|
1
|
Zamecnik CR, Sowa GM, Abdelhak A, Dandekar R, Bair RD, Wade KJ, Bartley CM, Kizer K, Augusto DG, Tubati A, Gomez R, Fouassier C, Gerungan C, Caspar CM, Alexander J, Wapniarski AE, Loudermilk RP, Eggers EL, Zorn KC, Ananth K, Jabassini N, Mann SA, Ragan NR, Santaniello A, Henry RG, Baranzini SE, Zamvil SS, Sabatino JJ, Bove RM, Guo CY, Gelfand JM, Cuneo R, von Büdingen HC, Oksenberg JR, Cree BAC, Hollenbach JA, Green AJ, Hauser SL, Wallin MT, DeRisi JL, Wilson MR. An autoantibody signature predictive for multiple sclerosis. Nat Med 2024:10.1038/s41591-024-02938-3. [PMID: 38641750 DOI: 10.1038/s41591-024-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
Although B cells are implicated in multiple sclerosis (MS) pathophysiology, a predictive or diagnostic autoantibody remains elusive. In this study, the Department of Defense Serum Repository (DoDSR), a cohort of over 10 million individuals, was used to generate whole-proteome autoantibody profiles of hundreds of patients with MS (PwMS) years before and subsequently after MS onset. This analysis defines a unique cluster in approximately 10% of PwMS who share an autoantibody signature against a common motif that has similarity with many human pathogens. These patients exhibit antibody reactivity years before developing MS symptoms and have higher levels of serum neurofilament light (sNfL) compared to other PwMS. Furthermore, this profile is preserved over time, providing molecular evidence for an immunologically active preclinical period years before clinical onset. This autoantibody reactivity was validated in samples from a separate incident MS cohort in both cerebrospinal fluid and serum, where it is highly specific for patients eventually diagnosed with MS. This signature is a starting point for further immunological characterization of this MS patient subset and may be clinically useful as an antigen-specific biomarker for high-risk patients with clinically or radiologically isolated neuroinflammatory syndromes.
Collapse
Affiliation(s)
- Colin R Zamecnik
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Gavin M Sowa
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Ahmed Abdelhak
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ravi Dandekar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca D Bair
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kristen J Wade
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher M Bartley
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kerry Kizer
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Danillo G Augusto
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Asritha Tubati
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Refujia Gomez
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Camille Fouassier
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chloe Gerungan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Colette M Caspar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Alexander
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Anne E Wapniarski
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Rita P Loudermilk
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Erica L Eggers
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nora Jabassini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Nicholas R Ragan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Adam Santaniello
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Roland G Henry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sergio E Baranzini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph J Sabatino
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Chu-Yueh Guo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey M Gelfand
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Richard Cuneo
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - H-Christian von Büdingen
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jorge R Oksenberg
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jill A Hollenbach
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Ari J Green
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mitchell T Wallin
- Department of Veterans Affairs, Multiple Sclerosis Center of Excellence, Washington, DC, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
|
2
|
Cordano C, Werneburg S, Abdelhak A, Bennett DJ, Beaudry-Richard A, Duncan GJ, Oertel FC, Boscardin WJ, Yiu HH, Jabassini N, Merritt L, Nocera S, Sin JH, Samana IP, Condor Montes SY, Ananth K, Bischof A, Nourbakhsh B, Hauser SL, Cree BAC, Emery B, Schafer DP, Chan JR, Green AJ. Synaptic injury in the inner plexiform layer of the retina is associated with progression in multiple sclerosis. Cell Rep Med 2024; 5:101490. [PMID: 38574736 PMCID: PMC11031420 DOI: 10.1016/j.xcrm.2024.101490] [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: 07/24/2023] [Revised: 02/01/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
While neurodegeneration underlies the pathological basis for permanent disability in multiple sclerosis (MS), predictive biomarkers for progression are lacking. Using an animal model of chronic MS, we find that synaptic injury precedes neuronal loss and identify thinning of the inner plexiform layer (IPL) as an early feature of inflammatory demyelination-prior to symptom onset. As neuronal domains are anatomically segregated in the retina and can be monitored longitudinally, we hypothesize that thinning of the IPL could represent a biomarker for progression in MS. Leveraging our dataset with over 800 participants enrolled for more than 12 years, we find that IPL atrophy directly precedes progression and propose that synaptic loss is predictive of functional decline. Using a blood proteome-wide analysis, we demonstrate a strong correlation between demyelination, glial activation, and synapse loss independent of neuroaxonal injury. In summary, monitoring synaptic injury is a biologically relevant approach that reflects a potential driver of progression.
Collapse
Affiliation(s)
- Christian Cordano
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sebastian Werneburg
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Ophthalmology & Visual Sciences, Michigan Neuroscience Institute, University of Michigan - Michigan Medicine, Ann Arbor, MI, USA
| | - Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel J Bennett
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra Beaudry-Richard
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Greg J Duncan
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Frederike C Oertel
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - W John Boscardin
- Department of Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Hao H Yiu
- Department of Biology, University of Maryland, College Park, MD, USA
| | - Nora Jabassini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lauren Merritt
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sonia Nocera
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jung H Sin
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isaac P Samana
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Shivany Y Condor Montes
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kirtana Ananth
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Antje Bischof
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bardia Nourbakhsh
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Ben Emery
- Jungers Center for Neurosciences Research, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Dorothy P Schafer
- Department of Neurobiology, Brudnik Neuropsychiatric Research Institute, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonah R Chan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Ari J Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
|
3
|
Affiliation(s)
- Stephen L Hauser
- From the UCSF Weill Institute for Neurosciences and the Department of Neurology, University of California, San Francisco, San Francisco
| |
Collapse
|
|
4
|
Kappos L, Traboulsee A, Li DKB, Bar-Or A, Barkhof F, Montalban X, Leppert D, Baldinotti A, Schneble HM, Koendgen H, Sauter A, Wang Q, Hauser SL. Ocrelizumab exposure in relapsing-remitting multiple sclerosis: 10-year analysis of the phase 2 randomized clinical trial and its extension. J Neurol 2024; 271:642-657. [PMID: 37906326 PMCID: PMC10827899 DOI: 10.1007/s00415-023-11943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023]
Abstract
Open-label extension (OLE) studies help inform long-term safety and efficacy of disease-modifying therapies in multiple sclerosis (MS). We report exploratory analyses from a phase 2 trial on the longest follow-up to date of ocrelizumab-treated patients with relapsing-remitting MS (RRMS). The primary treatment period (PTP) comprised four 24-week treatment cycles; participants were randomized to double-blind ocrelizumab (2000 mg or 600 mg), placebo, or interferon β-1a (open label) for one cycle, then dose-blinded ocrelizumab 1000 mg or 600 mg for the remaining cycles. The PTP was followed by consecutive assessed and unassessed treatment-free periods (TFPs) and then the OLE (ocrelizumab 600 mg every 24 weeks). Safety and efficacy were prospectively assessed. Of 220 participants randomized, 183 (84%) completed the PTP. After the TFP, 103 entered OLE (median OLE ocrelizumab exposure 6.5 years). Most common adverse events across all periods were infusion-related reactions. MRI activity, annualized relapse rate, and confirmed disability progression (CDP) rates remained low throughout. During the assessed TFP, there was a trend toward less and later B-cell repletion, and later CDP, for patients randomized to ocrelizumab; MRI activity was observed in 16.3% of patients, the earliest 24 weeks after the last ocrelizumab dose. This is the longest follow-up of ocrelizumab-treated patients with RRMS, with no new safety signals emerging during an observation period from 2008 to 2020. Results reinforce the sustained efficacy of long-term ocrelizumab. Reduced disease activity was maintained following interruption of 6-month dosing cycles, with no evidence of rebound.
Collapse
Affiliation(s)
- Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital and University of Basel, Basel, Switzerland.
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - David K B Li
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frederik Barkhof
- VU University Medical Centre, Amsterdam, The Netherlands
- UCL Institutes of Biomedical Engineering and Neurology, London, UK
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - David Leppert
- Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Harold Koendgen
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- UCB Farchim SA, Bulle, Switzerland
| | - Annette Sauter
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
- Janssen Pharmaceuticals, Allschwil, Basel-Landschaft, Switzerland
| | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
|
5
|
Abdelhak A, Antweiler K, Kowarik MC, Senel M, Havla J, Zettl UK, Kleiter I, Hoshi MM, Skripuletz T, Haarmann A, Stahmann A, Huss A, Gingele S, Krumbholz M, Selge C, Friede T, Ludolph AC, Overell J, Koendgen H, Clinch S, Wang Q, Ziemann U, Hauser SL, Kümpfel T, Green AJ, Tumani H. Patient-reported outcome parameters and disability worsening in progressive multiple sclerosis. Mult Scler Relat Disord 2024; 81:105139. [PMID: 38000130 PMCID: PMC10959125 DOI: 10.1016/j.msard.2023.105139] [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: 08/21/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES Detection and prediction of disability progression is a significant unmet need in people with progressive multiple sclerosis (PwPMS). Government and health agencies have deemed the use of patient-reported outcomes measurements (PROMs) in clinical practice and clinical trials a major strategic priority. Nevertheless, data documenting the clinical utility of PROMs in neurological diseases is scarce. This study evaluates if assessment of PROMs could track progression in PwPMS. METHODS Emerging blood Biomarkers in Progressive Multiple Sclerosis (EmBioProMS) investigated PROMs (Beck depression inventory-II (BDI-II), multiple sclerosis impact scale-29 (MSIS-29), fatigue scale for motor and cognition (FSMC)) in PwPMS (primary [PPMS] and secondary progressive MS [SPMS]). PROMs were evaluated longitudinally and compared between participants with disability progression (at baseline; retrospective evidence of disability progression (EDP), and during follow up (FU); prospective evidence of confirmed disability progression (CDP)) and those without progression. In an independent cohort of placebo participants of the phase III ORATORIO trial in PPMS, the diagnostic and prognostic value of another PROMs score (36-Item Short Form Survey [SF-36]) regarding CDP was evaluated. RESULTS EmBioProMS participants with EDP in the two years prior to inclusion (n = 136/227), or who suffered from CDP during FU (number of events= 88) had worse BDI-II, MSIS-29, and FSMC scores compared to PwPMS without progression. In addition, baseline MSIS29physical above 70th, 80th, and 90th percentiles predicted future CDP/ progression independent of relapse activity in EmBioProMS PPMS participants (HR of 3.7, 6.9, 6.7, p = 0.002, <0.001, and 0.001, respectively). In the placebo arm of ORATORIO (n = 137), the physical component score (PCS) of SF-36 worsened at week 120 compared to baseline, in cases who experienced progression over the preceding trial period (P = 0.018). Worse PCS at baseline was associated with higher hazard ratios of disability accumulation over the subsequent 120 weeks (HR: 2.01 [30th-], 2.11 [20th-], and 2.8 [10th percentile], P = 0.007, 0.012 and 0.005, respectively). CONCLUSIONS PROMs could provide additional, practical, cost-efficient, and remotely accessible insight about disability progression in PMS through standardized, structured, and quantifiable patient feedback.
Collapse
Affiliation(s)
- Ahmed Abdelhak
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA; Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | - Kai Antweiler
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Markus C Kowarik
- Department of Neurology and Stroke, University Hospital of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Makbule Senel
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Muna-Miriam Hoshi
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | - Axel Haarmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Stahmann
- Forschungs- und Projektentwicklungs-gGmbH, MS-Registry by the German MS-Society, Hanover, Germany
| | - Andre Huss
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | - Stefan Gingele
- Hannover Medical School, Department of Neurology, Hanover, Germany
| | - Markus Krumbholz
- Department of Neurology and Stroke, University Hospital of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Charlotte Selge
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany
| | - Albert C Ludolph
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany
| | | | | | | | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Ulf Ziemann
- Department of Neurology and Stroke, University Hospital of Tübingen, Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Stephen L Hauser
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Ari J Green
- Department of Neurology, University of California San Francisco (UCSF), San Francisco, USA
| | - Hayrettin Tumani
- Department of Neurology, University Hospital of Ulm, Oberer Eselsberg 45, Ulm 89081, Germany.
| |
Collapse
|
|
6
|
Ma Q, Augusto DG, Montero-Martin G, Caillier SJ, Osoegawa K, Cree BAC, Hauser SL, Didonna A, Hollenbach JA, Norman PJ, Fernandez-Vina M, Oksenberg JR. High-resolution DNA methylation screening of the major histocompatibility complex in multiple sclerosis. Front Neurol 2023; 14:1326738. [PMID: 38145128 PMCID: PMC10739394 DOI: 10.3389/fneur.2023.1326738] [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: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Background The HLA-DRB1 gene in the major histocompatibility complex (MHC) region in chromosome 6p21 is the strongest genetic factor identified as influencing multiple sclerosis (MS) susceptibility. DNA methylation changes associated with MS have been consistently detected at the MHC region. However, understanding the full scope of epigenetic regulations of the MHC remains incomplete, due in part to the limited coverage of this region by standard whole genome bisulfite sequencing or array-based methods. Methods We developed and validated an MHC capture protocol coupled with bisulfite sequencing and conducted a comprehensive analysis of the MHC methylation landscape in blood samples from 147 treatment naïve MS study participants and 129 healthy controls. Results We identified 132 differentially methylated region (DMRs) within MHC region associated with disease status. The DMRs overlapped with established MS risk loci. Integration of the MHC methylome with human leukocyte antigen (HLA) genetic data indicate that the methylation changes are significantly associated with HLA genotypes. Using DNA methylation quantitative trait loci (mQTL) mapping and the causal inference test (CIT), we identified 643 cis-mQTL-DMRs paired associations, including 71 DMRs possibly mediating causal relationships between 55 single nucleotide polymorphisms (SNPs) and MS risk. Results The results describe MS-associated methylation changes in MHC region and highlight the association between HLA genotypes and methylation changes. Results from the mQTL and CIT analyses provide evidence linking MHC region variations, methylation changes, and disease risk for MS.
