We have found six differentially methylated regions (DMRs) in the OR2L13, CAT, LCLAT1, HOXA5, RNF39, and CRTAC1 genes involved in inflammation and neurodegeneration, which indicates active epigenetic regulation of their expression.
Collapse
Affiliation(s)
- I S Kiselev
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - O A Baturina
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090 Russia
| | - M R Kabilov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090 Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- Federal Center for Brain and Neurotechnology, Federal Medical-Biological Agency, Moscow, 117997 Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| |
Collapse
|
14
|
Bishev D, Malone M, Best D, Bazikian Y. A case report of carbamazepine-induced oropharyngeal dysphagia in a patient with primary progressive multiple sclerosis. Clin Case Rep 2023; 11:e7185. [PMID: 37151936 PMCID: PMC10155505 DOI: 10.1002/ccr3.7185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/23/2023] [Indexed: 05/09/2023] Open
Abstract
Seventy-year-old male with primary progressive multiple sclerosis that had a severe episode of oropharyngeal dysphagia following initiation of carbamazepine. He was being treated for trigeminal neuralgia. Four days after discontinuation of carbamazepine resulted in a complete resolution of the patient's dysphagia, and he returned to baseline.
Collapse
Affiliation(s)
- Daniel Bishev
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Mercedes Malone
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Devon Best
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalInternal Medicine Residency ProgramGainesvilleFloridaUSA
| | - Yvette Bazikian
- Graduate Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
- HCA Florida North Florida HospitalGainesvilleFloridaUSA
| |
Collapse
|
15
|
Onoue H, Kato Y, Ishido H, Ogawa T, Akaiwa Y, Miyamoto T. [A case of primary progressive multiple sclerosis with improvement in cognitive impairment by anti-CD20 monoclonal antibody therapy]. Rinsho Shinkeigaku 2023; 63:152-158. [PMID: 36843088 DOI: 10.5692/clinicalneurol.cn-001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The patient was a 44-year-old man who developed cognitive impairment beginning at the age of 35 years that gradually worsened. The cognitive impairment led to a difficult social life, and he retired from his company. After hospitalization and workup, he was diagnosed with primary progressive multiple sclerosis (PPMS) that presented only with cognitive impairment for 10 years. Since he had multiple predictive factors for poor prognosis, anti-CD20 monoclonal antibody therapy was implemented. Cognitive impairment and cerebral blood flow SPECT findings improved, and he returned to a social life 3 months later. Anti-CD20 monoclonal antibody therapy was effective in improving cognitive impairment in a case of an advanced stage of PPMS.
Collapse
Affiliation(s)
- Hiroyuki Onoue
- Department of Neurology, Dokkyo Medical University Saitama Medical Center
| | - Yuta Kato
- Department of Neurology, Dokkyo Medical University Saitama Medical Center.,Department of Neurology, Showa University
| | - Hideaki Ishido
- Department of Neurology, Dokkyo Medical University Saitama Medical Center
| | - Tomohiro Ogawa
- Department of Neurology, Dokkyo Medical University Saitama Medical Center
| | - Yasuhisa Akaiwa
- Department of Neurology, Dokkyo Medical University Saitama Medical Center
| | - Tomoyuki Miyamoto
- Department of Neurology, Dokkyo Medical University Saitama Medical Center
| |
Collapse
|
16
|
Wong JK, Lin J, Kung NJ, Tse AL, Shimshak SJE, Roselle AK, Cali FM, Huang J, Beaty JM, Shue TM, Sadiq SA. Cerebrospinal fluid immunoglobulins in primary progressive multiple sclerosis are pathogenic. Brain 2023; 146:1979-1992. [PMID: 36732292 PMCID: PMC10151187 DOI: 10.1093/brain/awad031] [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: 08/10/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
Multiple sclerosis is clinically characterized by relapses and remissions (relapsing-remitting multiple sclerosis) that over time may evolve to a progressive course (secondary progressive multiple sclerosis) or as having a progressive course from disease onset (primary progressive multiple sclerosis). At present, it is not definitively known whether these clinical entities constitute a single pathological disease or whether these manifestations represent two distinct disease entities sharing inflammatory demyelination as a pathological feature. Here we show using a novel mouse model that CSF of primary progressive multiple sclerosis patients is unique in its capacity to induce motor disability and spinal cord pathology including demyelination, impaired remyelination, reactive astrogliosis, and axonal damage. Notably, removal of immunoglobulin G from primary progressive multiple sclerosis CSF via filtration or immunodepletion attenuates its pathogenic capacity. Furthermore, injection of recombinant antibodies derived from primary progressive multiple sclerosis CSF recapitulates the pathology. Our findings suggest that the clinical and pathological features of primary progressive multiple sclerosis are antibody-mediated and pathogenically distinct from relapsing-remitting and secondary progressive multiple sclerosis. Our study has potentially important implications for the development of specific therapies for patients with primary progressive multiple sclerosis.
Collapse
Affiliation(s)
- Jamie K Wong
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Jerry Lin
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Nathan J Kung
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Alexandra L Tse
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Serena J E Shimshak
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Anna K Roselle
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Francesca M Cali
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Jessie Huang
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Joseph M Beaty
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Taylor M Shue
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| | - Saud A Sadiq
- Tisch Multiple Sclerosis Research Center of New York, New York, NY 10019, USA
| |
Collapse
|
17
|
Canto-Gomes J, Da Silva-Ferreira S, Silva CS, Boleixa D, Martins da Silva A, González-Suárez I, Cerqueira JJ, Correia-Neves M, Nobrega C. People with Primary Progressive Multiple Sclerosis Have a Lower Number of Central Memory T Cells and HLA-DR(+) Tregs. Cells 2023; 12. [PMID: 36766781 DOI: 10.3390/cells12030439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The importance of circulating immune cells to primary progressive multiple sclerosis (PPMS) pathophysiology is still controversial because most immunotherapies were shown to be ineffective in treating people with PPMS (pwPPMS). Yet, although controversial, data exist describing peripheral immune system alterations in pwPPMS. This study aims to investigate which alterations might be present in pwPPMS free of disease-modifying drugs (DMD) in comparison to age- and sex-matched healthy controls. A multicentric cross-sectional study was performed using 23 pwPPMS and 23 healthy controls. The phenotype of conventional CD4+ and CD8+ T cells, regulatory T cells (Tregs), B cells, natural killer (NK) T cells and NK cells was assessed. Lower numbers of central memory CD4+ and CD8+ T cells and activated HLA-DR+ Tregs were observed in pwPPMS. Regarding NK and NKT cells, pwPPMS presented higher percentages of CD56dimCD57+ NK cells expressing NKp46 and of NKT cells expressing KIR2DL2/3 and NKp30. Higher disease severity scores and an increasing time since diagnosis was correlated with lower numbers of inhibitory NK cells subsets. Our findings contribute to reinforcing the hypotheses that alterations in peripheral immune cells are present in pwPPMS and that changes in NK cell populations are the strongest correlate of disease severity.
Collapse
|
18
|
Agliardi C, Guerini FR, Zanzottera M, Bolognesi E, Picciolini S, Caputo D, Rovaris M, Pasanisi MB, Clerici M. Myelin Basic Protein in Oligodendrocyte-Derived Extracellular Vesicles as a Diagnostic and Prognostic Biomarker in Multiple Sclerosis: A Pilot Study. Int J Mol Sci 2023; 24. [PMID: 36614334 DOI: 10.3390/ijms24010894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Approximately 15% of multiple sclerosis (MS) patients develop a progressive form of disease from onset; this condition (primary progressive-PP) MS is difficult to diagnose and treat, and is associated with a poor prognosis. Extracellular vesicles (EVs) of brain origin isolated from blood and their protein cargoes could function as a biomarker of pathological conditions. We verified whether MBP and MOG content in oligodendrocytes-derived EVs (ODEVs) could be biomarkers of MS and could help in the differential diagnosis of clinical MS phenotypes. A total of 136 individuals (7 clinically isolated syndrome (CIS), 18 PPMS, 49 relapsing remitting (RRMS)) and 70 matched healthy controls (HC) were enrolled. ODEVs were enriched from serum by immune-capture with anti-MOG antibody; MBP and MOG protein cargoes were measured by ELISA. MBP concentration in ODEVs was significantly increased in CIS (p < 0.001), RRMS (p < 0.001) and PPMS (p < 0.001) compared to HC and was correlated with disease severity measured by EDSS and MSSS. Notably, MBP concentration in ODEVs was also significantly augmented in PPMS compared to RRMS (p = 0.004) and CIS (p = 0.03). Logistic regression and ROC analyses confirmed these results. A minimally invasive blood test measuring the concentration of MBP in ODEVs is a promising tool that could facilitate MS diagnosis.
