Yana Said, Angeliki Filippatou, Conlan Tran, LuAnn Rezavi, Kai Guo, Matthew D. Smith, Yasmin Resto, John J. Chen, Peter A. Calabresi, Patrizio Caturegli, Sean J. Pittock, Eoin P. Flanagan, Elias S. Sotirchos
Objective
To assess the real-world performance of a live (LCBA) versus a fixed (FCBA) cell-based assay for the detection of serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin-4 (AQP4-IgG).
Methods
This was a retrospective study of patients evaluated at a single tertiary academic referral center, with serum testing performed clinically for AQP4-IgG and/or MOG-IgG by FCBA and LCBA on the same day. Additionally, frozen banked sera from the same day for patients tested only by one assay were retrieved and tested by the other assay. FCBA was performed by the Johns Hopkins Immunology Laboratory using Euroimmun kits with detection by indirect immunofluorescence (FCBA-IF), whereas LCBA was performed by the Mayo Clinic Neuroimmunology Laboratory with detection by flow cytometry (LCBA-FACS).
Results
Of 594 specimens with paired MOG-IgG testing, 500 were negative by both assays, 33 were positive by both assays, 56 were positive exclusively by LCBA-FACS, and 5 were only positive by FCBA-IF. Overall, MOG-IgG LCBA-FACS exhibited 95.1% sensitivity and 97.7% specificity, whereas MOG-IgG FCBA-IF had 45.7% sensitivity and 99.8% specificity. Of 577 specimens with paired AQP4-IgG testing, 503 were negative by both assays, 51 were positive by both assays, 21 were positive exclusively by LCBA-FACS, and 2 were only positive by FCBA-IF. Overall, AQP4-IgG LCBA-FACS exhibited 97.3% sensitivity and 100% specificity, whereas AQP4-IgG FCBA-IF had 71.6% sensitivity and 100% specificity.
Interpretation
LCBA-FACS for both MOG-IgG and AQP4-IgG had markedly better sensitivity than FCBA-IF, with similar specificity. The use of FCBA-IF may result in underrecognition of both MOG antibody-associated disease (MOGAD) and AQP4-IgG seropositive neuromyelitis optica spectrum disorder (NMOSD).
{"title":"Real-world clinical experience with serum MOG and AQP4 antibody testing by live versus fixed cell-based assay","authors":"Yana Said, Angeliki Filippatou, Conlan Tran, LuAnn Rezavi, Kai Guo, Matthew D. Smith, Yasmin Resto, John J. Chen, Peter A. Calabresi, Patrizio Caturegli, Sean J. Pittock, Eoin P. Flanagan, Elias S. Sotirchos","doi":"10.1002/acn3.52310","DOIUrl":"10.1002/acn3.52310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the real-world performance of a live (LCBA) versus a fixed (FCBA) cell-based assay for the detection of serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin-4 (AQP4-IgG).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study of patients evaluated at a single tertiary academic referral center, with serum testing performed clinically for AQP4-IgG and/or MOG-IgG by FCBA and LCBA on the same day. Additionally, frozen banked sera from the same day for patients tested only by one assay were retrieved and tested by the other assay. FCBA was performed by the Johns Hopkins Immunology Laboratory using Euroimmun kits with detection by indirect immunofluorescence (FCBA-IF), whereas LCBA was performed by the Mayo Clinic Neuroimmunology Laboratory with detection by flow cytometry (LCBA-FACS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 594 specimens with paired MOG-IgG testing, 500 were negative by both assays, 33 were positive by both assays, 56 were positive exclusively by LCBA-FACS, and 5 were only positive by FCBA-IF. Overall, MOG-IgG LCBA-FACS exhibited 95.1% sensitivity and 97.7% specificity, whereas MOG-IgG FCBA-IF had 45.7% sensitivity and 99.8% specificity. Of 577 specimens with paired AQP4-IgG testing, 503 were negative by both assays, 51 were positive by both assays, 21 were positive exclusively by LCBA-FACS, and 2 were only positive by FCBA-IF. Overall, AQP4-IgG LCBA-FACS exhibited 97.3% sensitivity and 100% specificity, whereas AQP4-IgG FCBA-IF had 71.6% sensitivity and 100% specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>LCBA-FACS for both MOG-IgG and AQP4-IgG had markedly better sensitivity than FCBA-IF, with similar specificity. The use of FCBA-IF may result in underrecognition of both MOG antibody-associated disease (MOGAD) and AQP4-IgG seropositive neuromyelitis optica spectrum disorder (NMOSD).</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 3","pages":"556-564"},"PeriodicalIF":4.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess blood exosome (Ex)-connexin (Cx)43 (encoded by GJA1) and its truncated isoforms in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), which show distinct alterations in astroglial Cx43.