Collapse
Affiliation(s)
- Qin Ma
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Danillo G. Augusto
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Gonzalo Montero-Martin
- Histocompatibility and Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
- HLA Histocompatibility and Immunogenetics Laboratory, Vitalant, Phoenix, AZ, United States
| | - Stacy J. Caillier
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Kazutoyo Osoegawa
- Histocompatibility and Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
| | - Bruce A. C. Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Stephen L. Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Alessandro Didonna
- Department of Anatomy and Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Jill A. Hollenbach
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Paul J. Norman
- Department of Biomedical Informatics and Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Marcelo Fernandez-Vina
- Histocompatibility and Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jorge R. Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
|
7
|
Abdelhak A, Benkert P, Schaedelin S, Boscardin WJ, Cordano C, Oechtering J, Ananth K, Granziera C, Melie-Garcia L, Montes SC, Beaudry-Richard A, Achtnichts L, Oertel FC, Lalive PH, Leppert D, Müller S, Henry RG, Pot C, Matthias A, Salmen A, Oksenberg JR, Disanto G, Zecca C, D’Souza M, Du Pasquier R, Bridel C, Gobbi C, Kappos L, Hauser SL, Cree BAC, Kuhle J, Green AJ. Neurofilament Light Chain Elevation and Disability Progression in Multiple Sclerosis. JAMA Neurol 2023; 80:1317-1325. [PMID: 37930670 PMCID: PMC10628837 DOI: 10.1001/jamaneurol.2023.3997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/16/2023] [Indexed: 11/07/2023]
Abstract
Importance Mechanisms contributing to disability accumulation in multiple sclerosis (MS) are poorly understood. Blood neurofilament light chain (NfL) level, a marker of neuroaxonal injury, correlates robustly with disease activity in people with MS (MS); however, data on the association between NfL level and disability accumulation have been conflicting. Objective To determine whether and when NfL levels are elevated in the context of confirmed disability worsening (CDW). Design, Setting, and Participants This study included 2 observational cohorts: results from the Expression, Proteomics, Imaging, Clinical (EPIC) study at the University of California San Francisco (since 2004) were confirmed in the Swiss Multiple Sclerosis Cohort (SMSC), a multicenter study in 8 centers since 2012. Data were extracted from EPIC in April 2022 (sampling July 1, 2004, to December 20, 2016) and SMSC in December 2022 (sampling June 6, 2012, to September 2, 2021). The study included 2 observational cohorts in tertiary MS centers. All participants of both cohorts with available NfL results were included in the study, and no eligible participants were excluded or declined to participate. Exposure Association between NfL z scores and CDW. Main Outcome Measures CDW was defined as Expanded Disability Status Scale (EDSS) worsening that was confirmed after 6 or more months and classified into CDW associated with clinical relapses (CDW-R) or independent of clinical relapses (CDW-NR). Visits were classified in relation to the disability worsening events into CDW(-2) for 2 visits preceding event, CDW(-1) for directly preceding event, CDW(event) for first diagnosis of EDSS increase, and the confirmation visit. Mixed linear and Cox regression models were used to evaluate NfL dynamics and to assess the association of NfL with future CDW, respectively. Results A total of 3906 EPIC visits (609 participants; median [IQR] age, 42.0 [35.0-50.0] years; 424 female [69.6%]) and 8901 SMSC visits (1290 participants; median [IQR] age, 41.2 [32.5-49.9] years; 850 female [65.9%]) were included. In CDW-R (EPIC, 36 events; SMSC, 93 events), NfL z scores were 0.71 (95% CI, 0.35-1.07; P < .001) units higher at CDW-R(-1) in EPIC and 0.32 (95% CI, 0.14-0.49; P < .001) in SMSC compared with stable MS samples. NfL elevation could be detected preceding CDW-NR (EPIC, 191 events; SMSC, 342 events) at CDW-NR(-2) (EPIC: 0.23; 95% CI, 0.01-0.45; P = .04; SMSC: 0.28; 95% CI, 0.18-0.37; P < .001) and at CDW-NR(-1) (EPIC: 0.27; 95% CI, 0.11-0.44; P < .001; SMSC: 0.09; 95% CI, 0-0.18; P = .06). Those findings were replicated in the subgroup with relapsing-remitting MS. Time-to-event analysis confirmed the association between NfL levels and future CDW-R within approximately 1 year and CDW-NR (in approximately 1-2 years). Conclusions and Relevance This cohort study documents the occurrence of NfL elevation in advance of clinical worsening and may hint to a potential window of ongoing dynamic central nervous system pathology that precedes the diagnosis of CDW.
Collapse
Affiliation(s)
- Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Pascal Benkert
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - W. John Boscardin
- Departments of Medicine and Epidemiology & Biostatistics, University of California at San Francisco, San Francisco
| | - Christian Cordano
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
- Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Johanna Oechtering
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Kirtana Ananth
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Shivany Condor Montes
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Alexandra Beaudry-Richard
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Lutz Achtnichts
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Frederike C. Oertel
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Patrice H. Lalive
- Unit of Neuroimmunology, Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - David Leppert
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Roland G. Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Caroline Pot
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Amandine Matthias
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jorge R. Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Giulio Disanto
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, ECO, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, ECO, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marcus D’Souza
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Renaud Du Pasquier
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Claire Bridel
- Unit of Neuroimmunology, Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Department of Neurology, Neurocenter of Southern Switzerland, ECO, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Stephen L. Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Bruce A. C. Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
| | - Jens Kuhle
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Multiple Sclerosis Center, Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Ari J. Green
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco
- Department of Ophthalmology, University of California at San Francisco, San Francisco
| |
Collapse
|
|
8
|
Puig-Casadevall M, Álvarez-Bravo G, Varela AQ, Robles-Cedeño R, Sànchez Cirera L, Miguela A, Laguillo G, Montalban X, Hauser SL, Ramió-Torrentà L. Progressive multifocal leukoencephalopathy in a patient with relapsing multiple sclerosis treated with ocrelizumab: A case report. Eur J Neurol 2023; 30:3357-3361. [PMID: 37485841 DOI: 10.1111/ene.15988] [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: 04/25/2023] [Revised: 06/03/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy is a rare but often fatal complication of some multiple sclerosis treatments. Although it has mainly been associated with natalizumab treatment, its appearance with other immunosuppressive therapies has also been reported. AIMS The aim of this case report is to describe the development of progressive multifocal encephalopathy in a patient with relapsing-remitting multiple sclerosis treated with ocrelizumab without previous use of natalizumab. CONCLUSIONS A summary of the presentation and disease course is provided, presented in the context of the current literature and likely pathophysiology.
Collapse
Affiliation(s)
- Marc Puig-Casadevall
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
| | - Gary Álvarez-Bravo
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Ana Quiroga Varela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
| | - René Robles-Cedeño
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
| | | | - Albert Miguela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
| | - Gemma Laguillo
- Radiology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, California, USA
| | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Salt, Spain
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Salt, Spain
- Instituto de Salud Carlos III, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Enfermedades inflamatorias (RD21/0002/0063), Madrid, Spain
- Medical Sciences Department, University of Girona, Girona, Spain
- Neurology Department, Dr. Josep Trueta University Hospital, Girona, Spain
| |
Collapse
|
|
9
|
Hauser SL, Kappos L, Bar-Or A, Wiendl H, Paling D, Williams M, Gold R, Chan A, Milo R, Das Gupta A, Karlsson G, Sullivan R, Graham G, Merschhemke M, Häring DA, Vermersch P. The Development of Ofatumumab, a Fully Human Anti-CD20 Monoclonal Antibody for Practical Use in Relapsing Multiple Sclerosis Treatment. Neurol Ther 2023; 12:1491-1515. [PMID: 37450172 PMCID: PMC10444716 DOI: 10.1007/s40120-023-00518-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
The importance of B cells in multiple sclerosis (MS) has been demonstrated through the advent of B-cell-depleting anti-CD20 antibody therapies. Ofatumumab is the first fully human anti-CD20 monoclonal antibody (mAb) developed and tested for subcutaneous (SC) self-administration at monthly doses of 20 mg, and has been approved in the US, UK, EU, and other regions and countries worldwide for the treatment of relapsing MS. The development goal of ofatumumab was to obtain a highly efficacious anti-CD20 therapy, with a safety and tolerability profile that allows for self-administration by MS patients at home and a positive benefit-risk balance for use in the broad relapsing MS population. This development goal was enabled by the unique binding site, higher affinity to B cells, and higher potency of ofatumumab compared to previous anti-CD20 mAbs; these properties of ofatumumab facilitate rapid B-cell depletion and maintenance with a low dose at a low injection volume (20 mg/0.4 ml). The high potency in turn enables the selective targeting of B cells that reside in the lymphatic system via subcutaneous (SC) administration. Through a comprehensive dose-finding program in two phase 2 studies (one intravenous and one SC) and model simulations, it was found that safety and tolerability can be further improved, and the risk of systemic injection-related reactions (IRRs) minimized, by avoiding doses ≥ 30 mg, and by reaching initial and rapid B-cell depletion via stepwise weekly administration of ofatumumab at Weeks 0, 1, and 2 (instead of a single high dose). Once near-complete B-cell depletion is reached, it can be maintained by monthly doses of 20 mg/0.4 ml. Indeed, in phase 3 trials (ASCLEPIOS I/II), rapid and sustained near-complete B-cell depletion (largely independent of body weight, race and other factors) was observed with this dosing regimen, which resulted in superior efficacy of ofatumumab versus teriflunomide on relapse rates, disability worsening, neuronal injury (serum neurofilament light chain), and imaging outcomes. Likely due to its fully human nature, ofatumumab has a low immunogenic risk profile-only 2 of 914 patients receiving ofatumumab in ASCLEPIOS I/II developed anti-drug antibodies-and this may also underlie the infrequent IRRs (20% with ofatumumab vs. 15% with the placebo injection in the teriflunomide arm) that were mostly (99.8%) mild to moderate in severity. The overall rates of infections and serious infections in patients treated with ofatumumab were similar to those in patients treated with teriflunomide (51.6% vs. 52.7% and 2.5% vs. 1.8%, respectively). The benefit-risk profile of ofatumumab was favorable compared to teriflunomide in the broad RMS population, and also in the predefined subgroups of both recently diagnosed and/or treatment-naïve patients, as well as previously disease-modifying therapy-treated patients. Interim data from the ongoing extension study (ALITHIOS) have shown that long-term treatment with ofatumumab up to 4 years is well-tolerated in RMS patients, with no new safety risks identified. In parallel to the phase 3 trials in which SC administration was carried out with a pre-filled syringe, an autoinjector pen for more convenient self-administration of the ofatumumab 20 mg dose was developed and is available for use in clinical practice.
Collapse
Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, and Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - David Paling
- Sheffield Institute of Translational Neuroscience, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Mitzi Williams
- Joi Life Wellness Multiple Sclerosis Neurology Center, Atlanta, GA, USA
| | - Ralf Gold
- Department of Neurology, St Josef-Hospital/Ruhr-University Bochum, Bochum, Germany
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ron Milo
- Department of Neurology, Barzilai Medical Center, Ashkelon/Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | | | | | | | | | | | - Patrick Vermersch
- Univ. Lille, INSERM U1172 LilNCog, CHU Lille, FHU Precise, 59000, Lille, France
| |
Collapse
|
|
10
|
Hauser SL, Zielman R, Das Gupta A, Xi J, Stoneman D, Karlsson G, Robertson D, Cohen JA, Kappos L. Efficacy and safety of four-year ofatumumab treatment in relapsing multiple sclerosis: The ALITHIOS open-label extension. Mult Scler 2023; 29:1452-1464. [PMID: 37691530 PMCID: PMC10580679 DOI: 10.1177/13524585231195346] [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: 03/30/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Ofatumumab has demonstrated superior efficacy and favorable safety for up to 2.5 years versus teriflunomide in relapsing multiple sclerosis (RMS). OBJECTIVE Further characterize efficacy and safety of ofatumumab in RMS. METHODS Efficacy set: patients randomized to ofatumumab/teriflunomide in ASCLEPIOS I/II (core). Safety set: patients who received ⩾ 1 dose of ofatumumab in ASCLEPIOS I/II, APLIOS, APOLITOS (all core), or ALITHIOS (umbrella open-label extension). Patients received continuous ofatumumab or were newly switched from teriflunomide. Data cut-off: 25 September 2021. RESULTS In the efficacy set (n = 1882), the continuous ofatumumab group had a low annualized relapse rate (ARR 0.05 (95% confidence interval: 0.04-0.07)), low numbers of gadolinium-enhancing (Gd+) T1 lesions (0.01 lesions/scan) and fewer new/enlarging T2 lesions (annualized rate 0.08). Overall, 78.8% met three-parameter "no evidence of disease activity" criteria through 4 years. Switching from teriflunomide led to reduced ARR, risk of confirmed disability worsening (CDW), new/enlarging T2 lesions, Gd+ T1 lesions, and serum neurofilament light chain. In the continuous and newly switched ofatumumab groups, cumulative 3- and 6-month CDW rates remained low. In the safety set (n = 1969), the most frequently reported adverse events were infections and infestations (58.35%). No new safety signals were identified. CONCLUSION Ofatumumab has a favorable longer-term benefit-risk profile in RMS. TRIAL REGISTRY ALITHIOS (NCT03650114): https://clinicaltrials.gov/ct2/show/NCT03650114.
Collapse
Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (UCSF), 1651 4th Street, Box 3126, San Francisco, CA 94143, USA
| | - Ronald Zielman
- Clinical Development, Novartis Pharma B.V., Amsterdam, The Netherlands
| | - Ayan Das Gupta
- Analytics, Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Jing Xi
- China Novartis Institutes for Biomedical Research Co. Ltd., Novartis, Shanghai, People’s Republic of China
| | - Dee Stoneman
- Global Medical, Novartis Pharma AG, Basel, Switzerland
| | | | - Derrick Robertson
- Department of Neurology, Multiple Sclerosis Division, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Ludwig Kappos
- MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Head, Spine and Neuromedicine, Biomedical and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
|
11
|
Chitnis T, Qureshi F, Gehman VM, Becich M, Bove R, Cree BAC, Gomez R, Hauser SL, Henry RG, Katrib A, Lokhande H, Paul A, Caillier SJ, Santaniello A, Sattarnezhad N, Saxena S, Weiner H, Yano H, Baranzini SE. Inflammatory and neurodegenerative serum protein biomarkers increase sensitivity to detect disease activity in multiple sclerosis. medRxiv 2023:2023.06.28.23291157. [PMID: 37461671 PMCID: PMC10350151 DOI: 10.1101/2023.06.28.23291157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Background/Objectives Serum proteomic analysis of deeply-phenotyped samples, biological pathway modeling and network analysis were performed to elucidate the inflammatory and neurodegenerative processes of multiple sclerosis (MS) and identify sensitive biomarkers of MS disease activity (DA). Methods Over 1100 serum proteins were evaluated in >600 samples from three MS cohorts to identify biomarkers of clinical and radiographic (gadolinium-enhancing lesions) new MS DA. Protein levels were analyzed and associated with presence of gadolinium-enhancing lesions, clinical relapse status (CRS), and annualized relapse rate (ARR) to create a custom assay panel. Results Twenty proteins were associated with increased clinical and radiographic MS DA. Serum neurofilament light chain (NfL) showed the strongest univariate correlation with radiographic and clinical DA measures. Multivariate modeling significantly outperformed univariate NfL to predict gadolinium lesion activity, CRS and ARR. Discussion These findings provide insight regarding correlations between inflammatory and neurodegenerative biomarkers and clinical and radiographic MS DA. Funding Octave Bioscience, Inc (Menlo Park, CA).