Collapse
|
19
|
Jerković A, Pavelin S, Šoda J, Vujović I, Rogić Vidaković M. Symptom-Level Disability Status Assessed with an Electronic Unsupervised Patient-Reported Expanded Disability Status Scale (ePR-EDSS) in Multiple Sclerosis Patients-The Example of Croatia. J Clin Med 2022; 11:jcm11144081. [PMID: 35887852 PMCID: PMC9319578 DOI: 10.3390/jcm11144081] [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: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 12/04/2022] Open
Abstract
The present study aimed to apply an electronic, unsupervised patient-reported Expanded Disability Status Scale (ePR-EDSS) to investigate disability severity in people with multiple sclerosis (pwMS) as a case study in Croatia in 2021, including demographic and comorbidity characteristics and multiple sclerosis (MS) disease-related factors. The cross-sectional study was conducted as an online survey from 4 October 2021 to 31 December 2021. Symptom-level disability status was assessed with ePR-EDSS for MS capturing MS-related disability across the spectrum of severity.The study enrolled 147 pwMS patients, of which 84% were women. The mean age ± standard deviation in the sample was 41.1 ± 11.3, and the mean disease duration was 8.5 ± 7.4 years, with a median EDSS score of 3.0 (range, 0−8). The distribution of the participants according to clinical forms of MS was as follows: 71% had relapsing-remitting MS, 13% had primary progressive MS, 4% had secondary progressive PMS, and 12% did not provide information on their MS type. Twenty-nine point two percent (29.2%) of the participants had comorbidities in addition to MS. EDSS scores indicate significant differences with regard to age (t = −3.51, p < 0.001), gender (χ2 = 8.04, p < 0.01), and immunomodulatory drug use (χ2 = 5.89, p < 0.05). An ePR-EDSS analysis of disability symptoms showed a significant difference in symptoms with regard to strength, sensation, coordination, vision, fatigue, mobility, and overall wellness among MS types. Participants with PPMS and SPMS were older on average, had higher EDSS, and had more pronounced symptoms of disability measured with ePR-EDSS compared to those with RRMS. Application of ePR-EDSS shows it to be a reliable eHealth tool for clinical assessment of pwMS disability status, and future studies should correlate it with standard self-report scales capturing MS symptoms such as fatigue, depression, anxiety, and stress.
Collapse
Affiliation(s)
- Ana Jerković
- Laboratory for Human and Experimental Neurophysiology (LAHEN), Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Sanda Pavelin
- Department of Neurology, University Hospital of Split, 21000 Split, Croatia;
| | - Joško Šoda
- Department of Marine Electrical Engineering and Information Technologies, Faculty of Maritime Studies, University of Split, 21000 Split, Croatia; (J.Š.); (I.V.)
| | - Igor Vujović
- Department of Marine Electrical Engineering and Information Technologies, Faculty of Maritime Studies, University of Split, 21000 Split, Croatia; (J.Š.); (I.V.)
| | - Maja Rogić Vidaković
- Laboratory for Human and Experimental Neurophysiology (LAHEN), Department of Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia;
- Correspondence: ; Tel.: +385-(0)-21-557-876 or +385-(0)-98-508-210; Fax: +358-(0)-21-557-955
| |
Collapse
|
20
|
Boziki M, Bakirtzis C, Sintila SA, Kesidou E, Gounari E, Ioakimidou A, Tsavdaridou V, Skoura L, Fylaktou A, Nikolaidou V, Stangou M, Nikolaidis I, Giantzi V, Karafoulidou E, Theotokis P, Grigoriadis N. Ocrelizumab in Patients with Active Primary Progressive Multiple Sclerosis: Clinical Outcomes and Immune Markers of Treatment Response. Cells 2022; 11:cells11121959. [PMID: 35741088 PMCID: PMC9222195 DOI: 10.3390/cells11121959] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Ocrelizumab is a B-cell-depleting monoclonal antibody approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) and active primary progressive MS (aPPMS). This prospective, uncontrolled, open-label, observational study aimed to assess the efficacy of ocrelizumab in patients with aPPMS and to dissect the clinical, radiological and laboratory attributes of treatment response. In total, 22 patients with aPPMS followed for 24 months were included. The primary efficacy outcome was the proportion of patients with optimal response at 24 months, defined as patients free of relapses, free of confirmed disability accumulation (CDA) and free of T1 Gd-enhancing lesions and new/enlarging T2 lesions on the brain and cervical MRI. In total, 14 (63.6%) patients and 13 patients (59.1%) were classified as responders at 12 and 24 months, respectively. Time exhibited a significant effect on mean absolute and normalized gray matter cerebellar volume (F = 4.342, p = 0.23 and F = 4.279, p = 0.024, respectively). Responders at 24 months exhibited reduced peripheral blood ((%) of CD19+ cells) plasmablasts compared to non-responders at the 6-month point estimate (7.69 ± 4.4 vs. 22.66 ± 7.19, respectively, p = 0.043). Response to ocrelizumab was linked to lower total and gray matter cerebellar volume loss over time. Reduced plasmablast depletion was linked for the first time to sub-optimal response to ocrelizumab in aPPMS.
Collapse
Affiliation(s)
- Marina Boziki
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Christos Bakirtzis
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Styliani-Aggeliki Sintila
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Evangelia Kesidou
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Evdoxia Gounari
- Microbiology Laboratory, Department of Immunology, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.G.); (A.I.); (V.T.); (L.S.)
| | - Aliki Ioakimidou
- Microbiology Laboratory, Department of Immunology, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.G.); (A.I.); (V.T.); (L.S.)
| | - Vasiliki Tsavdaridou
- Microbiology Laboratory, Department of Immunology, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.G.); (A.I.); (V.T.); (L.S.)
| | - Lemonia Skoura
- Microbiology Laboratory, Department of Immunology, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.G.); (A.I.); (V.T.); (L.S.)
| | - Asimina Fylaktou
- National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (V.N.)
| | - Vasiliki Nikolaidou
- National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, 54642 Thessaloniki, Greece; (A.F.); (V.N.)
| | - Maria Stangou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Ioannis Nikolaidis
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Virginia Giantzi
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Eleni Karafoulidou
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Paschalis Theotokis
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
| | - Nikolaos Grigoriadis
- Multiple Sclerosis Center of the 2nd Neurological University Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General University Hospital, 54636 Thessaloniki, Greece; (M.B.); (C.B.); (S.-A.S.); (E.K.); (I.N.); (V.G.); (E.K.); (P.T.)
- Special Unit for Biomedical Research and Education, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- Correspondence:
| |
Collapse
|
21
|
Kiselev IS, Kulakova OG, Danilova LV, Baturina OA, Kabilov MR, Popova EV, Boyko AN, Favorova OO. [Genome-Wide Analysis of DNA Methylation in Cd4+ T Lymphocytes of Patients with Primary Progressive Multiple Sclerosis Indicates Involvement of This Epigenetic Process in the Disease Immunopathogenesis]. Mol Biol (Mosk) 2022; 56:468-475. [PMID: 35621102 DOI: 10.31857/s0026898422030089] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 06/15/2023]
Abstract
The pathogenesis of multiple sclerosis (MS), a chronic disease of the CNS, includes autoimmune and neurodegenerative components. In most cases, patients develop relapsing-remitting MS (RRMS), while 10-15% of patients develop primary progressive MS (PPMS), which differs from RRMS in the mechanisms of the pathological process, some demographic, and some clinical characteristics. These differences may be explained by the epigenetic regulation of gene expression in PPMS including DNA methylation as one of the key epigenetic processes. The features of DNA methylation in various cell populations in PPMS patients remain understudied. The goal of this study is to identify differentially methylated CpG sites (DMSs) of the genome of CD4+ T lymphocytes, which characterize PPMS. The study included eight treatment-naive PPMS patients and eight healthy controls. Genome-wide analysis of DNA methylation of CD4+ T lymphocytes was performed using high-density DNA microarrays. We have identified 108 DMSs, which distinguish PPMS patients from healthy controls. In PPMS patients 81% of the DMSs are hypermethylated. More than a half of the identified DMSs are located in known genes in CpG islands and adjacent regions, which indicates a high functional significance of these DMSs in PPMS development. Analysis of the overrepresentation of DMS-containing genes in the main biological processes demonstrates their involvement in the regulation of cell adhesion to the extracellular matrix and the development of the immune response, i.e., antigen processing and presentation, and development of the immune system. Genome-wide analysis of DNA methylation in CD4+ T lymphocytes of PPMS patients indicates the involvement of this epigenetic process in the immunopathogenesis of the disease. These results may help better understand the pathogenesis of this severe form of MS.