Methods
Serum Exs from 48 patients with MS (34 relapsing–remitting, 14 secondary-progressive), 35 with NMOSD, 20 with other inflammatory neurologic diseases (OIND), and 17 healthy controls (HC) were subjected to quantitative Western blotting for Cx43, single-molecule array for neurofilament-L, and quantitative polymerase chain reaction for non-coding RNAs detected by RNA sequencing. Sera from control and astroglia-specific Cx43 inducible conditional knockout (Cx43-icKO) mice with experimental autoimmune encephalomyelitis (EAE) were also tested.
Results
Ex-GJA1-29k was markedly higher in MS than in NMOSD, OIND, and HC; it successively increased at relapse, remission, and secondary progression, and positively correlated with disability scores. Ex-hsa-miR-133b and other hsa-miRs that bind to full-length Cx43 were significantly lower in secondary-progressive MS than in HC, and Ex-hsa-miR-133b was negatively correlated with disability scores. Ex-GJA1-11k expression was lower in NMOSD at relapse than in HC and OIND, and was negatively correlated with disability score worsening and Ex-neurofilament-L levels. NMOSD at relapse had significantly higher expression of small nucleolar RNA (SNORD37, SNORD95, and SNORD97) than HC, and SNORD37 and SNORD95 showed strong negative correlations with disability scores. Control mice showed increased Ex-GJA1-43k and -29k during EAE; this effect was markedly reduced in Cx43-icKO mice with attenuated EAE.
Interpretation
Blood Ex-Cx43-truncated isoforms and small non-coding RNAs, which partially come from brain astroglia, are distinctly dysregulated in MS and NMSOD.
{"title":"Blood exosome connexins and small RNAs related to demyelinating disease activity","authors":"Guzailiayi Maimaitijiang, Jun-ichi Kira, Yuri Nakamura, Mitsuru Watanabe, Ezgi Ozdemir Takase, Satoshi Nagata, Ayako Sakoda, Xu Zhang, Katsuhisa Masaki, Ryo Yamasaki, Noriko Isobe, Hiroo Yamaguchi, Tomohiro Imamura","doi":"10.1002/acn3.52307","DOIUrl":"10.1002/acn3.52307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess blood exosome (Ex)-connexin (Cx)43 (encoded by <i>GJA1</i>) and its truncated isoforms in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), which show distinct alterations in astroglial Cx43.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Serum Exs from 48 patients with MS (34 relapsing–remitting, 14 secondary-progressive), 35 with NMOSD, 20 with other inflammatory neurologic diseases (OIND), and 17 healthy controls (HC) were subjected to quantitative Western blotting for Cx43, single-molecule array for neurofilament-L, and quantitative polymerase chain reaction for non-coding RNAs detected by RNA sequencing. Sera from control and astroglia-specific Cx43 inducible conditional knockout (<i>Cx43-icKO</i>) mice with experimental autoimmune encephalomyelitis (EAE) were also tested.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ex-GJA1-29k was markedly higher in MS than in NMOSD, OIND, and HC; it successively increased at relapse, remission, and secondary progression, and positively correlated with disability scores. Ex-hsa-miR-133b and other hsa-miRs that bind to full-length Cx43 were significantly lower in secondary-progressive MS than in HC, and Ex-hsa-miR-133b was negatively correlated with disability scores. Ex-GJA1-11k expression was lower in NMOSD at relapse than in HC and OIND, and was negatively correlated with disability score worsening and Ex-neurofilament-L levels. NMOSD at relapse had significantly higher expression of small nucleolar RNA (SNORD37, SNORD95, and SNORD97) than HC, and SNORD37 and SNORD95 showed strong negative correlations with disability scores. Control mice showed increased Ex-GJA1-43k and -29k during EAE; this effect was markedly reduced in <i>Cx43-icKO</i> mice with attenuated EAE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Blood Ex-Cx43-truncated isoforms and small non-coding RNAs, which partially come from brain astroglia, are distinctly dysregulated in MS and NMSOD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 3","pages":"538-555"},"PeriodicalIF":4.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marc Zanello, Berthold Voges, Ramesh Chelvarajah, Arjune Sen, Željka Petelin Gadže, Guillaume Penchet, Alessandro De Benedictis, Riccardo Fornaro, Masaki Iwasaki, Keiya Iijima, Elena Jiltsova, Goran Mrak, Sami Barrit, Alessandro Moiraghi, Andrea Landi, Marcus Neale, Shailendra Magdum, François Caire, Bertrand Godet, Philippe Domenech, Raphael Gaillard, Marc Guenot, Jason Labuschagne, Alexandre Rainha Campos, Herbert Rooijakkers, Riëm El Tahry, Tatiana Von Hertwig Fernandes De Oliveira, Amelia Alvarez-Sala, Cristina V. Torres, Fernando Vale, Johan Pallud, Romain Carron
Objective
Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy (DRE) and is indicated for implantation on the left vagus nerve-only. In rare cases right-sided VNS may be the only option. With only seven published cases in the literature, data on safety and effectiveness of right-sided VNS is very limited.