Collapse
|
|
12
|
Bar-Or A, Thanei GA, Harp C, Bernasconi C, Bonati U, Cross AH, Fischer S, Gaetano L, Hauser SL, Hendricks R, Kappos L, Kuhle J, Leppert D, Model F, Sauter A, Koendgen H, Jia X, Herman AE. Blood neurofilament light levels predict non-relapsing progression following anti-CD20 therapy in relapsing and primary progressive multiple sclerosis: findings from the ocrelizumab randomised, double-blind phase 3 clinical trials. EBioMedicine 2023; 93:104662. [PMID: 37354600 DOI: 10.1016/j.ebiom.2023.104662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Neurofilament light chain (NfL), a neuronal cytoskeletal protein that is released upon neuroaxonal injury, is associated with multiple sclerosis (MS) relapsing activity and has demonstrated some prognostic ability for future relapse-related disease progression, yet its value in assessing non-relapsing disease progression remains unclear. METHODS We examined baseline and longitudinal blood NfL levels in 1421 persons with relapsing MS (RMS) and 596 persons with primary progressive MS (PPMS) from the pivotal ocrelizumab MS trials. NfL treatment-response and risk for disease worsening (including disability progression into the open-label extension period and slowly expanding lesions [SELs] on brain MRI) at baseline and following treatment with ocrelizumab were evaluated using time-to-event analysis and linear regression models. FINDINGS In persons from the RMS control arms without acute disease activity and in the entire PPMS control arm, higher baseline NfL was prognostic for greater whole brain and thalamic atrophy, greater volume expansion of SELs, and clinical progression. Ocrelizumab reduced NfL levels vs. controls in persons with RMS and those with PPMS, and abrogated the prognostic value of baseline NfL on disability progression. Following effective suppression of relapse activity by ocrelizumab, NfL levels at weeks 24 and 48 were significantly associated with long-term risk for disability progression, including up to 9 years of observation in RMS and PPMS. INTERPRETATION Highly elevated NfL from acute MS disease activity may mask a more subtle NfL abnormality that reflects underlying non-relapsing progressive biology. Ocrelizumab significantly reduced NfL levels, consistent with its effects on acute disease activity and disability progression. Persistently elevated NfL levels, observed in a subgroup of persons under ocrelizumab treatment, demonstrate potential clinical utility as a predictive biomarker of increased risk for clinical progression. Suppression of relapsing biology with high-efficacy immunotherapy provides a window into the relationship between NfL levels and future non-relapsing progression. FUNDING F. Hoffmann-La Roche Ltd.
Collapse
Affiliation(s)
- Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | | | - Anne H Cross
- Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | | | - Ludwig Kappos
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland
| | - David Leppert
- Multiple Sclerosis Centre, Neurology, Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
|
13
|
Zamecnik CR, Sowa GM, Abdelhak A, Dandekar R, Bair RD, Wade KJ, Bartley CM, Tubati A, Gomez R, Fouassier C, Gerungan C, Alexander J, Wapniarski AE, Loudermilk RP, Eggers EL, Zorn KC, Ananth K, Jabassini N, Mann SA, Ragan NR, Santaniello A, Henry RG, Baranzini SE, Zamvil SS, Bove RM, Guo CY, Gelfand JM, Cuneo R, von Büdingen HC, Oksenberg JR, Cree BAC, Hollenbach JA, Green AJ, Hauser SL, Wallin MT, DeRisi JL, Wilson MR. A Predictive Autoantibody Signature in Multiple Sclerosis. medRxiv 2023:2023.05.01.23288943. [PMID: 37205595 PMCID: PMC10187343 DOI: 10.1101/2023.05.01.23288943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Although B cells are implicated in multiple sclerosis (MS) pathophysiology, a predictive or diagnostic autoantibody remains elusive. Here, the Department of Defense Serum Repository (DoDSR), a cohort of over 10 million individuals, was used to generate whole-proteome autoantibody profiles of hundreds of patients with MS (PwMS) years before and subsequently after MS onset. This analysis defines a unique cluster of PwMS that share an autoantibody signature against a common motif that has similarity with many human pathogens. These patients exhibit antibody reactivity years before developing MS symptoms and have higher levels of serum neurofilament light (sNfL) compared to other PwMS. Furthermore, this profile is preserved over time, providing molecular evidence for an immunologically active prodromal period years before clinical onset. This autoantibody reactivity was validated in samples from a separate incident MS cohort in both cerebrospinal fluid (CSF) and serum, where it is highly specific for patients eventually diagnosed with MS. This signature is a starting point for further immunological characterization of this MS patient subset and may be clinically useful as an antigen-specific biomarker for high-risk patients with clinically- or radiologically-isolated neuroinflammatory syndromes.
Collapse
Affiliation(s)
- Colin R. Zamecnik
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gavin M. Sowa
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | - Ahmed Abdelhak
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ravi Dandekar
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rebecca D. Bair
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kristen J. Wade
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christopher M. Bartley
- UCSF Weill Institute for Neurosciences, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Asritha Tubati
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Refujia Gomez
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Camille Fouassier
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Chloe Gerungan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica Alexander
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Anne E. Wapniarski
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rita P. Loudermilk
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Erica L. Eggers
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Kelsey C. Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Kirtana Ananth
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Nora Jabassini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sabrina A. Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Nicholas R. Ragan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Adam Santaniello
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Roland G. Henry
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sergio E. Baranzini
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Scott S. Zamvil
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Riley M. Bove
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Chu-Yueh Guo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeffrey M. Gelfand
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Richard Cuneo
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - H.-Christian von Büdingen
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jorge R. Oksenberg
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce AC Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jill A. Hollenbach
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
| | - Ari J. Green
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Stephen L. Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| | - Mitchell T. Wallin
- Veterans Affairs, Multiple Sclerosis Center of Excellence, Washington, DC and University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Michael R. Wilson
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA
| |
Collapse
|
|
14
|
Ma Q, Shams H, Didonna A, Baranzini SE, Cree BAC, Hauser SL, Henry RG, Oksenberg JR. Integration of epigenetic and genetic profiles identifies multiple sclerosis disease-critical cell types and genes. Commun Biol 2023; 6:342. [PMID: 36997638 PMCID: PMC10063586 DOI: 10.1038/s42003-023-04713-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Genome-wide association studies (GWAS) successfully identified multiple sclerosis (MS) susceptibility variants. Despite this notable progress, understanding the biological context of these associations remains challenging, due in part to the complexity of linking GWAS results to causative genes and cell types. Here, we aimed to address this gap by integrating GWAS data with single-cell and bulk chromatin accessibility data and histone modification profiles from immune and nervous systems. MS-GWAS associations are significantly enriched in regulatory regions of microglia and peripheral immune cell subtypes, especially B cells and monocytes. Cell-specific polygenic risk scores were developed to examine the cumulative impact of the susceptibility genes on MS risk and clinical phenotypes, showing significant associations with risk and brain white matter volume. The findings reveal enrichment of GWAS signals in B cell and monocyte/microglial cell-types, consistent with the known pathology and presumed targets of effective MS therapeutics.
Collapse
Affiliation(s)
- Qin Ma
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Hengameh Shams
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Alessandro Didonna
- Department of Anatomy and Cell Biology, Brody School of Medicine, East Carolina University, Greenville, NC, 27834, USA
| | - Sergio E Baranzini
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.
| |
Collapse
|
|
15
|
Bove R, Poole S, Cuneo R, Gupta S, Sabatino J, Harms M, Cooper T, Rowles W, Miller N, Gomez R, Lincoln R, McPolin K, Powers K, Santaniello A, Renschen A, Bevan CJ, Gelfand JM, Goodin DS, Guo CY, Romeo AR, Hauser SL, Campbell Cree BA. Remote Observational Research for Multiple Sclerosis: A Natural Experiment. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/2/e200070. [PMID: 36585249 PMCID: PMC9808915 DOI: 10.1212/nxi.0000000000200070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 04/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Prospective, deeply phenotyped research cohorts monitoring individuals with chronic neurologic conditions, such as multiple sclerosis (MS), depend on continued participant engagement. The COVID-19 pandemic restricted in-clinic research activities, threatening this longitudinal engagement, but also forced adoption of televideo-enabled care. This offered a natural experiment in which to analyze key dimensions of remote research: (1) comparison of remote vs in-clinic visit costs from multiple perspectives and (2) comparison of the remote with in-clinic measures in cross-sectional and longitudinal disability evaluations. METHODS Between March 2020 and December 2021, 207 MS cohort participants underwent hybrid in-clinic and virtual research visits; 96 contributed 100 "matched visits," that is, in-clinic (Neurostatus-Expanded Disability Status Scale [NS-EDSS]) and remote (televideo-enabled EDSS [tele-EDSS]; electronic patient-reported EDSS [ePR-EDSS]) evaluations. Clinical, demographic, and socioeconomic characteristics of participants were collected. RESULTS The costs of remote visits were lower than in-clinic visits for research investigators (facilities, personnel, parking, participant compensation) but also for participants (travel, caregiver time) and carbon footprint (p < 0.05 for each). Median cohort EDSS was similar between the 3 modalities (NS-EDSS: 2, tele-EDSS: 1.5, ePR-EDSS: 2, range 0.6.5); the remote evaluations were each noninferior to the NS-EDSS within ±0.5 EDSS point (TOST for noninferiority, p < 0.01 for each). Furthermore, year to year, the % of participants with worsening/stable/improved EDSS scores was similar, whether each annual evaluation used NS-EDSS or whether it switched from NS-EDSS to tele-EDSS. DISCUSSION Altogether, the current findings suggest that remote evaluations can reduce the costs of research participation for patients, while providing a reasonable evaluation of disability trajectory longitudinally. This could inform the design of remote research that is more inclusive of diverse participants.
Collapse
Affiliation(s)
- Riley Bove
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA.
| | - Shane Poole
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Richard Cuneo
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Sasha Gupta
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Joseph Sabatino
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Meagan Harms
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Tifffany Cooper
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - William Rowles
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Nicolette Miller
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Refujia Gomez
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Robin Lincoln
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Kira McPolin
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Kyra Powers
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Adam Santaniello
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Adam Renschen
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Carolyn J Bevan
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Jeffrey M Gelfand
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Douglas S Goodin
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Chu-Yueh Guo
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Andrew R Romeo
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Stephen L Hauser
- From the UCSF Weill Institute for Neuroscience, Division of Neuroimmunology and Glial Biology, Department of Neurology, University of California San Francisco, San Francisco, CA
| | | | | |
Collapse
|
|
16
|
Gupta S, Simic M, Sagan SA, Shepherd C, Duecker J, Sobel RA, Dandekar R, Wu GF, Wu W, Pak JE, Hauser SL, Lim W, Wilson MR, Zamvil SS. CAR-T Cell-Mediated B-Cell Depletion in Central Nervous System Autoimmunity. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200080. [PMID: 36657993 PMCID: PMC9853314 DOI: 10.1212/nxi.0000000000200080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-CD20 monoclonal antibody (mAb) B-cell depletion is a remarkably successful multiple sclerosis (MS) treatment. Chimeric antigen receptor (CAR)-T cells, which target antigens in a non-major histocompatibility complex (MHC)-restricted manner, can penetrate tissues more thoroughly than mAbs. However, a previous study indicated that anti-CD19 CAR-T cells can paradoxically exacerbate experimental autoimmune encephalomyelitis (EAE) disease. We tested anti-CD19 CAR-T cells in a B-cell-dependent EAE model that is responsive to anti-CD20 B-cell depletion similar to the clinical benefit of anti-CD20 mAb treatment in MS. METHODS Anti-CD19 CAR-T cells or control cells that overexpressed green fluorescent protein were transferred into C57BL/6 mice pretreated with cyclophosphamide (Cy). Mice were immunized with recombinant human (rh) myelin oligodendrocyte protein (MOG), which causes EAE in a B-cell-dependent manner. Mice were evaluated for B-cell depletion, clinical and histologic signs of EAE, and immune modulation. RESULTS Clinical scores and lymphocyte infiltration were reduced in mice treated with either anti-CD19 CAR-T cells with Cy or control cells with Cy, but not with Cy alone. B-cell depletion was observed in peripheral lymphoid tissue and in the CNS of mice treated with anti-CD19 CAR-T cells with Cy pretreatment. Th1 or Th17 populations did not differ in anti-CD19 CAR-T cell, control cell-treated animals, or Cy alone. DISCUSSION In contrast to previous data showing that anti-CD19 CAR-T cell treatment exacerbated EAE, we observed that anti-CD19 CAR-T cells ameliorated EAE. In addition, anti-CD19 CAR-T cells thoroughly depleted B cells in peripheral tissues and in the CNS. However, the clinical benefit occurred independently of antigen specificity or B-cell depletion.
Collapse
Affiliation(s)
- Sasha Gupta
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Milos Simic
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Sharon A Sagan
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Chanelle Shepherd
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Jason Duecker
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Raymond A Sobel
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Ravi Dandekar
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Gregory F Wu
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Wesley Wu
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - John E Pak
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Stephen L Hauser
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Wendell Lim
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Michael R Wilson
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA
| | - Scott S Zamvil
- From the Department of Neurology (S.G., S.A.S., C.S., R.D., S.L.H., M.R.W., S.S.Z.), Weill Institute for Neurosciences, University of California San Francisco, CA; Department of Cellular Molecular Pharmacology (M.S., J.D., W.L.), University of California San Francisco Cell Design Institute, CA; Veterans Affairs Health Care System (R.A.S.), Department of Pathology, Stanford University School of Medicine, CA; Departments of Neurology and Pathology and Immunology (G.F.W.), Washington University in St. Louis, MO; and Chan Zuckerberg Biohub (W.W., J.E.P.), San Francisco, CA.
| |
Collapse
|
|
17
|
Block VJ, Cheng S, Juwono J, Cuneo R, Kirkish G, Alexander AM, Khan M, Akula A, Caverzasi E, Papinutto N, Stern WA, Pletcher MJ, Marcus GM, Olgin JE, Hauser SL, Gelfand JM, Bove R, Cree BAC, Henry RG. Association of daily physical activity with brain volumes and cervical spinal cord areas in multiple sclerosis. Mult Scler 2023; 29:363-373. [PMID: 36573559 PMCID: PMC9972237 DOI: 10.1177/13524585221143726] [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] [Indexed: 12/28/2022]
Abstract
BACKGROUND Remote activity monitoring has the potential to evaluate real-world, motor function, and disability at home. The relationships of daily physical activity with spinal cord white matter and gray matter (GM) areas, multiple sclerosis (MS) disability and leg function, are unknown. OBJECTIVE Evaluate the association of structural central nervous system pathology with ambulatory disability. METHODS Fifty adults with progressive or relapsing MS with motor disability who could walk >2 minutes were assessed using clinician-evaluated, patient-reported outcomes, and quantitative brain and spinal cord magnetic resonance imaging (MRI) measures. Fitbit Flex2, worn on the non-dominant wrist, remotely assessed activity over 30 days. Univariate and multivariate analyses were performed to assess correlations between physical activity and other disability metrics. RESULTS Mean age was 53.3 years and median Expanded Disability Status Scale (EDSS) was 4.0. Average daily step counts (STEPS) were highly correlated with EDSS and walking measures. Greater STEPS were significantly correlated with greater C2-C3 spinal cord GM areas (ρ = 0.39, p = 0.04), total cord area (TCA; ρ = 0.35, p = 0.04), and cortical GM volume (ρ = 0.32, p = 0.04). CONCLUSION These results provide preliminary evidence that spinal cord GM area is a neuroanatomical substrate associated with STEPS. STEPS could serve as a proxy to alert clinicians and researchers to possible changes in structural nervous system pathology.