Collapse
Affiliation(s)
- I S Kiselev
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- National Medical Research Center for Cardiology, Moscow, 121552 Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- National Medical Research Center for Cardiology, Moscow, 121552 Russia
| | - L V Danilova
- Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, 119991 Russia
- Johns Hopkins School of Medicine, Baltimore, MD 21205 USA
| | - O A Baturina
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090 Russia
| | - M R Kabilov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090 Russia
| | - E V Popova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- Federal Center for Brain and Neurotechnology, Federal Medical and Biological Agency of the Russian Federation, Moscow, 117997 Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- National Medical Research Center for Cardiology, Moscow, 121552 Russia
| |
Collapse
|
22
|
Štourač P, Bednářová J, Pavelek Z, Vališ M. Primary progressive multiple sclerosis overlapping with anti-GAD and anti-Hu antibodies positive neurological syndromes. Neurol Neurochir Pol 2021; 56:187-190. [PMID: 34704603 DOI: 10.5603/pjnns.a2021.0078] [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: 05/20/2021] [Revised: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Pavel Štourač
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Jana Bednářová
- Department of Clinical Microbiology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zbyšek Pavelek
- Department of Neurology, University Hospital Hradec Králové and Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Martin Vališ
- Department of Neurology, University Hospital Hradec Králové and Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| |
Collapse
|
23
|
Filip P, Dufek M, Mangia S, Michaeli S, Bareš M, Schwarz D, Rektor I, Vojtíšek L. Alterations in Sensorimotor and Mesiotemporal Cortices and Diffuse White Matter Changes in Primary Progressive Multiple Sclerosis Detected by Adiabatic Relaxometry. Front Neurosci 2021; 15:711067. [PMID: 34594184 PMCID: PMC8476998 DOI: 10.3389/fnins.2021.711067] [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: 05/17/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The research of primary progressive multiple sclerosis (PPMS) has not been able to capitalize on recent progresses in advanced magnetic resonance imaging (MRI) protocols. Objective: The presented cross-sectional study evaluated the utility of four different MRI relaxation metrics and diffusion-weighted imaging in PPMS. Methods: Conventional free precession T1 and T2, and rotating frame adiabatic T1ρ and T2ρ in combination with diffusion-weighted parameters were acquired in 13 PPMS patients and 13 age- and sex-matched controls. Results: T1ρ, a marker of crucial relevance for PPMS due to its sensitivity to neuronal loss, revealed large-scale changes in mesiotemporal structures, the sensorimotor cortex, and the cingulate, in combination with diffuse alterations in the white matter and cerebellum. T2ρ, particularly sensitive to local tissue background gradients and thus an indicator of iron accumulation, concurred with similar topography of damage, but of lower extent. Moreover, these adiabatic protocols outperformed both conventional T1 and T2 maps and diffusion tensor/kurtosis approaches, methods previously used in the MRI research of PPMS. Conclusion: This study introduces adiabatic T1ρ and T2ρ as elegant markers confirming large-scale cortical gray matter, cerebellar, and white matter alterations in PPMS invisible to other in vivo biomarkers.
Collapse
Affiliation(s)
- Pavel Filip
- Department of Neurology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czechia.,Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Michal Dufek
- First Department of Neurology, Faculty of Medicine, University Hospital of St. Anne, Masaryk University, Brno, Czechia
| | - Silvia Mangia
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Shalom Michaeli
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Martin Bareš
- First Department of Neurology, Faculty of Medicine, University Hospital of St. Anne, Masaryk University, Brno, Czechia.,Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Daniel Schwarz
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czechia.,Institute of Biostatistics and Analyses, Ltd., Masaryk University Spin-Off, Brno, Czechia
| | - Ivan Rektor
- Central European Institute of Technology, Masaryk University, Neuroscience Centre, Brno, Czechia
| | - Lubomír Vojtíšek
- Central European Institute of Technology, Masaryk University, Neuroscience Centre, Brno, Czechia
| |
Collapse
|
24
|
Mancinelli CR, Rossi ND, Capra R. Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology. Ther Clin Risk Manag 2021; 17:765-776. [PMID: 34354358 PMCID: PMC8331077 DOI: 10.2147/tcrm.s282390] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/18/2021] [Indexed: 11/23/2022] Open
Abstract
The success of selective B-cells depleting therapies, as the anti-CD20 antibodies, in patients with multiple sclerosis (MS) has confirmed that B-cells are critical in the immune pathogenesis of the disease. Ocrelizumab, a humanized monoclonal antibody that selectively targets CD20+ B-cells, profoundly suppresses acute inflammatory disease activity, representing a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS). It is also the first proven therapy able to slow disability progression in primary progressive multiple sclerosis (PPMS), particularly in patients with signs of acute radiological activity before being enrolled. Effectiveness has widely been demonstrated in randomized clinical trials (RCTs), and recently confirmed in open-label extension trials. Here, we review the role of B-cells in MS, the mechanism of action of ocrelizumab, its pharmacokinetics and pharmacodynamics, and the clinical data supporting its use, as well as safety data. We focus on issues related to the maintenance of immunocompetence, essential to ensure an immune response to either a primary infection or a vaccination. Lastly, we discuss about the possible role of ocrelizumab as an exit strategy from natalizumab-treated patients at risk of developing multifocal progressive leukoencephalopathy. In view of using ocrelizumab chronically, collecting long-term safety data and finding strategies to minimize adverse events will be extremely relevant.
Collapse
Affiliation(s)
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Brescia, Italy
| |
Collapse
|
25
|
Burman J. Delaying the inevitable: Are disease modifying drugs for progressive MS worthwhile? Mult Scler Relat Disord 2021; 54:103134. [PMID: 34247107 DOI: 10.1016/j.msard.2021.103134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
Ocrelizumab and siponimod have a scientifically proven effect in progressive MS and decrease the risk of disability in the short-term. The primary endpoints in the pivotal trials of ocrelizumab and siponimod were reported as a hazard ratio of 3-month confirmed disability progression, which was reported to be 0.76-0.79. Based on this, both drugs were subsequently licensed for use in patients with progressive multiple sclerosis. Hazard ratios are not easily communicated to patients and therefore the alternative endpoint average postponement of disability was calculated with data from the pivotal trials. After two years of treatment, the average postponement of disability was 16 days per year with ocrelizumab and 19 days with siponimod. Over time, the average postponement of disability reached a plateau, when further treatment added little value. Taken together, these data suggest that these interventions have a short-lived and limited clinical effect in patients with progressive MS.
Collapse
Affiliation(s)
- Joachim Burman
- Department of Neurology, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
26
|
Abstract
The success of ocrelizumab in reducing confirmed disability accumulation in primary progressive multiple sclerosis (PPMS) via CD20-targeted depletion implicates B cells as causal agents in the pathogenesis of PPMS. This review explores the possible mechanisms by which B cells contribute to disease progression in PPMS, specifically exploring cytokine production, antigen presentation, and antibody synthesis. B cells may contribute to disease progression in PPMS through cytokine production, specifically GM-CSF and IL-6, which can drive naïve T-cell differentiation into pro-inflammatory Th1/Th17 cells. B cell production of the cytokine LT-α may induce follicular dendritic cell production of CXCL13 and lead indirectly to T and B cell infiltration into the CNS. In contrast, production of IL-10 by B cells likely induces an anti-inflammatory effect that may play a role in reducing neuroinflammation in PPMS. Therefore, reduced production of IL-10 may contribute to disease worsening. B cells are also capable of potent antigen presentation and may induce pro-inflammatory T-cell differentiation via cognate interactions. B cells may also contribute to disease activity via antibody synthesis, although it's unlikely the benefit of ocrelizumab in PPMS occurs via antibody decrement. Finally, various B cell subsets likely promulgate pro- or anti-inflammatory effects in MS.
Collapse
Affiliation(s)
- Jameson P Holloman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States
| | - Robert C Axtell
- Department of Arthritis and Clinical Immunology Research, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States.,Department of Microbiology and Immunology, Oklahoma University Health Science Center, Oklahoma City, OK, United States
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, United States.,Department of Immunology, University of Texas Southwestern, Dallas, TX, United States
| | - Gregory F Wu
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States.,Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, United States
| |
Collapse
|
27
|
Moreira Ferreira VF, Liu Y, Healy BC, Stankiewicz JM. Effectiveness and safety of dimethyl fumarate in progressive multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211010832. [PMID: 33996142 PMCID: PMC8108088 DOI: 10.1177/20552173211010832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background There is limited data analyzing the safety and effectiveness of dimethyl fumarate (DMF) in the progressive multiple sclerosis (PMS) population. Objective To analyze the safety and effectiveness of DMF in patients with PMS. Methods We used Cox proportional hazards models to compare the time to confirmed worsening and improvement on the Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25FW) between patients treated with DMF and glatiramer acetate (GA) for at least one year. Results We included 46 patients treated with DMF and 42 patients treated with GA. The safety and tolerability of GA and DMF were consistent with established profiles. There was no difference in confirmed EDSS progression. A trend towards reduced T25FW was seen in the DMF compared to GA after adjustment (HR = 0.86; 95% CI:0.37, 1.98; p = 0.72 and HR = 0.60; 95% CI:0.27, 1.34; p = 0.21, respectively). Conclusion Dimethyl fumarate showed a trend towards reduction in T25FW but no evidence of clinically significant impact on EDSS. The small sample precluded definitive determination.
Collapse
Affiliation(s)
- Vanessa F Moreira Ferreira
- Department of Neurology, Brigham and Women's Hospital, Brigham MS Center, Harvard Medical School, Boston, MA, USA
| | - Yanqing Liu
- Department of Neurology, Brigham and Women's Hospital, Brigham MS Center, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Brigham MS Center, Harvard Medical School, Boston, MA, USA
| | - James M Stankiewicz
- Department of Neurology, Brigham and Women's Hospital, Brigham MS Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
28
|
Abstract
Background Ocrelizumab is an anti-CD20 monoclonal antibody that has been shown to reduce disability progression in primary progressive multiple sclerosis (MS). The adverse event profile is still being determined through postmarketing surveillance and case reports. Objective To report a case of severe late-onset neutropenia associated with ocrelizumab in a patient with primary progressive MS. Methods Case report. Result A 34-year-old male with primary progressive MS developed severe late-onset neutropenia 42 days after infusion of ocrelizumab, which necessitated hospital admission and administration of broad-spectrum antibiotics and granulocyte colony-stimulating factor. Conclusion Late-onset neutropenia is a rare complication of ocrelizumab. Patients should be counseled to present for urgent evaluation if they develop fever.