Methods
An anonymous 38-item questionnaire was sent to expert surgeons implanting VNS for DRE. The questions covered demographics and clinical characteristics, the reason for right-sided implantation and both neurological and surgical outcomes of right-sided VNS.
Results
The survey captured 38 cases of right-sided VNS (18 females, mean age at surgery of 28.0 ± 16.3 years). Right-sided VNS was performed because of VNS lead deficiency (n = 20), anatomical constraints (n = 8), infection of a left-sided VNS site (n = 9), and presence of a left ventricular shunt (n = 1). Thirty-two patients (84%) had a preoperative cardiac assessment. Three patients presented postoperative cardiac side-effects. Right-sided VNS was stopped at last follow-up in three patients: due to deep infection (n = 1), due to dyspnea (n = 1), and due to sleep apnea syndrome (n = 1). Twenty-one patients (55%) were responders to right-sided VNS and the mean reduction of seizure frequency under right-sided VNS was 56.2 ± 18.8%. Focusing on seizure frequency reduction between right-sided VNS and left-sided VNS: 20 patients experienced similar effectiveness, 1 experienced lesser effectiveness, and 2 patients experienced greater effectiveness with right-sided VNS.
Interpretation
This multicenter case series significantly augments the available literature on right-sided VNS. This suggests comparable effectiveness to left-sided VNS but potentially lower tolerability. Further studies are warranted to better evaluate safety and efficacy of right-sided VNS.
{"title":"Right-sided vagus nerve stimulation: Worldwide collection and perspectives","authors":"Marc Zanello, Berthold Voges, Ramesh Chelvarajah, Arjune Sen, Željka Petelin Gadže, Guillaume Penchet, Alessandro De Benedictis, Riccardo Fornaro, Masaki Iwasaki, Keiya Iijima, Elena Jiltsova, Goran Mrak, Sami Barrit, Alessandro Moiraghi, Andrea Landi, Marcus Neale, Shailendra Magdum, François Caire, Bertrand Godet, Philippe Domenech, Raphael Gaillard, Marc Guenot, Jason Labuschagne, Alexandre Rainha Campos, Herbert Rooijakkers, Riëm El Tahry, Tatiana Von Hertwig Fernandes De Oliveira, Amelia Alvarez-Sala, Cristina V. Torres, Fernando Vale, Johan Pallud, Romain Carron","doi":"10.1002/acn3.52312","DOIUrl":"10.1002/acn3.52312","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy (DRE) and is indicated for implantation on the left vagus nerve-only. In rare cases right-sided VNS may be the only option. With only seven published cases in the literature, data on safety and effectiveness of right-sided VNS is very limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An anonymous 38-item questionnaire was sent to expert surgeons implanting VNS for DRE. The questions covered demographics and clinical characteristics, the reason for right-sided implantation and both neurological and surgical outcomes of right-sided VNS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The survey captured 38 cases of right-sided VNS (18 females, mean age at surgery of 28.0 ± 16.3 years). Right-sided VNS was performed because of VNS lead deficiency (<i>n</i> = 20), anatomical constraints (<i>n</i> = 8), infection of a left-sided VNS site (<i>n</i> = 9), and presence of a left ventricular shunt (<i>n</i> = 1). Thirty-two patients (84%) had a preoperative cardiac assessment. Three patients presented postoperative cardiac side-effects. Right-sided VNS was stopped at last follow-up in three patients: due to deep infection (<i>n</i> = 1), due to dyspnea (<i>n</i> = 1), and due to sleep apnea syndrome (<i>n</i> = 1). Twenty-one patients (55%) were responders to right-sided VNS and the mean reduction of seizure frequency under right-sided VNS was 56.2 ± 18.8%. Focusing on seizure frequency reduction between right-sided VNS and left-sided VNS: 20 patients experienced similar effectiveness, 1 experienced lesser effectiveness, and 2 patients experienced greater effectiveness with right-sided VNS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>This multicenter case series significantly augments the available literature on right-sided VNS. This suggests comparable effectiveness to left-sided VNS but potentially lower tolerability. Further studies are warranted to better evaluate safety and efficacy of right-sided VNS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 3","pages":"565-576"},"PeriodicalIF":4.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143121774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helen Tremlett, Feng Zhu, Karl Everett, Ayesha Asaf, Ali Manouchehrinia, Ping Li, Kyla A. McKay, Jan Hillert, Yinshan Zhao, Colleen Maxwell, Ruth Ann Marrie
Objective
Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre-MS onset.