Collapse
Affiliation(s)
- Valerie J Block
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Physical Therapy and Rehabilitation
Science, University of California San Francisco, San Francisco, CA,
USA
| | - Shuiting Cheng
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeremy Juwono
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Richard Cuneo
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Gina Kirkish
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amber M Alexander
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Mahir Khan
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Amit Akula
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Eduardo Caverzasi
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA/Department of Brain and Behavioral Sciences, University
of Pavia, Pavia, Italy
| | - Nico Papinutto
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | | | - Mark J Pletcher
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA/Department of
Medicine, University of California San Francisco, San Francisco, CA,
USA
| | - Gregory M Marcus
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Department of Epidemiology and Biostatistics,
University of California San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Jeffrey M Gelfand
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Riley Bove
- UCSF Weill Institute for Neurosciences,
Department of Neurology, University of California San Francisco, San
Francisco, CA, USA
| | - Bruce AC Cree
- BAC Cree UCSF Weill Institute for
Neurosciences, Department of Neurology, University of California, 1651 4th St
Suite 252, San Francisco, San Francisco, CA 94158, USA.
| | | |
Collapse
|
|
18
|
Hauser SL, Bar-Or A, Weber MS, Kletzl H, Günther A, Manfrini M, Model F, Mercier F, Petry C, Wing Q, Koendgen H, Smith T, Kappos L. Association of Higher Ocrelizumab Exposure With Reduced Disability Progression in Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/2/e200094. [PMID: 36792367 PMCID: PMC9931184 DOI: 10.1212/nxi.0000000000200094] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/19/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Ocrelizumab improved clinical and MRI measures of disease activity and progression in three phase 3 multiple sclerosis (MS) studies. Post hoc analyses demonstrated a correlation between the ocrelizumab serum concentration and the degree of blood B-cell depletion, and body weight was identified as the most influential covariate on ocrelizumab pharmacokinetics. The magnitude of ocrelizumab treatment benefit on disability progression was greater in lighter vs heavier patients. These observations suggest that higher ocrelizumab serum levels provide more complete B-cell depletion and a greater delay in disability progression. The current post hoc analyses assessed population exposure-efficacy/safety relationships of ocrelizumab in patients with relapsing and primary progressive MS. METHODS Patients in OPERA I/II and ORATORIO were grouped in exposure quartiles based on their observed individual serum ocrelizumab level over the treatment period. Exposure-response relationships were analyzed for clinical efficacy (24-week confirmed disability progression (CDP), annualized relapse rate [ARR], and MRI outcomes) and adverse events. RESULTS Ocrelizumab reduced new MRI lesion counts to nearly undetectable levels in patients with relapsing or primary progressive MS across all exposure subgroups, and reduced ARR in patients with relapsing MS to very low levels (0.13-0.18). A consistent trend of higher ocrelizumab exposure leading to lower rates of CDP was seen (0%-25% [lowest] to 75%-100% [highest] quartile hazard ratios and 95% confidence intervals; relapsing MS: 0.70 [0.41-1.19], 0.85 [0.52-1.39], 0.47 [0.25-0.87], and 0.34 [0.17-0.70] vs interferon β-1a; primary progressive MS: 0.88 [0.59-1.30], 0.86 [0.60-1.25], 0.77 [0.52-1.14], and 0.55 [0.36-0.83] vs placebo). Infusion-related reactions, serious adverse events, and serious infections were similar across exposure subgroups. DISCUSSION The almost complete reduction of ARR and MRI activity already evident in the lowest quartile, and across all ocrelizumab-exposure groups, suggests a ceiling effect. A consistent trend of higher ocrelizumab exposure leading to greater reduction in risk of CDP was observed, particularly in the relapsing MS trials, and was not associated with a higher rate of adverse events. Higher ocrelizumab exposure may provide improved control of disability progression by reducing disease activity below that detectable by ARR and MRI, and/or by attenuating other B-cell-related pathologies responsible for tissue damage. CLASSIFICATION OF EVIDENCE This analysis provides Class III evidence that higher ocrelizumab serum levels are related to greater reduction in risk of disability progression in patients with multiple sclerosis. The study is rated Class III because of the initial treatment randomization disclosure that occurred after inclusion in the open-label extension. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT01247324 (OPERA I), NCT01412333 (OPERA II), and NCT01194570 (ORATORIO).
Collapse
Affiliation(s)
- Stephen L Hauser
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland.
| | - Amit Bar-Or
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Martin S Weber
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Heidemarie Kletzl
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Andreas Günther
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Marianna Manfrini
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Fabian Model
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Francois Mercier
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Claire Petry
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Qing Wing
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Harold Koendgen
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Terence Smith
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| | - Ludwig Kappos
- From the UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco (S.L.H.); Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Institute of Neuropathology and Department of Neurology (M.S.W.), Universitätsmedizin Göttingen Fraunhofer-Institute for Translational Medicine and Pharmacology ITMP, Göttingen, Germany; F. Hoffmann-La Roche Ltd (H. Kletzl, A.G., M.M., F. Model, F. Mercier, C.P., Q.W., H. Koendgen), Basel, Switzerland; NeuMatRx Ltd (T.S.), Bath, UK; and University Hospital Basel (L.K.), University of Basel, Switzerland
| |
Collapse
|
|
19
|
Shams H, Shao X, Santaniello A, Kirkish G, Harroud A, Ma Q, Isobe N, Schaefer CA, McCauley JL, Cree BAC, Didonna A, Baranzini SE, Patsopoulos NA, Hauser SL, Barcellos LF, Henry RG, Oksenberg JR. Polygenic risk score association with multiple sclerosis susceptibility and phenotype in Europeans. Brain 2023; 146:645-656. [PMID: 35253861 PMCID: PMC10169285 DOI: 10.1093/brain/awac092] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Polygenic inheritance plays a pivotal role in driving multiple sclerosis susceptibility, an inflammatory demyelinating disease of the CNS. We developed polygenic risk scores (PRS) of multiple sclerosis and assessed associations with both disease status and severity in cohorts of European descent. The largest genome-wide association dataset for multiple sclerosis to date (n = 41 505) was leveraged to generate PRS scores, serving as an informative susceptibility marker, tested in two independent datasets, UK Biobank [area under the curve (AUC) = 0.73, 95% confidence interval (CI): 0.72-0.74, P = 6.41 × 10-146] and Kaiser Permanente in Northern California (KPNC, AUC = 0.8, 95% CI: 0.76-0.82, P = 1.5 × 10-53). Individuals within the top 10% of PRS were at higher than 5-fold increased risk in UK Biobank (95% CI: 4.7-6, P = 2.8 × 10-45) and 15-fold higher risk in KPNC (95% CI: 10.4-24, P = 3.7 × 10-11), relative to the median decile. The cumulative absolute risk of developing multiple sclerosis from age 20 onwards was significantly higher in genetically predisposed individuals according to PRS. Furthermore, inclusion of PRS in clinical risk models increased the risk discrimination by 13% to 26% over models based only on conventional risk factors in UK Biobank and KPNC, respectively. Stratifying disease risk by gene sets representative of curated cellular signalling cascades, nominated promising genetic candidate programmes for functional characterization. These pathways include inflammatory signalling mediation, response to viral infection, oxidative damage, RNA polymerase transcription, and epigenetic regulation of gene expression to be among significant contributors to multiple sclerosis susceptibility. This study also indicates that PRS is a useful measure for estimating susceptibility within related individuals in multicase families. We show a significant association of genetic predisposition with thalamic atrophy within 10 years of disease progression in the UCSF-EPIC cohort (P < 0.001), consistent with a partial overlap between the genetics of susceptibility and end-organ tissue injury. Mendelian randomization analysis suggested an effect of multiple sclerosis susceptibility on thalamic volume, which was further indicated to be through horizontal pleiotropy rather than a causal effect. In summary, this study indicates important, replicable associations of PRS with enhanced risk assessment and radiographic outcomes of tissue injury, potentially informing targeted screening and prevention strategies.
Collapse
Affiliation(s)
- Hengameh Shams
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA.,Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Xiaorong Shao
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Adil Harroud
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Qin Ma
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Noriko Isobe
- Department of Neurology, Graduate School of medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | | | | | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL, USA.,Dr. John T. Macdonald Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Alessandro Didonna
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA.,Department of Anatomy and Cell Biology, East Carolina University, Greenville, NC 27834, USA
| | - Sergio E Baranzini
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Nikolaos A Patsopoulos
- Systems Biology and Computer Science Program, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, 02115 MA, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA 02115, USA.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Lisa F Barcellos
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158, USA
| |
Collapse
|
|
20
|
Ganzetti M, Graves JS, Holm SP, Dondelinger F, Midaglia L, Gaetano L, Craveiro L, Lipsmeier F, Bernasconi C, Montalban X, Hauser SL, Lindemann M. Neural correlates of digital measures shown by structural MRI: a post-hoc analysis of a smartphone-based remote assessment feasibility study in multiple sclerosis. J Neurol 2023; 270:1624-1636. [PMID: 36469103 PMCID: PMC9970954 DOI: 10.1007/s00415-022-11494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A study was undertaken to evaluate remote monitoring via smartphone sensor-based tests in people with multiple sclerosis (PwMS). This analysis aimed to explore regional neural correlates of digital measures derived from these tests. METHODS In a 24-week, non-randomized, interventional, feasibility study (NCT02952911), sensor-based tests on the Floodlight Proof-of-Concept app were used to assess cognition (smartphone-based electronic Symbol Digit Modalities Test), upper extremity function (Draw a Shape Test, Pinching Test), and gait and balance (Static Balance Test, Two-Minute Walk Test, U-Turn Test). In this post-hoc analysis, digital measures and standard clinical measures (e.g., Nine-Hole Peg Test [9HPT]) were correlated against regional structural magnetic resonance imaging outcomes. Seventy-six PwMS aged 18-55 years with an Expanded Disability Status Scale score of 0.0-5.5 were enrolled from two different sites (USA and Spain). Sixty-two PwMS were included in this analysis. RESULTS Worse performance on digital and clinical measures was associated with smaller regional brain volumes and larger ventricular volumes. Whereas digital and clinical measures had many neural correlates in common (e.g., putamen, globus pallidus, caudate nucleus, lateral occipital cortex), some were observed only for digital measures. For example, Draw a Shape Test and Pinching Test measures, but not 9HPT score, correlated with volume of the hippocampus (r = 0.37 [drawing accuracy over time on the Draw a Shape Test]/ - 0.45 [touching asynchrony on the Pinching Test]), thalamus (r = 0.38/ - 0.41), and pons (r = 0.35/ - 0.35). CONCLUSIONS Multiple neural correlates were identified for the digital measures in a cohort of people with early MS. Digital measures showed associations with brain regions that clinical measures were unable to demonstrate, thus providing potential novel information on functional ability compared with standard clinical assessments.
Collapse
Affiliation(s)
- Marco Ganzetti
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jennifer S. Graves
- grid.266100.30000 0001 2107 4242Department of Neurosciences, University of California San Diego, San Diego, CA USA
| | - Sven P. Holm
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Frank Dondelinger
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland ,grid.419481.10000 0001 1515 9979Present Address: Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luciana Midaglia
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Gaetano
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Licinio Craveiro
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Corrado Bernasconi
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Xavier Montalban
- grid.411083.f0000 0001 0675 8654Department of Neurology-Neuroimmunology, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Stephen L. Hauser
- grid.266102.10000 0001 2297 6811Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Michael Lindemann
- grid.417570.00000 0004 0374 1269F. Hoffmann-La Roche Ltd, Basel, Switzerland
| |
Collapse
|
|
21
|
Cordano C, Nourbakhsh B, Yiu HH, Papinutto N, Caverzasi E, Abdelhak A, Oertel FC, Beaudry-Richard A, Santaniello A, Sacco S, Bennett DJ, Gomez A, Sigurdson CJ, Hauser SL, Magliozzi R, Cree BA, Henry RG, Green AJ. Differences in Age-related Retinal and Cortical Atrophy Rates in Multiple Sclerosis. Neurology 2022; 99:e1685-e1693. [PMID: 36038272 PMCID: PMC9559941 DOI: 10.1212/wnl.0000000000200977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The timing of neurodegeneration in multiple sclerosis (MS) remains unclear. It is critical to understand the dynamics of neuroaxonal loss if we hope to prevent or forestall permanent disability in MS. We therefore used a deeply phenotyped longitudinal cohort to assess and compare rates of neurodegeneration in retina and brain throughout the MS disease course. METHODS We analyzed 597 patients with MS who underwent longitudinal optical coherence tomography imaging annually for 4.5 ± 2.4 years and 432 patients who underwent longitudinal MRI scans for 10 ± 3.4 years, quantifying macular ganglion cell-inner plexiform layer (GCIPL) volume and cortical gray matter (CGM) volume. The association between the slope of decline in the anatomical structure and the age of entry in the cohort (categorized by the MRI cohort's age quartiles) was assessed by hierarchical linear models. RESULTS The rate of CGM volume loss declined with increasing age of study entry (1.3% per year atrophy for the age of entry in the cohort younger than 35 years; 1.1% for older than 35 years and younger than 41; 0.97% for older than 41 years and younger than 49; 0.9% for older than 49 years) while the rate of GCIPL thinning was highest in patients in the youngest quartile, fell by more than 50% in the following age quartile, and then stabilized (0.7% per year thinning for the age of entry in the cohort younger than 35 years; 0.29% for age older than 35 and younger than 41 years; 0.34% for older than 41 and younger than 49 years; 0.33% for age older than 49 years). DISCUSSION An age-dependent reduction in retinal and cortical volume loss rates during relapsing-remitting MS suggests deceleration in neurodegeneration in the earlier period of disease and further indicates that the period of greatest adaptive immune-mediated inflammatory activity is also the period with the greatest neuroaxonal loss.