Collapse
Affiliation(s)
| | - James Yun
- Nepean Hospital, Nepean Hospital, Penrith, New South Wales, Australia
| | - William Stevenson
- Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| | - Karl Ng
- Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
| |
Collapse
|
29
|
Pérez-Miralles FC, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Maurino J, Carreres-Polo J, Casanova B. Brain region volumes and their relationship with disability progression and cognitive function in primary progressive multiple sclerosis. Brain Behav 2021; 11:e02044. [PMID: 33486890 PMCID: PMC8035443 DOI: 10.1002/brb3.2044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Evidence on regional changes resulting from neurodegenerative processes underlying primary progressive multiple sclerosis (PPMS) is still limited. We assessed brain region volumes and their relationship with disability progression and cognitive function in PPMS patients. METHODS This was an MRI analysis of 43 patients from the prospective Understanding Primary Progressive Multiple Sclerosis (UPPMS) cohort study. MRI scans were performed within 3 months before enrollment and at month 12. RESULTS Gray matter volume of declive and white matter volumes adjacent to left straight gyrus, right calcarine sulcus, and right inferior occipital gyrus significantly decreased from baseline to month 12. Baseline white matter volumes adjacent to right amygdala and left cuneus significantly differed between patients with and without disability progression, as well as baseline gray matter volumes of left cuneus, right parahippocampal gyrus, right insula, left superior frontal gyrus, declive, right inferior temporal gyrus, right superior temporal gyrus (pole), and right calcarine sulcus. Baseline gray matter volumes of right cuneus and right superior temporal gyrus positively correlated with 12-month Selective Reminding Test and Word List Generation performance, respectively. Gray matter changes in right superior semilunar lobe and white matter adjacent to left declive and right cerebellar tonsil also positively correlated with Word List Generation scores, while white matter change in left inferior semilunar lobe positively correlated with Symbol Digit Modalities Test performance after 12 months. CONCLUSIONS White and gray matter volumes of specific brain regions could predict disability progression and cognitive performance of PPMS patients after one year.
Collapse
Affiliation(s)
| | | | - Antonio García-Merino
- Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - José Ramón Ara
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Guillermo Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari Josep Trueta and Hospital Santa Caterina, IDIBGI, Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona, Spain
| | | | - Óscar Fernández
- Department of Neurology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Sara Moreno-García
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Maurino
- Department of Medical, Roche Farma S.A, Madrid, Spain
| | - Joan Carreres-Polo
- Department of Radiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| |
Collapse
|
30
|
Butzkueven H, Spelman T, Horakova D, Hughes S, Solaro C, Izquierdo G, Kubala Havrdová E, Grand'Maison F, Prat A, Girard M, Hupperts R, Onofrj M, Lugaresi A, Taylor B, Giovannoni G, Kappos L, Hauser SL, Montalban X, Craveiro L, Freitas R, Model F, Overell J, Muros-Le Rouzic E, Sauter A, Wang Q, Wormser D, Wolinsky JS. Risk of requiring a wheelchair in primary progressive multiple sclerosis: Data from the ORATORIO trial and the MSBase registry. Eur J Neurol 2021; 29:1082-1090. [PMID: 33724638 PMCID: PMC9292576 DOI: 10.1111/ene.14824] [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: 12/03/2020] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 01/27/2023]
Abstract
Background and purpose Reaching Expanded Disability Status Scale (EDSS) ≥7.0 represents the requirement for a wheelchair. Here we (i) assess the effect of ocrelizumab on time to EDSS ≥7.0 over the ORATORIO (NCT01194570) double‐blind and extended controlled periods (DBP+ECP), (ii) quantify likely long‐term benefits by extrapolating results, and (iii) assess the plausibility of extrapolations using an independent real‐world cohort (MSBase registry; ACTRN12605000455662). Methods Post hoc analyses assessing time to 24‐week confirmed EDSS ≥7.0 in two cohorts of patients with primary progressive multiple sclerosis (baseline EDSS 3.0–6.5) were investigated in ORATORIO and MSBase. Results In the ORATORIO DBP+ECP, ocrelizumab reduced the risk of 24‐week confirmed EDSS ≥7.0 (hazard ratio = 0.54, 95% confidence interval [CI]: 0.31–0.92; p = 0.022). Extrapolated median time to 24‐week confirmed EDSS ≥7.0 was 12.1 and 19.2 years for placebo and ocrelizumab, respectively (7.1‐year delay [95% CI: −4.3 to 18.4]). In MSBase, the median time to 24‐week confirmed EDSS ≥7.0 was 12.4 years. Conclusions Compared with placebo, ocrelizumab significantly delayed time to 24‐week confirmed wheelchair requirement in ORATORIO. The plausibility of the extrapolated median time to reach this milestone in the placebo group was supported by observed real‐world data from MSBase. Extrapolated benefits for ocrelizumab over placebo could represent a truly meaningful delay in loss of ambulation and independence.
Collapse
Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Medicine and Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Stella Hughes
- Department of Neurology, Craigavon Area Hospital, Craigavon, UK.,Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Eva Kubala Havrdová
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University, Prague, Czech Republic
| | | | - Alexandre Prat
- CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | | | | | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Bruce Taylor
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience and MS Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| |
Collapse
|
31
|
Brown LJ, Li J, Brunner M, Snoke M, La HA. Societal costs of primary progressive multiple sclerosis in Australia and the economic impact of a hypothetical disease-modifying treatment that could delay disease progression. J Med Econ 2021; 24:140-149. [PMID: 33461357 DOI: 10.1080/13696998.2021.1872585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIMS Primary progressive multiple sclerosis (PPMS) has a progressive course of disability with continuous neurological worsening. We investigated societal costs of PPMS in Australia and the economic impact of increasing the independence of people with PPMS through delaying disease progression. METHODS This prevalence-based retrospective cost-of-illness analysis used observational data from publicly available secondary data sources and literature findings. Direct and indirect costs of PPMS were considered. A replica estimated population was created using the National Centre for Social and Economic Modelling (NATSEM) microsimulation model of the Australian tax and transfer system (STINMOD+). Using a budget impact analysis approach, we modelled the effect on PPMS costs of an effective hypothetical disease-modifying treatment (DMT) that delays disease progression by a year from mild to moderate and a further year from moderate to severe PPMS. RESULTS An estimated 31,650 Australians have multiple sclerosis (MS) including 4,430 with PPMS. The proportion with PPMS was estimated to increase with age and disease severity. Overall 25% of males with MS, and 10% of females, were estimated to have PPMS. Societal cost of PPMS in Australia in 2018 was estimated at AU$418.1 million. Indirect costs contributed 67.5% of total costs, attributable to reduced workforce participation and need for informal care. The modelled DMT was estimated to create savings of AU$14.9 million (3.6%). Fewer people had moderate and severe PPMS resulting in major cost savings, partially offset by increased costs of treatment, care and support for a relative increase in the number of people with mild PPMS and their increased productivity losses. LIMITATIONS Publicly available data may be incomplete. The potential cost of the DMT was not considered. CONCLUSIONS The economic burden of PPMS was estimated at AU$418 million in 2018. An effective DMT that delayed progression from disease severity states by one year could provide significant cost savings.
Collapse
Affiliation(s)
- Laurie J Brown
- National Centre for Social and Economic Modelling (NATSEM), Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | - Jinjing Li
- National Centre for Social and Economic Modelling (NATSEM), Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| | | | - Martin Snoke
- Roche Products Pty Limited, Sydney, NSW, Australia
| | - Hai A La
- National Centre for Social and Economic Modelling (NATSEM), Institute for Governance and Policy Analysis, University of Canberra, Canberra, ACT, Australia
| |
Collapse
|
32
|
Armoiry X, Späth HM, Henaine AM, Dussart C, Counsell C, Connock M. Ocrelizumab not recommended in France for patients with primary progressive multiple sclerosis while recommended in England: a review comparing the assessment by HAS and NICE. Expert Opin Biol Ther 2020; 21:741-747. [PMID: 33356643 DOI: 10.1080/14712598.2021.1865305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ocrelizumab is the first approved drug for primary progressive multiple sclerosis. Following appraisal by health technology assessment (HTA) bodies, this medicine has not been widely covered across European countries. We have compared the HTA process in England and France. AREA COVERED We undertook an analysis of relevant documents that were published by the two HTA bodies. We analyzed patients' availability of Ocrelizumab at the different stages of the process. EXPERT OPINION We identified differences in the assessment, one being the use of a different population of the pivotal trial, which has resulted in the consideration of distinct clinical effectiveness estimates. Ocrelizumab became available earlier in France as part of an early access program. However, rapid access was discontinued for newly eligible patients following an opinion concluding that Ocrelizumab yielded no additional benefit over placebo. This opinion was not compatible with the criteria allowing reimbursement in France.In England, there was no early access program and following an appraisal that included cost-effectiveness evaluation combined with pricing agreements, medicine was finally recommended. In conclusion, differences in the HTA process may result in appreciable differences in timing and outcome from marketing authorization to the adoption of newly licensed drugs.