Methods
We identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991–2020) (“administrative” cohort), and the Swedish MS Registry (“clinical” cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency-room [ED]) pre-onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex.
Results
The administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre-onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre-onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre-onset (ED visits [Ontario] = 3.04; 95% CI: 2.94–3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44–2.59). In the year pre-onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13–3.48 vs. females = 2.90; 95% CI: 2.79–3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20-year-olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre-onset (physician visit RR [year-5] = 1.08; 95% CI: 1.02–1.14; RR [year-1] = 1.39;1.33–1.46).
Interpretation
Higher healthcare use was evident decades before MS onset, escalating 6–7 years pre-onset, peaking the year before, being disproportionately higher for males and older PwMS.
{"title":"Healthcare use is elevated two decades before a first demyelinating event and differs by age and sex","authors":"Helen Tremlett, Feng Zhu, Karl Everett, Ayesha Asaf, Ali Manouchehrinia, Ping Li, Kyla A. McKay, Jan Hillert, Yinshan Zhao, Colleen Maxwell, Ruth Ann Marrie","doi":"10.1002/acn3.52267","DOIUrl":"10.1002/acn3.52267","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Elevated healthcare use before multiple sclerosis (MS) onset suggests earlier opportunity to identify MS. Yet their timing and sociodemographic effects are unclear. We examined rates of healthcare use (and by age/sex) for >two decades pre-MS onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified people with MS (PwMS) using administrative data from Canada (Ontario) and Sweden (1991–2020) (“administrative” cohort), and the Swedish MS Registry (“clinical” cohort). The first MS/demyelinating diagnostic code (administrative) or symptom onset (clinical) defined MS onset. We compared annual rates of healthcare use (hospital, physician, and emergency-room [ED]) pre-onset between PwMS and up to five matched population controls using negative binomial regression, and by age/sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The administrative cohort = 35,018/136,007 PwMS/controls (Ontario), and 10,269/51,297 (Sweden). Rates of healthcare use were higher for PwMS than controls up to 28 (of 29) years (Ontario) and up to 15 (of 19) years (Sweden) pre-onset. Annual healthcare use rose steadily as onset approached, particularly escalating 7 years pre-onset in Ontario (e.g., hospital visit rate ratios [RRs] exceeded 1.30), and 6 years in Sweden (physician visit RRs > 1.10). RRs peaked the year pre-onset (ED visits [Ontario] = 3.04; 95% CI: 2.94–3.13, physician visits [Sweden] = 2.51; 95% CI: 2.44–2.59). In the year pre-onset, RRs were disproportionately higher for males (ED RRs [Ontario] = 3.30; 95% CI: 3.13–3.48 vs. females = 2.90; 95% CI: 2.79–3.02), and dropped steadily by age (physician visit RRs [Sweden] = 2.61/2.27/1.97/1.72 for 50/40/30/20-year-olds). The smaller clinical cohort (7604/37,974 PwMS/controls) exhibited similar patterns, albeit more modest, with RRs elevated up to 5 years pre-onset (physician visit RR [year-5] = 1.08; 95% CI: 1.02–1.14; RR [year-1] = 1.39;1.33–1.46).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Higher healthcare use was evident decades before MS onset, escalating 6–7 years pre-onset, peaking the year before, being disproportionately higher for males and older PwMS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 2","pages":"415-432"},"PeriodicalIF":4.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52267","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ermelinda De Meo, Ferran Prados Carrasco, J William L Brown, Alasdair J Coles, Nick G Cunniffe, Amy E Jolly, Baris Kanber, Rebecca Samson, Frederik Barkhof, Declan Chard
Objective: To assess the pathological mechanisms contributing to white matter (WM) lesion expansion or contraction and remyelination in multiple sclerosis (MS).