Collapse
Affiliation(s)
- Christian Cordano
- From the Department of Neurology (C.C., N.P., E.C., A.A., F.C.O., A.B.-R., A.S., S.S., D.J.B., A.G., S.L.H., B.A.C.C., R.G.H., A.J.G.), UCSF Weill Institute for Neurosciences, University of California, San Francisco; Department of Neurology (B.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biology (H.H.Y.), University of Maryland, College Park; Department of Pathology (C.J.S.), University of California, San Diego, La Jolla; and Department of Neurosciences (R.M.), Biomedicine and Movement Sciences, University of Verona, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Zhou X, Baumann R, Gao X, Mendoza M, Singh S, Sand IK, Xia Z, Cox LM, Chitnis T, Yoon H, Moles L, Caillier SJ, Santaniello A, Ackermann G, Harroud A, Lincoln R, Gomez R, Peña AG, Digga E, Hakim DJ, Vazquez-Baeza Y, Soman K, Warto S, Humphrey G, Farez M, Gerdes LA, Oksenberg JR, Zamvil SS, Chandran S, Connick P, Otaegui D, Castillo-Triviño T, Hauser SL, Gelfand JM, Weiner HL, Hohlfeld R, Wekerle H, Graves J, Bar-Or A, Cree BA, Correale J, Knight R, Baranzini SE. Gut microbiome of multiple sclerosis patients and paired household healthy controls reveal associations with disease risk and course. Cell 2022; 185:3467-3486.e16. [PMID: 36113426 PMCID: PMC10143502 DOI: 10.1016/j.cell.2022.08.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/21/2022] [Accepted: 08/18/2022] [Indexed: 02/07/2023]
Abstract
Changes in gut microbiota have been associated with several diseases. Here, the International Multiple Sclerosis Microbiome Study (iMSMS) studied the gut microbiome of 576 MS patients (36% untreated) and genetically unrelated household healthy controls (1,152 total subjects). We observed a significantly increased proportion of Akkermansia muciniphila, Ruthenibacterium lactatiformans, Hungatella hathewayi, and Eisenbergiella tayi and decreased Faecalibacterium prausnitzii and Blautia species. The phytate degradation pathway was over-represented in untreated MS, while pyruvate-producing carbohydrate metabolism pathways were significantly reduced. Microbiome composition, function, and derived metabolites also differed in response to disease-modifying treatments. The therapeutic activity of interferon-β may in part be associated with upregulation of short-chain fatty acid transporters. Distinct microbial networks were observed in untreated MS and healthy controls. These results strongly support specific gut microbiome associations with MS risk, course and progression, and functional changes in response to treatment.
Collapse
Affiliation(s)
- Xiaoyuan Zhou
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Ryan Baumann
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Xiaohui Gao
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Myra Mendoza
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Sneha Singh
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lau M. Cox
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hongsup Yoon
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospitals, Ludwig-Maximilians-Universität München, and Munich Cluster of Systems Neurology (SyNergy), München, Germany
- Department Neuroimmunology, Max Planck Institute (MPI) of Neurobiology, Munich, Germany
| | - Laura Moles
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Stacy J. Caillier
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Gail Ackermann
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Adil Harroud
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Robin Lincoln
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | | | | | - Elise Digga
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Joseph Hakim
- Department of Bioinformatics and Systems Biology, University of California, San Diego, La Jolla, CA, USA
| | - Yoshiki Vazquez-Baeza
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
| | - Karthik Soman
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Shannon Warto
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Greg Humphrey
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Mauricio Farez
- Department of Neurology, Institute for Neurological Research Dr. Raul Carrea (FLENI), Buenos Aires, Argentina
| | - Lisa Ann Gerdes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jorge R. Oksenberg
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Scott S. Zamvil
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | | | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Otaegui
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Tamara Castillo-Triviño
- Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
- Department of Neurology, Hospital Universitario Donostia and Neurosciences Area, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Stephen L. Hauser
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Jeffrey M. Gelfand
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Howard L. Weiner
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospitals, Ludwig-Maximilians-Universität München, and Munich Cluster of Systems Neurology (SyNergy), München, Germany
| | - Hartmut Wekerle
- Department Neuroimmunology, Max Planck Institute (MPI) of Neurobiology, Munich, Germany
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania, Pennsylvania, PA, USA
| | - Bruce A.C. Cree
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raul Carrea (FLENI), Buenos Aires, Argentina
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
| | - Sergio E. Baranzini
- Weill Institute for Neurosciences. Department of Neurology, University of California, San Francisco, CA, USA
| | | |
Collapse
|
|
23
|
Schmierer K, Hauser SL, Kappos L, Montalban X, Craveiro L, Hughes R, Prajapati K, Koendgen H, Pradhan A, Wolinsky JS. 034 Updated safety analysis of ocrelizumab in multiple sclerosis. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOngoing safety reporting is crucial to understanding the long-term benefit-risk profile of ocrelizumab in multiple sclerosis (MS). Safety/efficacy of ocrelizumab have been characterised in Phase II (NCT00676715) and III (NCT01247324/NCT01412333/NCT01194570) trials in relapsing-remitting MS, relapsing MS (RMS) and primary progressive MS (PPMS). Here, we report safety evaluations from ocrelizumab clinical trials and open-label extensions up to January 2019, and selected post-marketing data.MethodsSafety outcomes are reported for the ocrelizumab all-exposure population in Phase II/III and ongoing Phase IIIb trials. To account for different exposure lengths, rates per 100 patient years (PY) are presented.ResultsIn clinical trials, 4,611 patients with MS received ocrelizumab (14,329 PY exposure). Reported rates per 100 PY (95% confidence interval) were: adverse events (AEs), 252 (249–254); serious AEs, 7.33(6.89–7.79); infections, 76.7 (75.3–78.2); serious infections, 1.99 (1.77–2.23); malignancies, 0.46 (0.35–0.58); and AEs leading to discontinuation, 1.08 (0.92–1.27). Updated ocrelizumab all-exposure population data and selected post-marketing data will be presented.ConclusionsReported event rates in the ocrelizumab all-exposure clinical trial population and post-mar- keting settings remain generally consistent with the controlled treatment period in RMS/PPMS populations. Regular reporting of long-term safety data will continue.k.schmierer@qmul.ac.uk
Collapse
|
|
24
|
Giovannoni G, Kappos L, Seze JD, Hauser SL, Overell J, Koendgen H, Prajapati K, Manfrini M, Wang Q, Wolinsky JS. 020 Long-term efficacy of ocrelizumab in relapsing multiple sclerosis: 6 study years. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundEfficacy/safety of ocrelizumab in relapsing multiple sclerosis were demonstrated in the OPERA I/II (NCT01247324/NCT01412333) double-blind period (DBP). We assessed the efficacy of switching to or maintaining ocrelizumab after 4 years of the open-label extension (OLE).MethodsAt OLE commencement, patients continued ocrelizumab (OCR-OCR) or switched from interferon-β-1a to OCR (IFN-OCR). Adjusted annualised relapse rate (ARR), time-to-onset of 24-week confirmed disability progression (CDP24) and risk of requiring a walking aid (Expanded Disability Status Scale score ≥6.0) from DBP baseline were analysed.ResultsAmong IFN-OCR switchers, ARR decreased year-on-year from 0.2 in the pre-switch year to 0.04 in OLE Year 4; OCR-OCR continuers maintained low ARRs (pre-switch, 0.13; OLE Year 4, 0.05). CDP24 was lower year-on-year in OCR-OCR continuers versus IFN-OCR switchers in the pre-switch year (7.7% vs 12.0%) and at OLE Year 4 (19.2% vs 23.7%); p<0.05 all comparisons. Over the DBP and OLE, risk of requiring a walking aid was 44% lower (p=0.004) in OCR-OCR continuers versus IFN-OCR switchers.ConclusionsAfter 6 years of follow-up, rates of patients with CDP24 and risk of requiring a walking aid remained lower in earlier initiators of ocrelizumab (OCR-OCR) versus those initially receiving IFN (IFN-OCR), demonstrating maintained benefits of earlier treatment with ocrelizumab.g.giovannoni@qmul.ac.uk
Collapse
|
|
25
|
Schmierer K, Bar-Or A, Bermel R, Weber MS, Hughes R, Lin CJ, Wang JM, Craviero L, Hauser SL, Derfuss T. 033 Ocrelizumab: serum Ig levels and serious infections. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAn apparent association between decreased Ig levels and serious infections (SIs) was pre- viously reported. Here, we characterised the temporal evolution of Ig levels and risk of SIs by baseline Ig quartile over 6 years in OPERA I/II (NCT01247324/NCT01412333), ORATORIO (NCT01194570), and their open-label extensions.MethodsSerum Ig levels were measured ≥24 weeks. Baseline IgG/IgM/IgA quartiles (g/L) were determined; Q1 represents the lowest quartile. Changes in Ig levels and SI rates by baseline quartiles were assessed.ResultsOver 6 years, mean change in IgG levels, g/L (% change) per year by quartile were: Q1, -0.24 (-2.9%); Q2, -0.32 (-3.2%); Q3, -0.40 (-3.6%); Q4, -0.40 (-3.0%) in OPERA, and Q1, -0.23 (-2.9%); Q2, -0.28 (-2.9%);Q3 -0.35 (-3.1%); Q4, -0.51 (-3.8%) in ORATORIO. SI rates/100PY (95% CI) were: Q1, 1.63 (0.95–2.61); Q2, 1.55(0.90–2.48); Q3, 1.51 (0.86–2.45); Q4, 1.11 (0.57–1.94) in OPERA, and Q1, 4.04 (2.66–5.87); Q2, 3.81 (2.46–5.62); Q3, 5.39 (3.76–7.50); Q4, 2.17 (1.22–3.59) in ORATORIO. Changes in IgM/IgA will also be presented.ConclusionsPatients with lower baseline IgG demonstrated less absolute IgG decline, but similar per- centage decline, versus patients with higher baseline IgG. SI rates were low, and similar across quartiles.k.schmierer@qmul.ac.uk
Collapse
|
|
26
|
Li J, Zaslavsky M, Su Y, Guo J, Sikora MJ, van Unen V, Christophersen A, Chiou SH, Chen L, Li J, Ji X, Wilhelmy J, McSween AM, Palanski BA, Mallajosyula VVA, Bracey NA, Dhondalay GKR, Bhamidipati K, Pai J, Kipp LB, Dunn JE, Hauser SL, Oksenberg JR, Satpathy AT, Robinson WH, Dekker CL, Steinmetz LM, Khosla C, Utz PJ, Sollid LM, Chien YH, Heath JR, Fernandez-Becker NQ, Nadeau KC, Saligrama N, Davis MM. KIR +CD8 + T cells suppress pathogenic T cells and are active in autoimmune diseases and COVID-19. Science 2022; 376:eabi9591. [PMID: 35258337 PMCID: PMC8995031 DOI: 10.1126/science.abi9591] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
In this work, we find that CD8+ T cells expressing inhibitory killer cell immunoglobulin-like receptors (KIRs) are the human equivalent of Ly49+CD8+ regulatory T cells in mice and are increased in the blood and inflamed tissues of patients with a variety of autoimmune diseases. Moreover, these CD8+ T cells efficiently eliminated pathogenic gliadin-specific CD4+ T cells from the leukocytes of celiac disease patients in vitro. We also find elevated levels of KIR+CD8+ T cells, but not CD4+ regulatory T cells, in COVID-19 patients, correlating with disease severity and vasculitis. Selective ablation of Ly49+CD8+ T cells in virus-infected mice led to autoimmunity after infection. Our results indicate that in both species, these regulatory CD8+ T cells act specifically to suppress pathogenic T cells in autoimmune and infectious diseases.
Collapse
Affiliation(s)
- Jing Li
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Maxim Zaslavsky
- Program in Computer Science, Stanford University, Stanford, CA, USA
| | - Yapeng Su
- Institute for Systems Biology, Seattle, WA, USA
| | - Jing Guo
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael J. Sikora
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vincent van Unen
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Asbjørn Christophersen
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, University of Oslo, Oslo, Norway
| | - Shin-Heng Chiou
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Liang Chen
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Jiefu Li
- The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Xuhuai Ji
- Human Immune Monitoring Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Julie Wilhelmy
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Alana M. McSween
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Nathan A. Bracey
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Gopal Krishna R. Dhondalay
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Kartik Bhamidipati
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joy Pai
- Program in Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucas B. Kipp
- Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey E. Dunn
- Division of Neuroimmunology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Stephen L. Hauser
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Jorge R. Oksenberg
- Department of Neurology and UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ansuman T. Satpathy
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - William H. Robinson
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Cornelia L. Dekker
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Lars M. Steinmetz
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Genome Technology Center, Stanford University, Palo Alto, CA, USA
- European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany
| | - Chaitan Khosla
- Department of Chemistry, Stanford University, Stanford, CA, USA
- Department of Chemical Engineering, Stanford University, Stanford, CA, USA
- Stanford ChEM-H, Stanford University, Stanford, CA, USA
| | - Paul J. Utz
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ludvig M. Sollid
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Yueh-Hsiu Chien
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - James R. Heath
- Institute for Systems Biology, Seattle, WA, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Kari C. Nadeau
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Naresha Saligrama
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark M. Davis
- Institute of Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, USA
- The Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
|
27
|
Kaplan TB, Gopal A, Block VJ, Suskind AM, Zhao C, Polgar-Turcsanyi M, Saraceno TJ, Gomez R, Santaniello A, Consortium SUMMIT, Ayoubi NE, Cree BA, Hauser SL, Weiner H, Chitnis T, Khoury S, Bove R. Challenges to Longitudinal Characterization of Lower Urinary Tract Dysfunction in Multiple Sclerosis. Mult Scler Relat Disord 2022; 62:103793. [DOI: 10.1016/j.msard.2022.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/01/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
|
|
28
|
Ziemssen T, Arnold DL, Alvarez E, Cross AH, Willi R, Li B, Kukkaro P, Kropshofer H, Ramanathan K, Merschhemke M, Kieseier B, Su W, Häring DA, Hauser SL, Kappos L, Kuhle J. Prognostic Value of Serum Neurofilament Light Chain for Disease Activity and Worsening in Patients With Relapsing Multiple Sclerosis: Results From the Phase 3 ASCLEPIOS I and II Trials. Front Immunol 2022; 13:852563. [PMID: 35432382 PMCID: PMC9009385 DOI: 10.3389/fimmu.2022.852563] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Objective This study aims to confirm the prognostic value of baseline serum neurofilament light chain (sNfL) for on-study disease activity and worsening in patients with relapsing MS (RMS). Background Previous post-hoc studies suggested that sNfL could be a prognostic biomarker in RMS. In the phase 3 ASCLEPIOS I/II trials in which ofatumumab demonstrated better efficacy outcomes than teriflunomide, treatment with ofatumumab also led to significantly reduced sNfL levels compared to teriflunomide treatment. Design/Methods In this study, we report protocol-planned analyses from the pooled ASCLEPIOS I/II trials (N=1882). Per protocol, patients were stratified by median baseline sNfL levels (9.3 pg/ml) into high (>median) and low (≤median) categories to prognosticate: annualized rate of new/enlarging T2 (neT2) lesions in year 1 and 2, annualized relapse rate, annual percentage change in whole brain (WB) and regional brain volume [thalamus, white matter (WM), cortical gray matter (cGM)], and disability outcomes. Similar analyses were performed for the recently diagnosed (within 3 years), treatment-naive patients (no prior disease-modifying therapy) subgroup. Results High versus low sNfL at baseline was prognostic of increased on-study T2 lesion formation at year 1 (relative increase: ofatumumab +158%; teriflunomide +69%, both p<0.001), which persisted in year 2 (+65%, p=0.124; +46%, p=0.003); of higher annual percentage change of WB volume (ofatumumab, −0.32% vs. −0.24%, p=0.044, and teriflunomide, −0.43% vs. −0.29%, p=0.002), thalamic volume (−0.56% vs. −0.31%, p=0.047 and −0.94% vs. −0.49%, p<0.001), and WM volume (−0.30% vs. −0.19%, p=0.083 and −0.38% vs. −0.18%, p=0.003) but not of cGM volume (−0.39% vs. −0.32%, p=0.337 and −0.49% vs. −0.46%, p=0.563). A single sNfL assessment at baseline was not prognostic for on-study relapses or disability worsening. Results were similar in the subgroup of recently diagnosed, treatment-naive patients. Conclusion This study confirms that baseline sNfL levels are prognostic of future on-study lesion formation and whole brain and regional atrophy in all RMS patients, including recently diagnosed, treatment-naive patients.