Collapse
Affiliation(s)
- Xavier Armoiry
- Pharmacy Department, University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Lyon University Hospitals, "Edouard Herriot" Hospital, Lyon, France.,Division of health sciences, University of Warwick, Warwick Medical School, Coventry, UK
| | - Hans-Martin Späth
- Public health department, University of Lyon, University Lyon 1, Lyon, France
| | - Anna-Maria Henaine
- Clinical pharmacy department, School of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Claude Dussart
- Public health department, University of Lyon, University Lyon 1, Lyon, France
| | - Carl Counsell
- University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, UK
| | - Martin Connock
- Division of health sciences, University of Warwick, Warwick Medical School, Coventry, UK
| |
Collapse
|
33
|
Rothstein TL. Gray Matter Matters: A Longitudinal Magnetic Resonance Voxel-Based Morphometry Study of Primary Progressive Multiple Sclerosis. Front Neurol 2020; 11:581537. [PMID: 33281717 PMCID: PMC7689315 DOI: 10.3389/fneur.2020.581537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/14/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Multiple Sclerosis (MS) lesions in white matter (WM) are easily detected with conventional MRI which induce inflammation thereby generating contrast. WM lesions do not consistently explain the extent of clinical disability, cognitive impairment, or the source of an exacerbation. Gray matter (GM) structures including the cerebral cortex and various deep nuclei are known to be affected early in Primary Progressive Multiple Sclerosis (PPMS) and drive disease progression, disability, fatigue, and cognitive dysfunction. However, little is known about how rapidly GM lesions develop and accumulate over time. Objective: The purpose of this study is to analyze the degree and rate of progression in 25 patients with PPMS using voxel-based automated volumetric quantitation. Methods: This is a retrospective single-center study which includes a cohort of 25 patients with PPMS scanned utilizing NeuroQuant® 3 dimensional voxel-based morphometry (3D VBM) automated analysis and database and restudied after a period of ~1 year (11–14 months). Comparisons with normative data were acquired for whole brain, forebrain parenchyma, cortical GM, hippocampus, thalamus, superior and inferior lateral ventricles. GM volume changes were correlated with their clinical motor and cognitive scores using Extended Disability Status Scales (EDSS) and Montreal Cognitive Assessments (MoCA). Results: Steep reductions occurred in cerebral cortical GM and deep GM nuclei volumes which correlated with each patient's clinical and cognitive impairment. The median observed percentile volume losses were statistically significant compared with the 50th percentile for each GM component. Longitudinal assessments of an unselected sample of one dozen patients involved in the PPMS study showed prominent losses occurring mainly in cortical GM and hippocampus which were reflected in their EDSS and MoCA. The longitudinal results were compared with a similar sample of patients having Relapsing MS (RMS) whose GM values were largely in normal range, annualized volume GM changes were much less, while WM hyperintensities were in abnormal range in half the unselected cases. Conclusions: Knowledge of the degree and rapidity with which cortical atrophy and deep GM volume loss develops clarifies the source of progressive cognitive and clinical decline in PPMS.
Collapse
Affiliation(s)
- Ted L Rothstein
- Department of Neurology, Multiple Sclerosis Clinical Care and Research Center, George Washington University School of Medicine, Washington, DC, United States
| |
Collapse
|
34
|
Nayak S, Sechi E, Flanagan EP, Messina S, Kassa R, Kantarci O, Weinshenker BG, Keegan BM. Inflammatory activity following motor progression due to critical CNS demyelinating lesions. Mult Scler 2020; 27:1037-1045. [PMID: 32812487 DOI: 10.1177/1352458520948745] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND New inflammatory activity is of unclear frequency and clinical significance in progressive multiple sclerosis (MS); it is uncertain in patient cohorts with motor progression due to critical demyelinating lesions. OBJECTIVES The aim of this study is to determine the likelihood of central nervous system (CNS) inflammatory activity, assessed by new clinical relapses or active magnetic resonance imaging (MRI) lesions, following onset of motor progression due to critical demyelinating lesions. METHODS Patients with progressive upper motor neuron impairment for ⩾1 year attributable to critical demyelinating lesions with single CNS lesion (progressive solitary sclerosis (PSS)), 2 to 5 total CNS demyelinating lesions (progressive "pauci-sclerosis" (PPS)), or >5 CNS demyelinating lesions and progressive exclusively unilateral monoparesis or hemiparesis (PUHMS) were identified. Clinical data were reviewed for acute MS relapses, and subsequent MRI was reviewed for active T1-gadolinium-enhancing or T2-demyelinating lesions. RESULTS None of the 91 patients (22 PSS, 40 PPS, 29 PUHMS) identified experienced clinical relapses over a median clinical follow-up of 93 months (range: 12-518 months). Nine patients (10%) developed active lesions over median 84 months radiologic follow-up (range: 12-518 months). Active lesions occurred in 24% PUHMS, 5% PSS, and 3% PPS cohorts. CONCLUSION New inflammatory activity, defined by active lesions and clinical relapses following motor progression in patients with critical demyelinating lesions, is low. Disease-modifying therapies that reduce demyelinating relapses and active MRI lesions are of uncertain benefit in these cohorts.
Collapse
Affiliation(s)
- Shreya Nayak
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Steven Messina
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Roman Kassa
- Department of Neurology, Mayo Clinic, Rochester, MN, USA/Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Orhun Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - B Mark Keegan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
35
|
Kozin MS, Kulakova OG, Kiselev IS, Boyko AN, Favorova OO. [Variability of the Mitochondrial Genome and Development of the Primary Progressing form of Multiple Sclerosis]. Mol Biol (Mosk) 2020; 54:596-602. [PMID: 32799222 DOI: 10.31857/s0026898420040084] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
Recently, it has been shown that dysfunction of mitochondria is an important component of the molecular mechanisms of the development of many neurodegenerative diseases. These include multiple sclerosis, a chronic autoimmune and neurodegenerative disease of the central nervous system, which is characterized by clinical heterogeneity. The role of genetic variability of mitochondrial DNA in the development of various clinical forms of multiple sclerosis is poorly understood. The aim of present study was to analyze the association often mitochondrial DNA single nucleotide polymorphisms and the nine most common European mitochondrial haplogroups (H, J, K, U, T, I, V, W and X) with a severe and relatively rare multiple sclerosis disease form-primary progressive multiple sclerosis. 110 patients with primary progressive multiple sclerosis and 406 healthy controls were enrolled in the study, all ethnic Russians. For the first time association of the m.12308*G (rs2853498) variant (P = 0.024) and haplogroup U (P = 0.0004, passes the adjustment for multiple comparisons: Pcorr = 0.0076) with primary progressive multiple sclerosis was shown. Comparison of these data with the results of our previous study [1], that was focused on the role of mitochondrial genome variability in susceptibility to the most common form of multiple sclerosis, relapsing-remitting multiple sclerosis, leads to the conclusion that two different mitochondrial haplogroups, U and J, are involved in the development of two different clinical forms of multiple sclerosis. The results may contribute to the identification of new targets for the treatment of primary progressive multiple sclerosis, for which there is no effective pathogenetic treatment at the moment.
Collapse
Affiliation(s)
- M S Kozin
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- Federal Center for the Brain and Neurotechnologies, Moscow, 117997 Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - I S Kiselev
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
- Federal Center for the Brain and Neurotechnologies, Moscow, 117997 Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| |
Collapse
|
36
|
Wolinsky JS, Engmann NJ, Pei J, Pradhan A, Markowitz C, Fox EJ. An exploratory analysis of the efficacy of ocrelizumab in patients with multiple sclerosis with increased disability. Mult Scler J Exp Transl Clin 2020; 6:2055217320911939. [PMID: 32206332 PMCID: PMC7079307 DOI: 10.1177/2055217320911939] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Ocrelizumab, an anti-CD20 humanized monoclonal antibody, reduced disease progression in pivotal trials of patients with relapsing (OPERA I, OPERA II) and primary progressive (ORATORIO) multiple sclerosis (MS). These effects may be particularly important among patients with increased disability. Objective In this post hoc exploratory analysis, we evaluated the efficacy of ocrelizumab on disability progression among a subgroup of patients with MS who had increased baseline disability levels (Expanded Disability Status Scale scores ≥4.0) in the pivotal trials. Methods During the double-blind period, patients received ocrelizumab 600 mg intravenously every 24 weeks for 96 weeks in the OPERA trials (versus interferon β-1a 44 μg subcutaneously three times per week) and for 120 weeks in ORATORIO (versus placebo). Kaplan–Meier and Cox survival analyses were used to assess disability outcome measures. Results Baseline demographic, disease, and treatment characteristics were generally comparable across treatment groups in patients with increased disability from the OPERA and ORATORIO trials. Ocrelizumab treatment numerically, and in some instances significantly, reduced confirmed disability progression versus the comparator in these patients. Conclusions In patients with increased baseline disability, ocrelizumab reduced the risk of confirmed disability progression versus interferon β-1a in patients with relapsing-onset MS and versus placebo in patients with progression-onset MS.