Methods: We assessed 1,613 lesions in 49 people with relapsing-remitting MS in the CCMR-One bexarotene trial (EudraCT 2014-003145-99). We measured lesion orientation relative to WM tracts, surface-in gradients and veins. Jacobian deformation was used to assess lesion expansion over 6 months, while magnetization transfer ratio (MTR) imaging was used to assess remyelination.
Results: At baseline, 33% of lesions were aligned with veins, 2% along WM tracts, 0% with surface-in gradients, and 4% orthogonal to veins. No significant differences were observed in lesion shape, while lesions aligned with surface-in gradients and with veins had lower volume compared to all remaining orientations. At follow-up, 13% of lesions expanded and 7% contracted. The directions for both expansion and contraction were 18% and 8%, respectively, along WM tracts, 20% and 15% parallel to veins, 22% and 23% orthogonal to veins and 0% and 1% along surface-in gradients. Bexarotene had no effect on lesion expansion or contraction, but MTR significantly increased in lesions aligned with surface-in gradients and veins.
Interpretation: Lesion expansion and shrinkage are affected by venous and WM tract factors, but these do not influence bexarotene's capacity to promote remyelination. This, instead, appears to be affected by surface-in factors. To limit lesion expansion and maximize tissue repair, multiple processes may need to be targeted.
{"title":"An MRI assessment of mechanisms underlying lesion growth and shrinkage in multiple sclerosis.","authors":"Ermelinda De Meo, Ferran Prados Carrasco, J William L Brown, Alasdair J Coles, Nick G Cunniffe, Amy E Jolly, Baris Kanber, Rebecca Samson, Frederik Barkhof, Declan Chard","doi":"10.1002/acn3.52308","DOIUrl":"https://doi.org/10.1002/acn3.52308","url":null,"abstract":"<p><strong>Objective: </strong>To assess the pathological mechanisms contributing to white matter (WM) lesion expansion or contraction and remyelination in multiple sclerosis (MS).</p><p><strong>Methods: </strong>We assessed 1,613 lesions in 49 people with relapsing-remitting MS in the CCMR-One bexarotene trial (EudraCT 2014-003145-99). We measured lesion orientation relative to WM tracts, surface-in gradients and veins. Jacobian deformation was used to assess lesion expansion over 6 months, while magnetization transfer ratio (MTR) imaging was used to assess remyelination.</p><p><strong>Results: </strong>At baseline, 33% of lesions were aligned with veins, 2% along WM tracts, 0% with surface-in gradients, and 4% orthogonal to veins. No significant differences were observed in lesion shape, while lesions aligned with surface-in gradients and with veins had lower volume compared to all remaining orientations. At follow-up, 13% of lesions expanded and 7% contracted. The directions for both expansion and contraction were 18% and 8%, respectively, along WM tracts, 20% and 15% parallel to veins, 22% and 23% orthogonal to veins and 0% and 1% along surface-in gradients. Bexarotene had no effect on lesion expansion or contraction, but MTR significantly increased in lesions aligned with surface-in gradients and veins.</p><p><strong>Interpretation: </strong>Lesion expansion and shrinkage are affected by venous and WM tract factors, but these do not influence bexarotene's capacity to promote remyelination. This, instead, appears to be affected by surface-in factors. To limit lesion expansion and maximize tissue repair, multiple processes may need to be targeted.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vicente Quiroz, Umar Zubair, Luca Schierbaum, Amy Tam, Nicole Battaglia, Joshua Rong, Habibah A P Agianda, Julian E Alecu, Kathryn Yang, Darius Ebrahimi-Fakhari
Biallelic loss-of-function variants in AP4S1 cause childhood-onset hereditary spastic paraplegia. A recent report suggested that heterozygous AP4S1 variants lead to a syndrome of lower limb spasticity and dysregulation of sphincter function. We critically evaluate this claim against clinical observations in 28 heterozygous carriers of the same AP4S1 variant (NM_007077.3: c.289C>T, p.Arg97Ter). In these 14 males and 14 females (mean age: 37.6 ± 4.9 years [SD], range: 30-50 years), we ascertain no increased prevalence of neurological manifestations. Alternative causes should be considered when evaluating patients with heterozygous AP4S1 variants and neurological symptoms, as misattribution of pathogenicity can impact clinical care and genetic counseling.