Collapse
Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl-Gustav Carus, Dresden, Germany
- *Correspondence: Tjalf Ziemssen,
| | - Douglas L. Arnold
- Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- NeuroRx Research, Montreal, QC, Canada
| | - Enrique Alvarez
- Department of Neurology, Rocky Mountain MS Center at the University of Colorado, Aurora, CO, United States
| | - Anne H. Cross
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | | | - Bingbing Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | | | | | | | | | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | | | - Stephen L. Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic and MS Center, Department of Head, Spine and Neuromedicine, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic and MS Center, Department of Head, Spine and Neuromedicine, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
|
29
|
Gärtner J, Hauser SL, Bar-Or A, Montalban X, Cohen JA, Cross AH, Deiva K, Ganjgahi H, Häring DA, Li B, Pingili R, Ramanathan K, Su W, Willi R, Kieseier B, Kappos L. Efficacy and safety of ofatumumab in recently diagnosed, treatment-naive patients with multiple sclerosis: Results from ASCLEPIOS I and II. Mult Scler 2022; 28:1562-1575. [PMID: 35266417 PMCID: PMC9315184 DOI: 10.1177/13524585221078825] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Indexed: 12/11/2022]
Abstract
Background: In the phase III ASCLEPIOS I and II trials, participants with relapsing
multiple sclerosis receiving ofatumumab had significantly better clinical
and magnetic resonance imaging (MRI) outcomes than those receiving
teriflunomide. Objectives: To assess the efficacy and safety of ofatumumab versus teriflunomide in
recently diagnosed, treatment-naive (RDTN) participants from ASCLEPIOS. Methods: Participants were randomized to receive ofatumumab (20 mg subcutaneously
every 4 weeks) or teriflunomide (14 mg orally once daily) for up to
30 months. Endpoints analysed post hoc in the protocol-defined RDTN
population included annualized relapse rate (ARR), confirmed disability
worsening (CDW), progression independent of relapse activity (PIRA) and
adverse events. Results: Data were analysed from 615 RDTN participants (ofatumumab:
n = 314; teriflunomide: n = 301). Compared
with teriflunomide, ofatumumab reduced ARR by 50% (rate ratio (95%
confidence interval (CI)): 0.50 (0.33, 0.74);
p < 0.001), and delayed 6-month CDW by 46% (hazard ratio
(HR; 95% CI): 0.54 (0.30, 0.98); p = 0.044) and 6-month
PIRA by 56% (HR: 0.44 (0.20, 1.00); p = 0.049). Safety
findings were manageable and consistent with those of the overall ASCLEPIOS
population. Conclusion: The favourable benefit–risk profile of ofatumumab versus teriflunomide
supports its consideration as a first-line therapy in RDTN patients. ASCLEPIOS I and II are registered at ClinicalTrials.gov (NCT02792218 and
NCT02792231).
Collapse
Affiliation(s)
- Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neurology, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California - San Francisco, San Francisco, CA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jeffrey A Cohen
- Department of Neurology, Mellen MS Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anne H Cross
- Department of Neurology, Section of Neuroimmunology, Washington University School of Medicine, St Louis, MO, USA
| | - Kumaran Deiva
- Department of Pediatric Neurology, University Hospitals Paris Saclay, Hôpital Bicêtre, National Reference Center for Rare Inflammatory Brain and Spinal Diseases, Le Kremlin-Bicêtre, France
| | - Habib Ganjgahi
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK/Statistics Department, University of Oxford, Oxford, UK
| | | | - Bingbing Li
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, and Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital of Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
|
30
|
Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Reply to "Spinal cord atrophy is a preclinical marker of progressive MS". Ann Neurol 2022; 91:735-736. [PMID: 35233827 PMCID: PMC9511767 DOI: 10.1002/ana.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA.,Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Germany
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| |
Collapse
|
|
31
|
Hauser SL, Cross AH, Winthrop K, Wiendl H, Nicholas J, Meuth SG, Giacomini PS, Saccà F, Mancione L, Zielman R, Bagger M, Das Gupta A, Häring DA, Jehl V, Kieseier BC, Pingili R, Stoneman D, Su W, Willi R, Kappos L. Safety experience with continued exposure to ofatumumab in patients with relapsing forms of multiple sclerosis for up to 3.5 years. Mult Scler 2022; 28:1576-1590. [PMID: 35229668 PMCID: PMC9330270 DOI: 10.1177/13524585221079731] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Indexed: 01/03/2023]
Abstract
Background: Ofatumumab is approved for the treatment of relapsing multiple sclerosis
(RMS). Ongoing safety reporting is crucial to understand its long-term
benefit–risk profile. Objective: Report the safety and tolerability of ofatumumab in RMS after extended
treatment up to 3.5 years. Methods: Patients completing ASCLEPIOS I/II (phase 3), APLIOS, or APOLITOS (phase 2)
trials could enter ALITHIOS, a phase 3b, open-label, long-term safety study.
We analyzed cumulative data of continuous ofatumumab treatment and of
patients newly switched from teriflunomide. Results: The safety population had 1969 patients: 1292 continuously treated with
ofatumumab (median time-at-risk 35.5 months, 3253 patient-years) and 677
newly switched (median time-at-risk 18.3 months, 986 patient-years). A total
of 1650 patients (83.8%) had ⩾1 adverse events and 191 (9.7%) had ⩾1 serious
adverse events. No opportunistic infections or progressive multifocal
leukoencephalopathy events were identified; the risk of malignancies was
low. Mean serum immunoglobulin (Ig) G levels remained stable. Mean IgM
levels decreased but remained above the lower limit of normal in most.
Serious infection incidence was low; decreased Ig levels were not associated
with serious infections. Conclusion: In patients with up to 3.5 years’ exposure, ofatumumab was well tolerated,
with no new safety risks identified. These findings, with its established
effectiveness, support a favorable benefit–risk profile of ofatumumab in
RMS.
Collapse
Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Anne H Cross
- Washington University School of Medicine, St Louis, MO, USA
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Jacqueline Nicholas
- OhioHealth Multiple Sclerosis Center, Riverside Methodist Hospital, Columbus, OH, USA
| | - Sven G Meuth
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Paul S Giacomini
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Francesco Saccà
- Department of Neurosciences, Odontostomatological and Reproductive Sciences, University Federico II, Naples, Italy
| | - Linda Mancione
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Ayan Das Gupta
- Novartis Healthcare Pvt. Ltd, Hyderabad, Telangana, India
| | | | | | - Bernd C Kieseier
- Novartis Pharma AG, Basel, Switzerland and Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | | | - Wendy Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine, Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
|
32
|
Bove R, Schleimer E, Sukhanov P, Gilson M, Law SM, Barnecut A, Miller BL, Hauser SL, Sanders SJ, Rankin KP. Building a Precision Medicine Delivery Platform for Clinics: The University of California, San Francisco, BRIDGE Experience. J Med Internet Res 2022; 24:e34560. [PMID: 35166689 PMCID: PMC8889486 DOI: 10.2196/34560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
Despite an ever-expanding number of analytics with the potential to impact clinical care, the field currently lacks point-of-care technological tools that allow clinicians to efficiently select disease-relevant data about their patients, algorithmically derive clinical indices (eg, risk scores), and view these data in straightforward graphical formats to inform real-time clinical decisions. Thus far, solutions to this problem have relied on either bottom-up approaches that are limited to a single clinic or generic top-down approaches that do not address clinical users’ specific setting-relevant or disease-relevant needs. As a road map for developing similar platforms, we describe our experience with building a custom but institution-wide platform that enables economies of time, cost, and expertise. The BRIDGE platform was designed to be modular and scalable and was customized to data types relevant to given clinical contexts within a major university medical center. The development process occurred by using a series of human-centered design phases with extensive, consistent stakeholder input. This institution-wide approach yielded a unified, carefully regulated, cross-specialty clinical research platform that can be launched during a patient’s electronic health record encounter. The platform pulls clinical data from the electronic health record (Epic; Epic Systems) as well as other clinical and research sources in real time; analyzes the combined data to derive clinical indices; and displays them in simple, clinician-designed visual formats specific to each disorder and clinic. By integrating an application into the clinical workflow and allowing clinicians to access data sources that would otherwise be cumbersome to assemble, view, and manipulate, institution-wide platforms represent an alternative approach to achieving the vision of true personalized medicine.
Collapse
Affiliation(s)
- Riley Bove
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Erica Schleimer
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Paul Sukhanov
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michael Gilson
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sindy M Law
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew Barnecut
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L Miller
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Stephan J Sanders
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine P Rankin
- UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
|
33
|
Li J, Zaslavsky M, Su Y, Sikora MJ, van Unen V, Christophersen A, Chiou SH, Chen L, Li J, Ji X, Wilhelmy J, McSween AM, Palanski BA, Aditya Mallajosyula VV, Dhondalay GKR, Bhamidipati K, Pai J, Kipp LB, Dunn JE, Hauser SL, Oksenberg JR, Satpathy AT, Robinson WH, Steinmetz LM, Khosla C, Utz PJ, Sollid LM, Heath JR, Fernandez-Becker NQ, Nadeau KC, Saligrama N, Davis MM. Human KIR + CD8 + T cells target pathogenic T cells in Celiac disease and are active in autoimmune diseases and COVID-19. bioRxiv 2021:2021.12.23.473930. [PMID: 34981055 PMCID: PMC8722592 DOI: 10.1101/2021.12.23.473930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Previous reports show that Ly49 + CD8 + T cells can suppress autoimmunity in mouse models of autoimmune diseases. Here we find a markedly increased frequency of CD8 + T cells expressing inhibitory Killer cell Immunoglobulin like Receptors (KIR), the human equivalent of the Ly49 family, in the blood and inflamed tissues of various autoimmune diseases. Moreover, KIR + CD8 + T cells can efficiently eliminate pathogenic gliadin-specific CD4 + T cells from Celiac disease (CeD) patients' leukocytes in vitro . Furthermore, we observe elevated levels of KIR + CD8 + T cells, but not CD4 + regulatory T cells, in COVID-19 and influenza-infected patients, and this correlates with disease severity and vasculitis in COVID-19. Expanded KIR + CD8 + T cells from these different diseases display shared phenotypes and similar T cell receptor sequences. These results characterize a regulatory CD8 + T cell subset in humans, broadly active in both autoimmune and infectious diseases, which we hypothesize functions to control self-reactive or otherwise pathogenic T cells. ONE-SENTENCE SUMMARY Here we identified KIR + CD8 + T cells as a regulatory CD8 + T cell subset in humans that suppresses self-reactive or otherwise pathogenic CD4 + T cells.
Collapse
|
|
34
|
Ma Q, Caillier SJ, Muzic S, Wilson MR, Henry RG, Cree BAC, Hauser SL, Didonna A, Oksenberg JR. Specific hypomethylation programs underpin B cell activation in early multiple sclerosis. Proc Natl Acad Sci U S A 2021; 118:e2111920118. [PMID: 34911760 PMCID: PMC8713784 DOI: 10.1073/pnas.2111920118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/12/2022] Open
Abstract
Epigenetic changes have been consistently detected in different cell types in multiple sclerosis (MS). However, their contribution to MS pathogenesis remains poorly understood partly because of sample heterogeneity and limited coverage of array-based methods. To fill this gap, we conducted a comprehensive analysis of genome-wide DNA methylation patterns in four peripheral immune cell populations isolated from 29 MS patients at clinical disease onset and 24 healthy controls. We show that B cells from new-onset untreated MS cases display more significant methylation changes than other disease-implicated immune cell types, consisting of a global DNA hypomethylation signature. Importantly, 4,933 MS-associated differentially methylated regions in B cells were identified, and this epigenetic signature underlies specific genetic programs involved in B cell differentiation and activation. Integration of the methylome to changes in gene expression and susceptibility-associated regions further indicates that hypomethylated regions are significantly associated with the up-regulation of cell activation transcriptional programs. Altogether, these findings implicate aberrant B cell function in MS etiology.
Collapse
Affiliation(s)
- Qin Ma
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Stacy J Caillier
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Shaun Muzic
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Alessandro Didonna
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158
| |
Collapse
|
|
35
|
Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
Collapse
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| |
Collapse
|
|
36
|
Hauser SL, Kappos L, Montalban X, Craveiro L, Chognot C, Hughes R, Koendgen H, Pasquarelli N, Pradhan A, Prajapati K, Wolinsky JS. Safety of Ocrelizumab in Patients With Relapsing and Primary Progressive Multiple Sclerosis. Neurology 2021; 97:e1546-e1559. [PMID: 34475123 PMCID: PMC8548959 DOI: 10.1212/wnl.0000000000012700] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives To report safety of ocrelizumab (OCR) up to 7 years in patients with relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS) enrolled in clinical trials or treated in real-world postmarketing settings. Methods Safety analyses are based on integrated clinical and laboratory data for all patients who received OCR in 11 clinical trials, including the controlled treatment and open-label extension (OLE) periods of the phase 2 and 3 trials, plus the phase 3b trials VELOCE, CHORDS, CASTING, OBOE, ENSEMBLE, CONSONANCE, and LIBERTO. For selected adverse events (AEs), additional postmarketing data were used. Incidence rates of serious infections (SIs) and malignancies were contextualized using multiple epidemiologic sources. Results At data cutoff (January 2020), 5,680 patients with multiple sclerosis (MS) received OCR (18,218 patient-years [PY] of exposure) in clinical trials. Rates per 100 PY (95% confidence interval) of AEs (248; 246–251), serious AEs (7.3; 7.0–7.7), infusion-related reactions (25.9; 25.1–26.6), and infections (76.2; 74.9–77.4) were similar to those within the controlled treatment period of the phase 3 trials. Rates of the most common serious AEs, including SIs (2.01; 1.81–2.23) and malignancies (0.46; 0.37–0.57), were consistent with the ranges reported in epidemiologic data. Discussion Continuous administration of OCR for up to 7 years in clinical trials, as well as its broader use for more than 3 years in the real-world setting, are associated with a favorable and manageable safety profile, without emerging safety concerns, in a heterogeneous MS population. Classification of Evidence This analysis provides Class III evidence that long-term, continuous treatment with OCR has a consistent and favorable safety profile in patients with RMS and PPMS. This study is rated Class III because of the use of OLE data and historical controls.