Collapse
Affiliation(s)
- Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston, TX, USA
| | | | | | | | - Clyde Markowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward J Fox
- Central Texas Neurology Consultants, Round Rock, TX, USA
| |
Collapse
|
37
|
Engel S, Luessi F, Mueller A, Schopf RE, Zipp F, Bittner S. PPMS onset upon adalimumab treatment extends the spectrum of anti-TNF-α therapy-associated demyelinating disorders. Ther Adv Neurol Disord 2020; 13:1756286419895155. [PMID: 31921355 PMCID: PMC6940603 DOI: 10.1177/1756286419895155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Since their introduction in 1999, anti-tumour necrosis factor-α (anti-TNF-α)
therapies have been suspected repeatedly to be associated with the occurrence of
central nervous system (CNS) demyelinating disorders, including multiple
sclerosis (MS). However, recent publications were restricted to descriptions of
monophasic demyelinating events or cases of relapsing–remitting MS (RRMS). We
here provide the first case report of primary progressive MS (PPMS) onset upon
anti-TNF-α therapy as well as a literature review of previously published cases
of anti-TNF-α therapy-associated MS onset. The 51-year old male patient was
treated with adalimumab due to psoriasis arthritis. About 18 months after
treatment initiation, he developed slowly progressing neurological deficits
including gait impairment, paraesthesia of the lower limbs, strangury and visual
impairment, which led to the discontinuation of adalimumab therapy. Magnetic
resonance imaging of the brain and the spinal cord revealed multiple
inflammatory lesions and cerebrospinal fluid examination showed slight
pleocytosis and positive oligoclonal bands. Thus, PPMS was diagnosed according
to the 2017 revision of the McDonald criteria. As PPMS often causes only subtle
symptoms in the beginning and early treatment discontinuation of anti-TNF-α
therapy seems essential to improve the patient’s outcome, we think that it is
important to increase the awareness of slowly progressing neurological deficits
as a potential adverse event of anti-TNF-α therapy among all clinicians involved
in the initiation and monitoring of these drugs. In addition, the occurrence of
both RRMS and progressive MS upon anti-TNF-α therapy might suggest a shared
TNF-α-mediated pathophysiological mechanism in the evolution of all MS
subtypes.
Collapse
Affiliation(s)
- Sinah Engel
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Aneka Mueller
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Rudolf E Schopf
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn²), University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, Mainz 55131, Germany
| |
Collapse
|
38
|
Kiselev IS, Kulakova OG, Baulina NM, Bashinskaya VV, Popova EV, Boyko AN, Favorova OO. [Variability of the MIR196A2 Gene as a Risk Factor in Primary-Progressive Multiple Sclerosis Development]. Mol Biol (Mosk) 2019; 53:282-289. [PMID: 31099778 DOI: 10.1134/s0026898419020071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022]
Abstract
Multiple sclerosis is a chronic disease of the central nervous system, combining in its pathogenesis both autoimmune and neurodegenerative components, and is characterized by a highly heterogeneous clinical phenotype. Genetic susceptibility to the development of the most common relapsing-remitting course of the disease is extensively studied, while the genetic architecture of the aggressive primary progressive course of multiple sclerosis remains poorly understood. We analyzed the association of polymorphic variants in miRNA genes MIR146A, MIR196A2, and MIR499A with the risk of primary progressive multiple sclerosis one by one and in biallelic combinations with variants of immune-related genes; the analysis was performed in comparison with healthy individuals and with relapsing-remitting multiple sclerosis patients. The allele MIR196A2*C was useful in discriminating between two main courses of multiple sclerosis, one by one and in combination with alleles of the IFNAR2, IL7RA, IL6, PVT1, CD86, CCL5, and PSMB9 genes. The data presented in the current work may be used for the construction of a biomarker panel, to differentiate primary progressive and relapsing-remitting courses of multiple sclerosis on the initial stages of the disease.
Collapse
Affiliation(s)
- I S Kiselev
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia.,
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - N M Baulina
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - V V Bashinskaya
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - E V Popova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, 117997 Russia
| |
Collapse
|
39
|
Abstract
INTRODUCTION In the past decade, the role of B cells in the pathogenesis of multiple sclerosis (MS) is coming to the forefront. Depletion of B cells by anti-CD20 monoclonal antibodies (mAbs) has proved to decrease the activity of the relapsing-remitting MS (RRMS) and the progression of primary progressive MS (PPMS). Areas covered: In this review, the authors discuss the rationale of the depletion of B cells in RRMS and PPMS across recent studies on the role of B cells in the pathogenesis of MS; previous clinical trials with treatments targeting B cells; the mechanism of action of ocrelizumab - a second generation anti-CD20 mAb - and recent phase III clinical trials with ocrelizumab in RRMS and PPMS. Expert commentary: Ocrelizumab is the first anti-CD20 monoclonal antibody approved for RRMS and the first treatment approved for PPMS. The long-term effect and safety profile need to be evaluated in extension of clinical trials and in real-world studies.
Collapse
Affiliation(s)
- Kévin Bigaut
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France
| | - Jérôme De Seze
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France.,b Biopathologie de la Myéline,Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS) , Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine , 11 rue Humann, 67000 Strasbourg , France.,c Centre d'investigation clinique , INSERM U1434, Centre Hospitalier Universitaire de Strasbourg , 1 Place de l'Hôpital, 67000 Strasbourg , France
| | - Nicolas Collongues
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France.,b Biopathologie de la Myéline,Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS) , Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine , 11 rue Humann, 67000 Strasbourg , France.,c Centre d'investigation clinique , INSERM U1434, Centre Hospitalier Universitaire de Strasbourg , 1 Place de l'Hôpital, 67000 Strasbourg , France
| |
Collapse
|
40
|
Pawlitzki M, Schreiber S, Bittner D, Kreipe J, Leypoldt F, Rupprecht K, Carare RO, Meuth SG, Vielhaber S, Körtvélyessy P. CSF Neurofilament Light Chain Levels in Primary Progressive MS: Signs of Axonal Neurodegeneration. Front Neurol 2018; 9:1037. [PMID: 30631300 PMCID: PMC6315185 DOI: 10.3389/fneur.2018.01037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022] Open
Abstract
Objectives: Elevated neurofilament light chain (NFL) levels within the cerebrospinal fluid (CSF) are a biomarker representing axonal neurodegeneration in rapid progressive neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). It is unclear to what extent the levels of NFL increase in the CSF (CSF-NFL) in a chronic neuroinflammatory process with axonal neurodegeneration, as found in primary progressive multiple sclerosis (PPMS). Methods: We used a multicenter approach to statistically compare CSF-NFL levels between PPMS patients (n = 50), ALS patients (n = 50), and healthy controls (n = 50). Clinical findings, including disease duration, expanded disability status scale (EDSS), electrophysiological recordings such as visual evoked potentials or spinal and cerebral MRI, and previously administered treatment were selected as experimental parameters retrospectively. Results: Median [range] CSF-NFL concentrations in PPMS patients were significantly higher than in the controls [1724 (799–4275) pg/ml vs. 1202 (612–2934) pg/ml, p = 0.015], and significantly lower compared to ALS patients [1724 (799–4275) pg/ml vs. 10238 (2610–35138) pg/ml, p < 0.001]. There was no correlation between CSF-NFL and disease duration (p = 0.5), EDSS (p = 0.2) or treatment (p = 0.3). Conclusion: We conclude that CSF-NFL may mirror the proposed slow axonal degeneration in PPMS, but does not reflect the disease severity.
Collapse
Affiliation(s)
- Marc Pawlitzki
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Daniel Bittner
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Julia Kreipe
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Klemens Rupprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Münster, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, (DZNE), Magdeburg, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| |
Collapse
|
41
|
Vistbakka J, Sumelahti ML, Lehtimäki T, Elovaara I, Hagman S. Evaluation of serum miR-191-5p, miR-24-3p, miR-128-3p, and miR-376c-3 in multiple sclerosis patients. Acta Neurol Scand 2018. [PMID: 29527713 DOI: 10.1111/ane.12921] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biomarkers that could be used in early diagnosis of multiple sclerosis (MS), segregation of disease subtypes, and discrimination of the aggressive disease course from the benign one are urgently needed. OBJECTIVE The aim of this study was to investigate the specificity of circulating microRNAs: miR-191-5p, miR-128-3p, miR-24-3p, and miR-376c-3p in MS and evaluate their association with disease activity and disability progression. METHODS The expressions of circulating miRNAs were studied in serum of 100 subjects (53 relapsing-remitting (RRMS), 20 primary progressive (PPMS), and 27 controls), using miScript serum miRNA RT-PCR assay techniques. RESULTS In comparison with controls, miR-191-5p and miR-24-3p were overexpressed in RRMS and PPMS, with no differences between the subtypes. miR-24-3p correlated positively with the disability progression index in the combined group of all patients with MS. miR-128-3p showed tendency toward the predominant expression in PPMS and correlated positively with the annual relapse rate in RRMS. miR-376c-3p expression levels did not differ between the groups, and no associations were found to clinical parameters. CONCLUSION This study highlighted the connection of circulating miRNAs to MS. miR-24-3p and miR-128-3p showed a tendency of association with disability accumulation and disease activity, respectively. Further studies should evaluate their suitability for clinical use.