{"title":"Heterozygous variants in AP4S1 are not associated with a neurological phenotype.","authors":"Vicente Quiroz, Umar Zubair, Luca Schierbaum, Amy Tam, Nicole Battaglia, Joshua Rong, Habibah A P Agianda, Julian E Alecu, Kathryn Yang, Darius Ebrahimi-Fakhari","doi":"10.1002/acn3.52302","DOIUrl":"https://doi.org/10.1002/acn3.52302","url":null,"abstract":"<p><p>Biallelic loss-of-function variants in AP4S1 cause childhood-onset hereditary spastic paraplegia. A recent report suggested that heterozygous AP4S1 variants lead to a syndrome of lower limb spasticity and dysregulation of sphincter function. We critically evaluate this claim against clinical observations in 28 heterozygous carriers of the same AP4S1 variant (NM_007077.3: c.289C>T, p.Arg97Ter). In these 14 males and 14 females (mean age: 37.6 ± 4.9 years [SD], range: 30-50 years), we ascertain no increased prevalence of neurological manifestations. Alternative causes should be considered when evaluating patients with heterozygous AP4S1 variants and neurological symptoms, as misattribution of pathogenicity can impact clinical care and genetic counseling.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yahel Segal, Georgios Mangioris, Vanda Lennon, Binxia Yang, Divyanshu Dubey, Eoin P Flanagan, Andrew McKeon, John R Mills, Michel Toledano, Ivana Vodopivec, Sean J Pittock, Anastasia Zekeridou
Defining the CSF cytokine/chemokine and injury biomarker signature of glial fibrillary acidic protein (GFAP) autoimmunity can inform immunopathogenesis. CSF GFAP-IgG-positive samples (N = 98) were tested for 17 cytokines/chemokines, neurofilament light chain (NfL), and GFAP (ELLA, Bio-Techne). Controls included non-inflammatory (N = 42), AQP4-IgG-positive (N = 83), CNS infections (N = 13), and neurosarcoidosis (N = 32). IL5, IL6, IL10, IL8/CXCL8, CXCL9, CXCL10, CXCL13, BAFF, GM-CSF, IFN-gamma, and TNF-alpha concentrations were higher compared to non-inflammatory controls (P < 0.01). GFAP concentrations were similar to those of AQP4-IgG-positive patients; NfL was higher (P < 0.001) and correlated with MRI changes and outcomes. CSF cytokine/chemokine findings in GFAP autoimmunity correlate with histopathology; GFAP and NfL hold promise as disease biomarkers.
{"title":"CSF cytokine, chemokine and injury biomarker profile of glial fibrillary acidic protein (GFAP) autoimmunity.","authors":"Yahel Segal, Georgios Mangioris, Vanda Lennon, Binxia Yang, Divyanshu Dubey, Eoin P Flanagan, Andrew McKeon, John R Mills, Michel Toledano, Ivana Vodopivec, Sean J Pittock, Anastasia Zekeridou","doi":"10.1002/acn3.52305","DOIUrl":"https://doi.org/10.1002/acn3.52305","url":null,"abstract":"<p><p>Defining the CSF cytokine/chemokine and injury biomarker signature of glial fibrillary acidic protein (GFAP) autoimmunity can inform immunopathogenesis. CSF GFAP-IgG-positive samples (N = 98) were tested for 17 cytokines/chemokines, neurofilament light chain (NfL), and GFAP (ELLA, Bio-Techne). Controls included non-inflammatory (N = 42), AQP4-IgG-positive (N = 83), CNS infections (N = 13), and neurosarcoidosis (N = 32). IL5, IL6, IL10, IL8/CXCL8, CXCL9, CXCL10, CXCL13, BAFF, GM-CSF, IFN-gamma, and TNF-alpha concentrations were higher compared to non-inflammatory controls (P < 0.01). GFAP concentrations were similar to those of AQP4-IgG-positive patients; NfL was higher (P < 0.001) and correlated with MRI changes and outcomes. CSF cytokine/chemokine findings in GFAP autoimmunity correlate with histopathology; GFAP and NfL hold promise as disease biomarkers.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annals of Clinical and Translational Neurology 2016; 3(8): 588–606. doi: 10.1002/acn3.321
The authors regret that an error occurred during the assembly of Fig. 1A and C where the incorrect panel was used to represent the non-tg Pen-D5 and the α-syn tg control condition. The corrected figure is provided in the attachment. We apologize for this error.