Collapse
Affiliation(s)
- Stephen L Hauser
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth).
| | - Ludwig Kappos
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Xavier Montalban
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Licinio Craveiro
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Cathy Chognot
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Richard Hughes
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Harold Koendgen
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Noemi Pasquarelli
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Ashish Pradhan
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Kalpesh Prajapati
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| | - Jerry S Wolinsky
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Switzerland; Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, Spain; F. Hoffmann-La Roche Ltd. (L.C., C.C., R.H., H.K., N.P.), Basel, Switzerland; Genentech, Inc. (A.P.), South San Francisco, CA; IQVIA Solutions Inc. (K.P.), Amsterdam, The Netherlands; and Department of Neurology (J.S.W.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)
| |
Collapse
|
|
37
|
Schubert RD, Hawes IA, Ramachandran PS, Ramesh A, Crawford ED, Pak JE, Wu W, Cheung CK, O'Donovan BD, Tato CM, Lyden A, Tan M, Sit R, Sowa GM, Sample HA, Zorn KC, Banerji D, Khan LM, Bove R, Hauser SL, Gelfand AA, Johnson-Kerner BL, Nash K, Krishnamoorthy KS, Chitnis T, Ding JZ, McMillan HJ, Chiu CY, Briggs B, Glaser CA, Yen C, Chu V, Wadford DA, Dominguez SR, Ng TFF, Marine RL, Lopez AS, Nix WA, Soldatos A, Gorman MP, Benson L, Messacar K, Konopka-Anstadt JL, Oberste MS, DeRisi JL, Wilson MR. Author Correction: Pan-viral serology implicates enteroviruses in acute flaccid myelitis. Nat Med 2021; 27:1849. [PMID: 34548659 DOI: 10.1038/s41591-021-01429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryan D Schubert
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Isobel A Hawes
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Prashanth S Ramachandran
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akshaya Ramesh
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emily D Crawford
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - John E Pak
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Wesley Wu
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Brian D O'Donovan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Amy Lyden
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Rene Sit
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Gavin M Sowa
- School of Medicine, University of California, San Francisc, San Francisco, CA, USA
| | - Hannah A Sample
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Debarko Banerji
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Lillian M Khan
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Riley Bove
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amy A Gelfand
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bethany L Johnson-Kerner
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kendall Nash
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Joy Z Ding
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Hugh J McMillan
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Charles Y Chiu
- Department of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Benjamin Briggs
- Department of Pediatrics, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Carol A Glaser
- Department of Pediatric Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Cynthia Yen
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Victoria Chu
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Debra A Wadford
- Division of Communicable Disease Control, California Department of Public Health, Richmond, CA, USA
| | - Samuel R Dominguez
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Terry Fei Fan Ng
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel L Marine
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adriana S Lopez
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Allan Nix
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Kevin Messacar
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph L DeRisi
- Chan Zuckerberg Biohub, San Francisco, CA, USA.,Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA. .,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
|
38
|
Bove R, Bruce CA, Lunders CK, Pearce JR, Liu J, Schleimer E, Hauser SL, Stewart WF, Jones JB. Electronic Health Record Technology Designed for the Clinical Encounter: MS NeuroShare. Neurol Clin Pract 2021; 11:318-326. [PMID: 34484932 DOI: 10.1212/cpj.0000000000000986] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
Objective Advances in medical discoveries have bolstered expectations of precise and complete care, but delivering on such a promise for complex, chronic neurologic care delivery requires solving last-mile challenges. We describe the iterative human-centered design and pilot process for multiple sclerosis (MS) NeuroShare, a digital health solution that brings practical information to the point of care so that clinicians and patients with MS can view, discuss, and make informed decisions together. Methods We initiated a comprehensive human-centered process to iteratively design, develop, and implement a digital health solution for managing MS in the routine outpatient setting of the nonprofit Sutter Health system in Northern California. The human-centered codesign process included 3 phases: discovery and design, development, and implementation and pilot. Stakeholders included Sutter Health's Research Development and Dissemination team, academic domain experts, neurologists, patients with MS, and an advisory group. Results MS NeuroShare went live in November 2018. It included a patient- and clinician-facing web application that launches from the electronic health record, visually displays a patient's data relevant to MS, and prompts the clinician to comprehensively evaluate and treat the patient. Both patients and clinicians valued the ability to jointly view patient-generated and other data. Preliminary results suggest that MS NeuroShare promotes patient-clinician communication and more active patient participation in decision-making. Conclusions Lessons learned in the design and implementation of MS NeuroShare are broadly applicable to the design and implementation of digital tools aiming to improve the experience of delivering and receiving high-quality care for complex, neurologic conditions across large health systems.
Collapse
Affiliation(s)
- Riley Bove
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Christa A Bruce
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Chelsea K Lunders
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Jennifer R Pearce
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Jacqueline Liu
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Erica Schleimer
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Stephen L Hauser
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - Walter F Stewart
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| | - J B Jones
- Weill Institute for Neurosciences (RB, ES, SLH), Department of Neurology, University of California, San Francisco; Center for Health System Research (CAB, CKL, JL, JBJ), Sutter Health, Sacramento, CA; Plain Language Health (JRP), Pleasant Hill, CA; and Medcurio, Inc. (WFS), Oakland, CA
| |
Collapse
|
|
39
|
Montalban X, Graves J, Midaglia L, Mulero P, Julian L, Baker M, Schadrack J, Gossens C, Ganzetti M, Scotland A, Lipsmeier F, van Beek J, Bernasconi C, Belachew S, Lindemann M, Hauser SL. A smartphone sensor-based digital outcome assessment of multiple sclerosis. Mult Scler 2021; 28:654-664. [PMID: 34259588 PMCID: PMC8961252 DOI: 10.1177/13524585211028561] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Sensor-based monitoring tools fill a critical gap in multiple sclerosis (MS)
research and clinical care. Objective: The aim of this study is to assess performance characteristics of the
Floodlight Proof-of-Concept (PoC) app. Methods: In a 24-week study (clinicaltrials.gov: NCT02952911), smartphone-based active
tests and passive monitoring assessed cognition (electronic Symbol Digit
Modalities Test), upper extremity function (Pinching Test, Draw a Shape
Test), and gait and balance (Static Balance Test, U-Turn Test, Walk Test,
Passive Monitoring). Intraclass correlation coefficients (ICCs) and age- or
sex-adjusted Spearman’s rank correlation determined test–retest reliability
and correlations with clinical and magnetic resonance imaging (MRI) outcome
measures, respectively. Results: Seventy-six people with MS (PwMS) and 25 healthy controls were enrolled. In
PwMS, ICCs were moderate-to-good (ICC(2,1) = 0.61–0.85) across tests.
Correlations with domain-specific standard clinical disability measures were
significant for all tests in the cognitive (r = 0.82,
p < 0.001), upper extremity function (|r|=
0.40–0.64, all p < 0.001), and gait and balance domains
(r = −0.25 to −0.52, all p < 0.05;
except for Static Balance Test: r = −0.20,
p > 0.05). Most tests also correlated with Expanded
Disability Status Scale, 29-item Multiple Sclerosis Impact Scale items or
subscales, and/or normalized brain volume. Conclusion: The Floodlight PoC app captures reliable and clinically relevant measures of
functional impairment in MS, supporting its potential use in clinical
research and practice.
Collapse
Affiliation(s)
- Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jennifer Graves
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain and Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
|
40
|
Hauser SL. Curing Multiple Sclerosis: How to Know When We're There. Ann Neurol 2021; 90:539-541. [PMID: 34216039 DOI: 10.1002/ana.26155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco, CA, USA
| |
Collapse
|
|
41
|
Osoegawa K, Creary LE, Montero-Martín G, Mallempati KC, Gangavarapu S, Caillier SJ, Santaniello A, Isobe N, Hollenbach JA, Hauser SL, Oksenberg JR, Fernández-Viňa MA. High Resolution Haplotype Analyses of Classical HLA Genes in Families With Multiple Sclerosis Highlights the Role of HLA-DP Alleles in Disease Susceptibility. Front Immunol 2021; 12:644838. [PMID: 34211458 PMCID: PMC8240666 DOI: 10.3389/fimmu.2021.644838] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) susceptibility shows strong genetic associations with HLA alleles and haplotypes. We genotyped 11 HLA genes in 477 non-Hispanic European MS patients and their 954 unaffected parents using a validated next-generation sequencing (NGS) methodology. HLA haplotypes were assigned unequivocally by tracing HLA allele transmissions. We explored HLA haplotype/allele associations with MS using the genotypic transmission disequilibrium test (gTDT) and multiallelic TDT (mTDT). We also conducted a case-control (CC) study with all patients and 2029 healthy unrelated ethnically matched controls. We performed separate analyses of 54 extended multi-case families by reviewing transmission of haplotype blocks. The haplotype fragment including DRB5*01:01:01~DRB1*15:01:01:01 was significantly associated with predisposition (gTDT: p < 2.20e-16; mTDT: p =1.61e-07; CC: p < 2.22e-16) as reported previously. A second risk allele, DPB1*104:01 (gTDT: p = 3.69e-03; mTDT: p = 2.99e-03; CC: p = 1.00e-02), independent from the haplotype bearing DRB1*15:01 was newly identified. The allele DRB1*01:01:01 showed significant protection (gTDT: p = 8.68e-06; mTDT: p = 4.50e-03; CC: p = 1.96e-06). Two DQB1 alleles, DQB1*03:01 (gTDT: p = 2.86e-03; mTDT: p = 5.56e-02; CC: p = 4.08e-05) and DQB1*03:03 (gTDT: p = 1.17e-02; mTDT: p = 1.16e-02; CC: p = 1.21e-02), defined at two-field level also showed protective effects. The HLA class I block, A*02:01:01:01~C*03:04:01:01~B*40:01:02 (gTDT: p = 5.86e-03; mTDT: p = 3.65e-02; CC: p = 9.69e-03) and the alleles B*27:05 (gTDT: p = 6.28e-04; mTDT: p = 2.15e-03; CC: p = 1.47e-02) and B*38:01 (gTDT: p = 3.20e-03; mTDT: p = 6.14e-03; CC: p = 1.70e-02) showed moderately protective effects independently from each other and from the class II associated factors. By comparing statistical significance of 11 HLA loci and 19 haplotype segments with both untruncated and two-field allele names, we precisely mapped MS candidate alleles/haplotypes while eliminating false signals resulting from ‘hitchhiking’ alleles. We assessed genetic burden for the HLA allele/haplotype identified in this study. This family-based study including the highest-resolution of HLA alleles proved to be powerful and efficient for precise identification of HLA genotypes associated with both, susceptibility and protection to development of MS.
Collapse
Affiliation(s)
- Kazutoyo Osoegawa
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
| | - Lisa E Creary
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States.,Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gonzalo Montero-Martín
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States.,Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kalyan C Mallempati
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
| | - Sridevi Gangavarapu
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States
| | - Stacy J Caillier
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jill A Hollenbach
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Marcelo A Fernández-Viňa
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, CA, United States.,Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, United States
| |
Collapse
|
|
42
|
Kim K, Pröbstel AK, Baumann R, Dyckow J, Landefeld J, Kogl E, Madireddy L, Loudermilk R, Eggers EL, Singh S, Caillier SJ, Hauser SL, Cree BAC, Schirmer L, Wilson MR, Baranzini SE. Cell type-specific transcriptomics identifies neddylation as a novel therapeutic target in multiple sclerosis. Brain 2021; 144:450-461. [PMID: 33374005 DOI: 10.1093/brain/awaa421] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis is an autoimmune disease of the CNS in which both genetic and environmental factors are involved. Genome-wide association studies revealed more than 200 risk loci, most of which harbour genes primarily expressed in immune cells. However, whether genetic differences are translated into cell-specific gene expression profiles and to what extent these are altered in patients with multiple sclerosis are still open questions in the field. To assess cell type-specific gene expression in a large cohort of patients with multiple sclerosis, we sequenced the whole transcriptome of fluorescence-activated cell sorted T cells (CD4+ and CD8+) and CD14+ monocytes from treatment-naive patients with multiple sclerosis (n = 106) and healthy subjects (n = 22). We identified 479 differentially expressed genes in CD4+ T cells, 435 in monocytes, and 54 in CD8+ T cells. Importantly, in CD4+ T cells, we discovered upregulated transcripts from the NAE1 gene, a critical subunit of the NEDD8 activating enzyme, which activates the neddylation pathway, a post-translational modification analogous to ubiquitination. Finally, we demonstrated that inhibition of NEDD8 activating enzyme using the specific inhibitor pevonedistat (MLN4924) significantly ameliorated disease severity in murine experimental autoimmune encephalomyelitis. Our findings provide novel insights into multiple sclerosis-associated gene regulation unravelling neddylation as a crucial pathway in multiple sclerosis pathogenesis with implications for the development of tailored disease-modifying agents.