Collapse
Affiliation(s)
- J. Vistbakka
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
| | - M.-L. Sumelahti
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
- Department of Neurology; Tampere University Hospital; Tampere Finland
| | - T. Lehtimäki
- Department of Clinical Chemistry; Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere; Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - I. Elovaara
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
| | - S. Hagman
- Neuroimmunology Unit; Faculty of Medicine and Life Science; University of Tampere; Tampere Finland
| |
Collapse
|
42
|
Popova EV, Boyko AN, Barabanova MA, Antipova LN, Bakhtiyarova KZ, Belova AN, Solovieva VS, Belskaya GN, Lukashevich IG, Nikolaeva LI, Volkova LI, Turova EL, Kraeva AV, Goncharova ZA, Malkova NA, Poverennova IE, Sivertseva SA, Zhelnin AV, Trushnikova TN, Khabirov FA, Khaibullin TI. [ Primary progressive multiple sclerosis: current issues of timely diagnosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:35-40. [PMID: 29359731 DOI: 10.17116/jnevro201711710235-40] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article presents a review of international data on primary progressive multiple sclerosis (PPMS) and an analysis of factors influencing timely diagnosis of PPMS in a number of regions of the Russian Federation.
Collapse
Affiliation(s)
- E V Popova
- City Clinical Hospital #24, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - L N Antipova
- Krasnodar Clinical Hospital #2, Krasnodar, Russia
| | | | - A N Belova
- Volga Federal Medical Research Center, Nizhny Novgorod, Russia
| | | | - G N Belskaya
- South-Ural State Medical University, Chelyabinsk, Russia
| | | | - L I Nikolaeva
- City Center of Multiple Sclerosis of City Clinical Hospital #1, Chelyabinsk, Russia
| | - L I Volkova
- Ural State Medical University, Yekaterinburg, Russia
| | - E L Turova
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - A V Kraeva
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia; City Center of Multiple Sclerosis, Rostov-on-Don, Russia
| | - Z A Goncharova
- City Center of Multiple Sclerosis, Rostov-on-Don, Russia; Rostov State Medical University, Rostov-on-Don, Russia
| | - N A Malkova
- Novosibirsk State Medical University, Novosibirsk, Russia; Novosibirsk State Regional Hospital, Novosibirsk, Russia
| | - I E Poverennova
- Novosibirsk State Regional Hospital, Novosibirsk, Russia; Samara State Medical University, Samara, Russia
| | | | - A V Zhelnin
- Perm Regional Clinical Hospital, Perm, Russia
| | | | | | - T I Khaibullin
- Kazan State Medical Academy, Kazan, Russia; Republican Clinical Neurologic Center, Kazan, Russia
| |
Collapse
|
43
|
Abstract
The last several decades have witnessed considerable progress in our understanding of the pathogenesis, refining diagnostic criteria, and identifying therapies of value for modifying the course of relapsing forms of multiple sclerosis. While the pace of progress has lagged for those with progressive phase disease, this now seems to be changing. This review considers those characteristics of patients with primary progressive multiple sclerosis that may contribute to phase 3 trial success and identifies some of the thorny issues that remain ahead. The larger of the studies conducted thus far have sequentially informed our understanding of "pure" primary progressive disease, and also challenge both phase 3 and especially phase 2 trial designs and participant selection for investigations going forward. This may have particular relevance for testing therapeutics directed at neuroprotection and repair in the face of ongoing progression regardless of trial participant categorization using current conventional disease phenotypes.
Collapse
Affiliation(s)
- Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| |
Collapse
|
44
|
Gouveia A, Dias SP, Santos T, Rocha H, Coelho CR, Ruano L, Galego O, Diogo MC, Seixas D, Sá MJ, Batista S. Cognitive impairment and magnetic resonance imaging correlates in primary progressive multiple sclerosis. Acta Neurol Scand 2017; 136:109-115. [PMID: 27778334 DOI: 10.1111/ane.12702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To characterize cognitive impairment in primary progressive multiple sclerosis (PPMS) and to correlate the pattern of cognitive deficits with brain magnetic resonance imaging (MRI) volumetric data. MATERIALS AND METHODS In a multicenter cross-sectional study, we recruited consecutive patients with PPMS as well as age, sex, and education level-matched healthy controls (HC). All participants underwent neuropsychological (NP) assessment, and brain MRI was performed in patients with PPMS for analysis of lesion load, subcortical GM volumes, and regional cortical volumes. RESULTS We recruited 55 patients with PPMS and 36 HC. Thirty-six patients were included in the MRI analysis. Patients with PPMS performed significantly worse than HC in all NP tests. Subcortical GM volume was significantly correlated with all NP tests, except for Stroop Test, with the largest effect for the thalamus (r=-.516 [BVMT-R DR, P=.016 FDR-corrected] to r=.664 [SDMT, P<.001 FDR-corrected]). In the stepwise linear regression model, thalamic volume was the only predictor of performance in all NP tests. CONCLUSION Cognitive impairment is common in PPMS and affects all evaluated cognitive domains. Subcortical GM volume, particularly of the thalamus, is a strong predictor of cognitive performance, suggesting it has a central role in the pathophysiology of PPMS-related cognitive dysfunction.
Collapse
Affiliation(s)
- A. Gouveia
- Department of Neurology; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
| | - S. P. Dias
- Department of Neurology; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - T. Santos
- Department of Neurology; Centro Hospitalar Vila Nova de Gaia/Espinho; Vila Nova de Gaia Portugal
| | - H. Rocha
- Department of Neurology; Centro Hospitalar de São João; Porto Portugal
- Faculty of Medicine; Department of Clinical Neuroscience and Mental Health; University of Porto; Porto Portugal
| | - C. R. Coelho
- Department of Neurology; Centro Hospitalar de Setúbal; Setúbal Portugal
| | - L. Ruano
- Department of Neurology; Centro Hospitalar Entre Douro e Vouga; Santa Maria da Feira Portugal
- EPIUnit - Epidemiology Research Unit; Institute of Public Health; University of Porto; Porto Portugal
| | - O. Galego
- Department of Neuroradiology; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
| | - M. C. Diogo
- Department of Neuroradiology; Centro Hospitalar de Lisboa Central; Lisboa Portugal
| | - D. Seixas
- Department of Imaging Diagnosis; Centro Hospitalar de Vila Nova de Gaia/Espinho; Vila Nova de Gaia Portugal
- Faculty of Medicine; Department of Experimental Biology; Porto University; Porto Portugal
| | - M. J. Sá
- Department of Neurology; Centro Hospitalar de São João; Porto Portugal
- Faculty of Health Sciences; University Fernando Pessoa; Porto Portugal
| | - S. Batista
- Department of Neurology; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
- Faculty of Medicine; University of Coimbra; Coimbra Portugal
| |
Collapse
|
45
|
Popova EV, Kiselev IS, Boyko AN, Sivertseva SA, Malkova NA, Korobko DS, Spirin NN, Kasatkin DS, Karaeva AV, Turova EL, Spirina NN, Volkova LI, Baulina NM, Bashinskaya VV, Kulakova OG, Favorova OO. [Polymorphic variants of the immune response genes as risk factors for primary progressive multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:14-21. [PMID: 28617357 DOI: 10.17116/jnevro20171172214-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To analyze the involvement of immune response genes in the pathogenesis of primary progressive multiple sclerosis (PPMS). MATERIAL AND METHODS This multicenter study included 111 patients with PPMS from the Russian ethnic group. The association of PPMS with genes of immune system was analyzed by the study of polymorphic variants of genes of cytokines and genes of antigen-presenting cells. RESULTS AND CONCLUSION The genotypes of IL-4 (rs2243250)*C/C and CLEC16A (rs6498169)*G/G were associated with PPMS in Russians. The association between the HLA-DRB1*15 and PPMS found out in other populations was confirmed in Russians.
Collapse
Affiliation(s)
- E V Popova
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - I S Kiselev
- Cardiology research and clinical complex, Moscow, Russia; Tumen Regional Center of Multiple Sclerosis, Tumen, Russia
| | - A N Boyko
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - S A Sivertseva
- Novosibirsk Regional Center of Multiple Sclerosis and other Autoimmune Diseases 'GNOKB', Novosibirsk, Russia
| | - N A Malkova
- State Medical University, Novosibirsk, Russia
| | - D S Korobko
- State Medical University, Novosibirsk, Russia
| | - N N Spirin
- Yaroslavl State Medical University, Yaroslavl, Russia; Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - D S Kasatkin
- Yaroslavl State Medical University, Yaroslavl, Russia; Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - A V Karaeva
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - E L Turova
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - N N Spirina
- Yaroslavl State Medical University, Yaroslavl, Russia; Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - L I Volkova
- Sverdlovsk Regional Clinical Hospital #1, Yekaterinburg, Russia
| | - N M Baulina
- Cardiology research and clinical complex, Moscow, Russia; Tumen Regional Center of Multiple Sclerosis, Tumen, Russia
| | - V V Bashinskaya
- Cardiology research and clinical complex, Moscow, Russia; Tumen Regional Center of Multiple Sclerosis, Tumen, Russia
| | - O G Kulakova
- Cardiology research and clinical complex, Moscow, Russia; Tumen Regional Center of Multiple Sclerosis, Tumen, Russia
| | - O O Favorova
- Cardiology research and clinical complex, Moscow, Russia; Tumen Regional Center of Multiple Sclerosis, Tumen, Russia
| |
Collapse
|
46
|
Abstract
The focus of multiple sclerosis research has recently turned to the relatively rare and clearly more challenging condition of primary progressive multiple sclerosis (PPMS). Many risk factors such as genetic susceptibility, age, and Epstein–Barr virus (EBV) infection may interdepend on various levels, causing a complex pathophysiological cascade. Variable pathological mechanisms drive disease progression, including inflammation-associated axonal loss, continuous activation of central nervous system resident cells, such as astrocytes and microglia as well as mitochondrial dysfunction and iron accumulation. Histological studies revealed diffuse infiltration of the gray and white matter as well as of the meninges with inflammatory cells such as B-, T-, natural killer, and plasma cells. While numerous anti-inflammatory agents effective in relapsing remitting multiple sclerosis basically failed in treatment of PPMS, the B-cell-depleting monoclonal antibody ocrelizumab recently broke the dogma that PPMS cannot be treated by an anti-inflammatory approach by demonstrating efficacy in a phase 3 PPMS trial. Other treatments aiming at enhancing remyelination (MD1003) as well as EBV-directed treatment strategies may be promising agents on the horizon. In this article, we aim to summarize new advances in the understanding of risk factors, pathophysiology, and treatment of PPMS. Moreover, we introduce a novel concept to understand the nature of the disease and possible treatment strategies in the near future.