{"title":"Correction to α-synuclein conformational antibodies fused to penetratin are effective in models of Lewy body disease","authors":"","doi":"10.1002/acn3.52266","DOIUrl":"10.1002/acn3.52266","url":null,"abstract":"<p>Annals of Clinical and Translational Neurology 2016; 3(8): 588–606. doi: 10.1002/acn3.321</p><p>The authors regret that an error occurred during the assembly of Fig. 1A and C where the incorrect panel was used to represent the non-tg Pen-D5 and the α-syn tg control condition. The corrected figure is provided in the attachment. We apologize for this error.</p>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 2","pages":"454"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Silvan Büeler, Collene E. Anderson, Veronika Birkhäuser, Patrick Freund, Oliver Gross, Thomas M. Kessler, Christian W. Kündig, Lorenz Leitner, Nomah Mahnoor, Ulrich Mehnert, Raphael Röthlisberger, Stephanie A. Stalder, Stéphanie van der Lely, Carl M. Zipser, Gergely David, Martina D. Liechti
Objective
To characterize structural integrity of the lumbosacral enlargement and conus medullaris within one month after spinal cord injury (SCI).
Methods
Lumbosacral cord MRI data were acquired in patients with sudden onset (<7 days) SCI at the cervical or thoracic level approximately one month after injury and in healthy controls. Tissue integrity and loss were evaluated through diffusion tensor (DTI) and T2*-weighted imaging (cross-sectional area [CSA] measurements). Associations with the degree of neurological impairment were assessed using linear mixed-effects models.
Results
Twenty-one patients with SCI showed lower white matter (WM) fractional anisotropy (FA) (≤−13.3%) and higher WM radial diffusivity (≤14.6%) compared to 27 healthy controls. Differences were most pronounced in the lateral columns of WM. CSA measurements revealed no group differences. For the lateral columns, lower FA values were associated with lower motor scores and lower amplitudes of motor evoked potentials. For the dorsal columns, lower FA values were associated with lower amplitudes of somatosensory evoked potentials from the lower extremities.
Interpretation
One month after SCI, first signs of WM degeneration were apparent, without indication of tissue loss. The more pronounced differences observed in the lateral column could be attributed to anterograde degeneration of the motor tracts. The variability among DTI measurements remote from the lesion site can be partially explained by the degree of the SCI-induced neurological impairment. Together with previous studies, our findings indicate that impaired tissue integrity precedes tissue loss. The presented techniques have potential applications in monitoring the progression of various neurological diseases.
{"title":"Remote neurodegeneration in the lumbosacral cord one month after spinal cord injury: a cross-sectional MRI study","authors":"Silvan Büeler, Collene E. Anderson, Veronika Birkhäuser, Patrick Freund, Oliver Gross, Thomas M. Kessler, Christian W. Kündig, Lorenz Leitner, Nomah Mahnoor, Ulrich Mehnert, Raphael Röthlisberger, Stephanie A. Stalder, Stéphanie van der Lely, Carl M. Zipser, Gergely David, Martina D. Liechti","doi":"10.1002/acn3.52298","DOIUrl":"10.1002/acn3.52298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize structural integrity of the lumbosacral enlargement and conus medullaris within one month after spinal cord injury (SCI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Lumbosacral cord MRI data were acquired in patients with sudden onset (<7 days) SCI at the cervical or thoracic level approximately one month after injury and in healthy controls. Tissue integrity and loss were evaluated through diffusion tensor (DTI) and T2*-weighted imaging (cross-sectional area [CSA] measurements). Associations with the degree of neurological impairment were assessed using linear mixed-effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one patients with SCI showed lower white matter (WM) fractional anisotropy (FA) (≤−13.3%) and higher WM radial diffusivity (≤14.6%) compared to 27 healthy controls. Differences were most pronounced in the lateral columns of WM. CSA measurements revealed no group differences. For the lateral columns, lower FA values were associated with lower motor scores and lower amplitudes of motor evoked potentials. For the dorsal columns, lower FA values were associated with lower amplitudes of somatosensory evoked potentials from the lower extremities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>One month after SCI, first signs of WM degeneration were apparent, without indication of tissue loss. The more pronounced differences observed in the lateral column could be attributed to anterograde degeneration of the motor tracts. The variability among DTI measurements remote from the lesion site can be partially explained by the degree of the SCI-induced neurological impairment. Together with previous studies, our findings indicate that impaired tissue integrity precedes tissue loss. The presented techniques have potential applications in monitoring the progression of various neurological diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 3","pages":"523-537"},"PeriodicalIF":4.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ermelinda De Meo, Emilio Portaccio, Rosa Cortese, Luis Ruano, Benedetta Goretti, Claudia Niccolai, Francesco Patti, Clara Chisari, Paolo Gallo, Paola Grossi, Angelo Ghezzi, Marco Roscio, Flavia Mattioli, Chiara Stampatori, Marta Simone, Rosa Gemma Viterbo, Raffaello Bonacchi, Assunta Maria Rocca, Elisa Leveraro, Antonio Giorgio, Nicola De Stefano, Massimo Filippi, Matilde Inglese, Maria Pia Amato
Objectives
We aim to investigate cognitive phenotype distribution and MRI correlates across pediatric-, elderly-, and adult-onset MS patients as a function of disease duration.