Collapse
Affiliation(s)
- Kicheol Kim
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Anne-Katrin Pröbstel
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Neurologic Clinic and Policlinic, Departments of Medicine and Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Ryan Baumann
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Julia Dyckow
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Interdisciplinary Center for Neurosciences, University of Heidelberg, Mannheim, Germany
| | - James Landefeld
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Elva Kogl
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Lohith Madireddy
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Rita Loudermilk
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Erica L Eggers
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Sneha Singh
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Stacy J Caillier
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce A C Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lucas Schirmer
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Interdisciplinary Center for Neurosciences, University of Heidelberg, Mannheim, Germany
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Sergio E Baranzini
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, CA, USA.,Graduate Program in Bioinformatics, University of California, San Francisco, CA, USA
| |
Collapse
|
|
43
|
Hauser SL, Kappos L, Montalban X, Chognot C, Pradhan A, Prajapati K, Wolinsky JS. Tolérance d’ocrelizumab (OCR) : analyse actualisée des données de tolérance des patients atteints de sclérose en plaques récurrente (SEP-R) ou primaire progressive (SEP-PP). Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
|
44
|
Kappos L, Wolinsky JS, Giovannoni G, Arnold DL, Wang Q, Bernasconi C, Model F, Koendgen H, Manfrini M, Belachew S, Hauser SL. Contribution of Relapse-Independent Progression vs Relapse-Associated Worsening to Overall Confirmed Disability Accumulation in Typical Relapsing Multiple Sclerosis in a Pooled Analysis of 2 Randomized Clinical Trials. JAMA Neurol 2021; 77:1132-1140. [PMID: 32511687 PMCID: PMC7281382 DOI: 10.1001/jamaneurol.2020.1568] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Question What are the relative contributions of progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) to overall accumulating disability in patients with relapsing multiple sclerosis? Findings Applying a composite outcome measure to a typical population with active relapsing multiple sclerosis, this pooled analysis of 2 randomized clinical trials shows that the most part of confirmed disability accumulation occurs independently of relapse activity. Distinct prognostic factors were associated with PIRA vs RAW, and ocrelizumab had a beneficial outcome in both. Meaning These findings clearly demonstrate underlying progression in this relapsing multiple sclerosis population and challenge the current clinical distinction of relapsing and progressive forms of multiple sclerosis. Importance Accumulation of disability in multiple sclerosis may occur as relapse-associated worsening (RAW) or steady progression independent of relapse activity (PIRA), with PIRA regarded as a feature of primary and secondary progressive multiple sclerosis. Objective To investigate the contributions of relapse-associated worsening vs relapse-independent progression to overall confirmed disability accumulation (CDA) and assess respective baseline prognostic factors and outcomes of 2 treatments. Design, Setting, and Participants Analyses occurred from July 2015 to February 2020 on pooled data from the intention-to-treat population of 2 identical, phase 3, multicenter, double-blind, double-dummy, parallel-group randomized clinical trials (OPERA I and II) conducted between August 2011 and April 2015. In the trials, patients with relapsing multiple sclerosis (RMS), diagnosed using the 2010 revised McDonald criteria, were randomized from 307 trial sites in 56 countries; resulting data were analyzed in the pooled data set. Interventions Participants were randomized 1:1 to receive 600 mg of ocrelizumab by intravenous infusion every 24 weeks or subcutaneous interferon β-1a 3 times a week at a dose of 44 μg throughout a 96-week treatment period. Main Outcomes and Measures Confirmed disability accumulation was defined by an increase in 1 or more of 3 measures (Expanded Disability Status Scale, timed 25-ft walk, or 9-hole peg test), confirmed after 3 or 6 months, and classified per temporal association with confirmed clinical relapses (PIRA or RAW). Results In the pooled OPERA I and II population (1656 of 2096 eligible participants), baseline demographics and disease characteristics were similar for patients randomized to interferon β-1a vs ocrelizumab (mean [SD] age, 37.2 [9.2] vs 37.1 [9.2] years; 552 [66.6%] vs 541 women [65.4%]). After 96 weeks, 12-week composite CDA had occurred in 223 (29.6% by Kaplan-Meier estimate) randomized to interferon β-1a and 167 (21.1%) randomized to ocrelizumab; 24-week composite CDA had occurred in 170 (22.7%) taking interferon β-1a and 129 (16.2%) taking ocrelizumab. The PIRA events were the main contributors to 12-week and 24-week composite CDA after 96 weeks in patients treated with interferon β-1a (174 of 223 [78.0%] and 137 of 170 [80.6%], respectively) and ocrelizumab (147 of 167 [88.0%] and 115 of 129 [89.1%], respectively); a minority had CDA explained by RAW events (69 of 390 [17.7%] and 52 of 299 [17.4%], respectively). Very few patients with composite CDA experienced both RAW and PIRA events (17 of 390 [4.4%] for 12-week and 15 of 299 [5.0%] for 24-week composite CDA). Ocrelizumab (vs interferon β-1a) was associated with reduced risk of composite CDA (hazard ratio [HR], 0.67) and confirmed PIRA (HR, 0.78) and RAW (HR, 0.47) events. Conclusions and Relevance Most disability accumulation in RMS is not associated with overt relapses. This indicates an underlying progression in this typical RMS population and challenges the current clinical distinction of relapsing and progressive forms of multiple sclerosis. Ocrelizumab was superior to interferon β-1a in preventing both RAW and PIRA. Trial Registration ClinicalTrials.gov Identifiers: OPERA I (NCT01247324) and OPERA II (NCT01412333).
Collapse
Affiliation(s)
- Ludwig Kappos
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | - Douglas L Arnold
- McGill University, Montreal, Quebec, Canada.,NeuroRx Research, Montreal, Quebec, Canada
| | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | | | | | - Shibeshih Belachew
- F. Hoffmann-La Roche Ltd, Basel, Switzerland.,Now with Biogen, Cambridge, Massachusetts
| | - Stephen L Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
| |
Collapse
|
|
45
|
Giovannoni G, Kappos L, de Seze J, Hauser SL, Overell J, Koendgen H, Manfrini M, Wang Q, Wolinsky JS. Risk of requiring a walking aid after 6.5 years of ocrelizumab treatment in patients with relapsing multiple sclerosis: Data from the OPERA I and OPERA II trials. Eur J Neurol 2021; 29:1238-1242. [PMID: 33724637 PMCID: PMC9290576 DOI: 10.1111/ene.14823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
Background and purpose Requiring a walking aid is a fundamental milestone in multiple sclerosis (MS), represented by an Expanded Disability Status Scale (EDSS) score ≥6.0. In the present study, we assess the effect of ocrelizumab (OCR) on time to EDSS score ≥6.0 in relapsing MS. Methods Time to EDSS score ≥6.0 confirmed for ≥24 and ≥48 weeks was assessed over the course of 6.5 years (336 weeks) in the double‐blind period (DBP) and open‐label extension (OLE) period of the OPERA I (NCT01247324) and OPERA II (NCT01412333) studies. Results Time to reach EDSS score ≥6.0 was significantly delayed in those initially randomized to OCR versus interferon. Over 6.5 years, the risk of requiring a walking aid confirmed for ≥24 weeks was 34% lower among those who initiated OCR earlier versus delayed treatment (average hazard ratio [HR] DBP + OLE 0.66, 95% confidence interval [CI] 0.45–0.95; p = 0.024); the risk of requiring a walking aid confirmed for ≥48 weeks was 46% lower (average HR DBP+OLE 0.54, 95% CI 0.35–0.83; p = 0.004). Conclusion The reduced risk of requiring a walking aid in earlier initiators of OCR demonstrates the long‐term implications of earlier highly effective treatment.
Collapse
Affiliation(s)
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience and MS Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | | | | | | | | | - 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, TX, USA
| |
Collapse
|
|
46
|
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
|
|
47
|
Affiliation(s)
- Scott S Zamvil
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (S.S.Z., S.L.H.), and the Program in Immunology, University of California, San Francisco (S.S.Z) - both in San Francisco
| | - Stephen L Hauser
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (S.S.Z., S.L.H.), and the Program in Immunology, University of California, San Francisco (S.S.Z) - both in San Francisco
| |
Collapse
|
|
48
|
Abstract
Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative disease of the central nervous system, and the leading cause of nontraumatic neurological disability in young adults. Effective management requires a multifaceted approach to control acute attacks, manage progressive worsening, and remediate bothersome or disabling symptoms associated with this illness. Remarkable advances in treatment of all forms of MS, and especially for relapsing disease, have favorably changed the long-term outlook for many patients. There also has been a conceptual shift in understanding the immune pathology of MS, away from a purely T-cell-mediated model to recognition that B cells have a key role in pathogenesis. The emergence of higher-efficacy drugs requiring less frequent administration have made these preferred options in terms of tolerability and adherence. Many experts now recommend use of these as first-line treatment for many patients with early disease, before permanent disability is evident.
Collapse
Affiliation(s)
- Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco.
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco
| |
Collapse
|
|
49
|
Romeo AR, Rowles WM, Schleimer ES, Barba P, Hsu WY, Gomez R, Santaniello A, Zhao C, Pearce JR, Jones JB, Cree BC, Hauser SL, Gelfand JM, Stewart WF, Goodin DS, Bove RM. An electronic, unsupervised patient-reported Expanded Disability Status Scale for multiple sclerosis. Mult Scler 2020; 27:1432-1441. [PMID: 33236967 DOI: 10.1177/1352458520968814] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In persons with multiple sclerosis (MS), the Expanded Disability Status Scale (EDSS) is the criterion standard for assessing disability, but its in-person nature constrains patient participation in research and clinical assessments. OBJECTIVE The aim of this study was to develop and validate a scalable, electronic, unsupervised patient-reported EDSS (ePR-EDSS) that would capture MS-related disability across the spectrum of severity. METHODS We enrolled 136 adult MS patients, split into a preliminary testing Cohort 1 (n = 50), and a validation Cohort 2 (n = 86), which was evenly distributed across EDSS groups. Each patient completed an ePR-EDSS either immediately before or after a MS clinician's Neurostatus EDSS evaluation. RESULTS In Cohort 2, mean age was 50.6 years (range = 26-80) and median EDSS was 3.5 (interquartile range (IQR) = [1.5, 5.5]). The ePR-EDSS and EDSS agreed within 1-point for 86% of examinations; kappa for agreement within 1-point was 0.85 (p < 0.001). The correlation coefficient between the two measures was 0.91 (<0.001). DISCUSSION The ePR-EDSS was highly correlated with EDSS, with good agreement even at lower EDSS levels. For clinical care, the ePR-EDSS could enable the longitudinal monitoring of a patient's disability. For research, it provides a valid and rapid measure across the entire spectrum of disability and permits broader participation with fewer in-person assessments.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - J B Jones
- Sutter Health, Palo Alto Medical Foundation Research Institute, Walnut Creek, CA, USA
| | | | | | | | | | - Douglas S Goodin
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California San Francisco, San Francisco, CA, USA
| | - Riley M Bove
- UCSF MS and Neuroinflammation Center, Weill Institute for Neurosciences, Department of Neurology, Division of Neuroinflammation and Glial Biology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
|
50
|
Pröbstel AK, Zhou X, Baumann R, Wischnewski S, Kutza M, Rojas OL, Sellrie K, Bischof A, Kim K, Ramesh A, Dandekar R, Greenfield AL, Schubert RD, Bisanz JE, Vistnes S, Khaleghi K, Landefeld J, Kirkish G, Liesche-Starnecker F, Ramaglia V, Singh S, Tran EB, Barba P, Zorn K, Oechtering J, Forsberg K, Shiow LR, Henry RG, Graves J, Cree BAC, Hauser SL, Kuhle J, Gelfand JM, Andersen PM, Schlegel J, Turnbaugh PJ, Seeberger PH, Gommerman JL, Wilson MR, Schirmer L, Baranzini SE. Gut microbiota-specific IgA + B cells traffic to the CNS in active multiple sclerosis. Sci Immunol 2020; 5:5/53/eabc7191. [PMID: 33219152 DOI: 10.1126/sciimmunol.abc7191] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023]
Abstract
Changes in gut microbiota composition and a diverse role of B cells have recently been implicated in multiple sclerosis (MS), a central nervous system (CNS) autoimmune disease. Immunoglobulin A (IgA) is a key regulator at the mucosal interface. However, whether gut microbiota shape IgA responses and what role IgA+ cells have in neuroinflammation are unknown. Here, we identify IgA-bound taxa in MS and show that IgA-producing cells specific for MS-associated taxa traffic to the inflamed CNS, resulting in a strong, compartmentalized IgA enrichment in active MS and other neuroinflammatory diseases. Unlike previously characterized polyreactive anti-commensal IgA responses, CNS IgA cross-reacts with surface structures on specific bacterial strains but not with brain tissue. These findings establish gut microbiota-specific IgA+ cells as a systemic mediator in MS and suggest a critical role of mucosal B cells during active neuroinflammation with broad implications for IgA as an informative biomarker and IgA-producing cells as an immune subset to harness for therapeutic interventions.
Collapse
Affiliation(s)
- Anne-Katrin Pröbstel
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA. .,Neurologic Clinic and Policlinic and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital of Basel, University of Basel, 4031 Basel, Switzerland
| | - Xiaoyuan Zhou
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ryan Baumann
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Sven Wischnewski
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Michael Kutza
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, ON M5S 18A, Canada
| | - Katrin Sellrie
- Department of Biomolecular Systems, Max Planck Institute of Colloids and Interfaces, 14776 Potsdam, Germany
| | - Antje Bischof
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Kicheol Kim
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Akshaya Ramesh
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ravi Dandekar
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ariele L Greenfield
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Ryan D Schubert
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jordan E Bisanz
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Stephanie Vistnes
- Eli and Edythe Broad Center for Stem Cell Research and Regeneration Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Khashayar Khaleghi
- Department of Immunology, University of Toronto, Toronto, ON M5S 18A, Canada
| | - James Landefeld
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Gina Kirkish
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Friederike Liesche-Starnecker
- Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University Munich, 81675 Munich, Germany
| | - Valeria Ramaglia
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Sneha Singh
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Edwina B Tran
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Patrick Barba
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Kelsey Zorn
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Johanna Oechtering
- Neurologic Clinic and Policlinic and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital of Basel, University of Basel, 4031 Basel, Switzerland
| | - Karin Forsberg
- Department of Clinical Science, Neurosciences, Umeå University, 90185 Umeå, Sweden
| | - Lawrence R Shiow
- Eli and Edythe Broad Center for Stem Cell Research and Regeneration Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.,Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Roland G Henry
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jennifer Graves
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Bruce A C Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Stephen L Hauser
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Jens Kuhle
- Neurologic Clinic and Policlinic and Research Center for Clinical Neuroimmunology and Neuroscience Basel, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital of Basel, University of Basel, 4031 Basel, Switzerland
| | - Jeffrey M Gelfand
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Peter M Andersen
- Department of Clinical Science, Neurosciences, Umeå University, 90185 Umeå, Sweden
| | - Jürgen Schlegel
- Department of Neuropathology, School of Medicine, Institute of Pathology, Technical University Munich, 81675 Munich, Germany
| | - Peter J Turnbaugh
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA 94143, USA.,Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Peter H Seeberger
- Department of Biomolecular Systems, Max Planck Institute of Colloids and Interfaces, 14776 Potsdam, Germany
| | | | - Michael R Wilson
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Lucas Schirmer
- Department of Neurology and Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.,Interdisciplinary Center for Neurosciences, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sergio E Baranzini
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94158, USA. .,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA 94143, USA.,Graduate Program in Bioinformatics, University of California, San Francisco, San Francisco, CA 94158, USA
| |
Collapse
|