Collapse
Affiliation(s)
| | - Martin S Weber
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.,Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Ulm, Germany.,Specialty Clinic of Neurology Dietenbronn, Schwendi, Germany
| |
Collapse
|
47
|
Correale J, Gaitán MI, Ysrraelit MC, Fiol MP. Progressive multiple sclerosis: from pathogenic mechanisms to treatment. Brain 2017; 140:527-546. [PMID: 27794524 DOI: 10.1093/brain/aww258] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/18/2016] [Indexed: 12/30/2022] Open
Abstract
During the past decades, better understanding of relapsing-remitting multiple sclerosis disease mechanisms have led to the development of several disease-modifying therapies, reducing relapse rates and severity, through immune system modulation or suppression. In contrast, current therapeutic options for progressive multiple sclerosis remain comparatively disappointing and challenging. One possible explanation is a lack of understanding of pathogenic mechanisms driving progressive multiple sclerosis. Furthermore, diagnosis is usually retrospective, based on history of gradual neurological worsening with or without occasional relapses, minor remissions or plateaus. In addition, imaging methods as well as biomarkers are not well established. Magnetic resonance imaging studies in progressive multiple sclerosis show decreased blood-brain barrier permeability, probably reflecting compartmentalization of inflammation behind a relatively intact blood-brain barrier. Interestingly, a spectrum of inflammatory cell types infiltrates the leptomeninges during subpial cortical demyelination. Indeed, recent magnetic resonance imaging studies show leptomeningeal contrast enhancement in subjects with progressive multiple sclerosis, possibly representing an in vivo marker of inflammation associated to subpial demyelination. Treatments for progressive disease depend on underlying mechanisms causing central nervous system damage. Immunity sheltered behind an intact blood-brain barrier, energy failure, and membrane channel dysfunction may be key processes in progressive disease. Interfering with these mechanisms may provide neuroprotection and prevent disability progression, while potentially restoring activity and conduction along damaged axons by repairing myelin. Although most previous clinical trials in progressive multiple sclerosis have yielded disappointing results, important lessons have been learnt, improving the design of novel ones. This review discusses mechanisms involved in progressive multiple sclerosis, correlations between histopathology and magnetic resonance imaging studies, along with possible new therapeutic approaches.
Collapse
|
48
|
Abstract
AIMS To better understand the impact of the clinical course of multiple sclerosis (MS) and disability on employment, absenteeism, and related factors. MATERIALS AND METHODS This study included respondents to the North American Research Committee on Multiple Sclerosis Registry spring 2015 update survey who were US or Canadian residents, aged 18-65 years and reported having relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), or primary progressive MS (PPMS). The RRMS and SPMS participants were combined to form the relapsing-onset MS (RMS) group and compared with the PPMS group regarding employment status, absenteeism, and disability. Multivariable logistic regression was used to examine the relationship between employment-related outcomes and factors that may affect these relationships. RESULTS Of the 8004 survey respondents, 5887 (73.6%) were 18-65 years of age. The PPMS group (n = 344) had a higher proportion of males and older mean age at the time of the survey and at time of diagnosis than the RMS group (n = 4829). Female sex, age, age at diagnosis, cognitive and hand function impairment, fatigue, higher disability levels, ≥3 comorbidities, and a diagnosis of PPMS were associated with not working. After adjustment for disability, the employed PPMS sub-group reported similar levels of absenteeism to the employed RMS sub-group. LIMITATIONS Limitations of the study include self-report of information and the possibility that participants may not fully represent the working-age MS population. CONCLUSIONS In MS, employment status and absenteeism are negatively affected by disability, cognitive impairment, and fatigue. These findings underscore the need for therapies that prevent disability progression and other symptoms that negatively affect productivity in persons with MS to enable them to persist in the workforce.
Collapse
Affiliation(s)
- Amber Salter
- a Division of Biostatistics , School of Medicine, Washington University in St Louis , St Louis , MO , USA
| | - Nina Thomas
- b Genentech, Inc , South San Francisco , CA , USA
| | - Tuula Tyry
- c Dignity Health , St Joseph's Hospital and Medical Center , Phoenix , AZ , USA
| | - Gary Cutter
- d Department of Biostatistics , The University of Alabama at Birmingham School of Public Health , Birmingham , AL , USA
| | - Ruth Ann Marrie
- e Department of Internal Medicine and Community Health Sciences , University of Manitoba , Winnipeg , MB , Canada
| |
Collapse
|
49
|
Studer V, Rocchi C, Motta C, Lauretti B, Perugini J, Brambilla L, Pareja-Gutierrez L, Camera G, Barbieri FR, Marfia GA, Centonze D, Rossi S. Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability. Mult Scler J Exp Transl Clin 2017; 3:2055217317701317. [PMID: 28607756 PMCID: PMC5408506 DOI: 10.1177/2055217317701317] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background Sympathovagal imbalance has been associated with poor prognosis in chronic diseases, but there is conflicting evidence in multiple sclerosis. Objectives The objective of this study was to investigate the autonomic nervous system dysfunction correlation with inflammation and progression in multiple sclerosis. Methods Heart rate variability was analysed in 120 multiple sclerosis patients and 60 healthy controls during supine rest and head-up tilt test; the normalised units of low frequency and high frequency power were considered to assess sympathetic and vagal components, respectively. Correlation analyses with clinical and radiological markers of disease activity and progression were performed. Results Sympathetic dysfunction was closely related to the progression of disability in multiple sclerosis: progressive patients showed altered heart rate variability with respect to healthy controls and relapsing–remitting patients, with higher rest low frequency power and lacking the expected low frequency power increase during the head-up tilt test. In relapsing–remitting patients, disease activity, even subclinical, was associated with lower rest low frequency power, whereas stable relapsing–remitting patients did not differ from healthy controls. Less sympathetic reactivity and higher low frequency power at rest were associated with incomplete recovery from relapse. Conclusions Autonomic balance appears to be intimately linked with both the inflammatory activity of multiple sclerosis, which is featured by an overall hypoactivity of the sympathetic nervous system, and its compensatory plastic processes, which appear inefficient in case of worsening and progressive multiple sclerosis.
Collapse
Affiliation(s)
- Valeria Studer
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | - Camilla Rocchi
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | - Caterina Motta
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | | | - Jacopo Perugini
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy
| | - Laura Brambilla
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy
| | - Lorena Pareja-Gutierrez
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy
| | - Giorgia Camera
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy
| | | | | | - Diego Centonze
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Italy
| | - Silvia Rossi
- Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Isitituto Neurologico Carlo Besta, Italy
| |
Collapse
|
50
|
Javizian O, Metz LM, Deighton S, Koch MW. Smoking does not influence disability accumulation in primary progressive multiple sclerosis. Eur J Neurol 2017; 24:624-630. [PMID: 28239937 DOI: 10.1111/ene.13262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The modifiable risk factor cigarette smoking has been associated with an increased risk of developing multiple sclerosis (MS) and with disease activity in relapsing-remitting MS. However, less is known about the effect of smoking on disease progression in progressive MS. Here the association between cigarette smoking and disability accumulation in primary progressive MS (PPMS) is investigated. METHODS Kaplan-Meier survival analyses and Cox proportional hazard modelling were used to investigate the influence of cigarette smoking on the risk of reaching Expanded Disability Status Scale (EDSS) 4 and 6 as well as the time from EDSS 4 to 6 in patients with PPMS. RESULTS In all, 416 patients with PPMS and available smoking history were identified. Median time to EDSS 4 was 4 years in ever-smokers and 5 years in never-smokers (P = 0.27), and it was 9 years to EDSS 6 in both ever-smokers and never-smokers (P = 0.48). Smokers were not at increased risk of faster progression to EDSS 4, 6 and from EDSS 4 to 6. Age at disease onset was the strongest risk factor for progression to EDSS 4, 6 and from EDSS 4 to 6. CONCLUSIONS Our investigation of a large and well-characterized population based PPMS cohort suggests that cigarette smoking does not influence disability accumulation in PPMS. Our findings support the idea that PPMS is driven by different underlying pathomechanisms than relapsing-remitting MS.
Collapse
Affiliation(s)
- O Javizian
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - L M Metz
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - S Deighton
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - M W Koch
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| |
Collapse
|