Methods
In this cross-sectional study, we enrolled 1262 MS patients and 238 healthy controls, with neurological and cognitive assessments. A subset of 222 MS patients and 92 controls underwent 3T-MRI scan for brain atrophy and lesion analysis. Multinomial probabilistic models identified likelihood of belonging to cognitive phenotypes (“preserved-cognition,” “mild verbal memory/semantic fluency,” “mild multi-domain,” “severe attention/executive,” and “severe multi-domain”) and experiencing MRI abnormalities based on disease duration and age at onset.
Results
In all groups, the likelihood of “preserved-cognition” phenotype decreased, whereas “mild multi-domain” increased with longer disease duration. In pediatric- and adult-onset patients, the likelihood of “mild verbal memory/semantic fluency” phenotypes decreased with longer disease duration, and that of “severe multi-domain” increased with longer disease duration. Only in adult-onset patients, the likelihood of “severe executive/attention” phenotype increased with longer disease duration. All groups displayed escalating probabilities of cortical, thalamic, hippocampal, and deep gray matter atrophy over disease course. Compared to adult, pediatric-onset patients showed lower probability of experiencing thalamic atrophy with longer disease duration, while elderly-onset showed higher probability of experiencing cortical and hippocampal atrophy.
Interpretation
Age at MS onset significantly influences the distribution of cognitive phenotypes and the patterns of regional gray matter atrophy throughout the disease course.
{"title":"Pediatric, adult, and late onset multiple sclerosis: Cognitive phenotypes and gray matter atrophy","authors":"Ermelinda De Meo, Emilio Portaccio, Rosa Cortese, Luis Ruano, Benedetta Goretti, Claudia Niccolai, Francesco Patti, Clara Chisari, Paolo Gallo, Paola Grossi, Angelo Ghezzi, Marco Roscio, Flavia Mattioli, Chiara Stampatori, Marta Simone, Rosa Gemma Viterbo, Raffaello Bonacchi, Assunta Maria Rocca, Elisa Leveraro, Antonio Giorgio, Nicola De Stefano, Massimo Filippi, Matilde Inglese, Maria Pia Amato","doi":"10.1002/acn3.52291","DOIUrl":"10.1002/acn3.52291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aim to investigate cognitive phenotype distribution and MRI correlates across pediatric-, elderly-, and adult-onset MS patients as a function of disease duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, we enrolled 1262 MS patients and 238 healthy controls, with neurological and cognitive assessments. A subset of 222 MS patients and 92 controls underwent 3T-MRI scan for brain atrophy and lesion analysis. Multinomial probabilistic models identified likelihood of belonging to cognitive phenotypes (“preserved-cognition,” “mild verbal memory/semantic fluency,” “mild multi-domain,” “severe attention/executive,” and “severe multi-domain”) and experiencing MRI abnormalities based on disease duration and age at onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all groups, the likelihood of “preserved-cognition” phenotype decreased, whereas “mild multi-domain” increased with longer disease duration. In pediatric- and adult-onset patients, the likelihood of “mild verbal memory/semantic fluency” phenotypes decreased with longer disease duration, and that of “severe multi-domain” increased with longer disease duration. Only in adult-onset patients, the likelihood of “severe executive/attention” phenotype increased with longer disease duration. All groups displayed escalating probabilities of cortical, thalamic, hippocampal, and deep gray matter atrophy over disease course. Compared to adult, pediatric-onset patients showed lower probability of experiencing thalamic atrophy with longer disease duration, while elderly-onset showed higher probability of experiencing cortical and hippocampal atrophy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Age at MS onset significantly influences the distribution of cognitive phenotypes and the patterns of regional gray matter atrophy throughout the disease course.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 3","pages":"512-522"},"PeriodicalIF":4.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52291","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}