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CCR5-related signalling may link peripheral immune activation to brain chemokine responses in breast cancer ccr5相关信号可能将乳腺癌的外周免疫激活与脑趋化因子反应联系起来
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-10-17 DOI: 10.1016/j.jneuroim.2025.578782
Delyse McCaffrey , Cynthia Shannon Weickert , Adam K. Walker
Peripheral cancers trigger systemic inflammation that impacts the brain, causing cognitive, psychological, and sleep disturbances via cytokine elevation, oxidative stress, glial activation, and impaired neurogenesis. Although chemokine and growth factor increases and immune cell infiltration are well studied in tumour microenvironments, the brain's response to solid peripheral tumours is less understood. We implanted three murine mammary cancer types representing different stages of progression and immune involvement into mice, and measured chemokine and immune growth factor levels in blood and brain tissue (n = 40). Each cancer type induced distinct peripheral changes. CXCL1, associated with neutrophil activation, was the only chemokine elevated in the serum across all cancer types. Triple-negative lines (4T1.2, 67NR) also showed increased IL-2, G-CSF, and GM-CSF, reflecting expansion of neutrophils, myeloid cells, and T cells. In contrast, the EO771 model elevated CCL2, suggesting monocyte/macrophage recruitment into target tissue. However, these peripheral changes were not mirrored in the brain. Instead, levels of CCL5 (which recruits leukocytes), hippocampal levels of IL-12p40 (a macrophage chemoattractant), and IL-12p70 (which activates T cells and natural killer cells) levels were significantly elevated in response to peripheral cancers. These data reveal a prominent serum growth factor signature alluding to enhanced proliferation of hematopoietic progenitor cells in the bone marrow and mobilisation of mature immune cells into circulation. However, the brain's chemokine response suggests selective recruitment of T cells and monocytes/macrophages. Notably, higher serum CCL4 predicted greater hippocampal CCL5 increases, suggesting CCR5-related signalling may draw peripheral immune cells to the brain via increased chemotactic cues.
外周性癌症引发影响大脑的全身性炎症,通过细胞因子升高、氧化应激、神经胶质激活和神经发生受损,引起认知、心理和睡眠障碍。虽然趋化因子和生长因子的增加以及免疫细胞的浸润在肿瘤微环境中得到了很好的研究,但大脑对实体周围肿瘤的反应尚不清楚。我们将代表不同进展阶段和免疫参与的三种小鼠乳腺癌类型植入小鼠体内,并测量了血液和脑组织中的趋化因子和免疫生长因子水平(n = 40)。每种类型的癌症都会引起不同的外周变化。与中性粒细胞活化相关的CXCL1是所有癌症类型中血清中唯一升高的趋化因子。三阴性系(4T1.2, 67NR)也显示IL-2、G-CSF和GM-CSF升高,反映中性粒细胞、髓样细胞和T细胞的扩增。相比之下,EO771模型升高CCL2,表明单核细胞/巨噬细胞募集到靶组织。然而,这些外周的变化并没有反映在大脑中。相反,CCL5(招募白细胞)、海马IL-12p40(巨噬细胞化学引诱剂)和IL-12p70(激活T细胞和自然杀伤细胞)水平在外周血癌反应中显著升高。这些数据揭示了一个显著的血清生长因子特征,暗示了骨髓中造血祖细胞增殖增强和成熟免疫细胞进入循环的动员。然而,大脑的趋化因子反应表明T细胞和单核/巨噬细胞的选择性募集。值得注意的是,较高的血清CCL4预示着更大的海马CCL5的增加,这表明ccr5相关的信号可能通过增加的趋化线索将外周免疫细胞吸引到大脑。
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引用次数: 0
The real-world experience of biologics for neuromyelitis optica spectrum disorders as first-line and switched therapy 神经脊髓炎视谱障碍生物制剂作为一线和转换治疗的现实世界经验。
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-11-04 DOI: 10.1016/j.jneuroim.2025.578799
Ayano Matsuyoshi , Koji Shinoda , Hajime Takeuchi , Keisuke Mizutani , Yuu-ichi Kira , Kazunori Iwao , Mitsuru Watanabe , Katsuhisa Masaki , Noriko Isobe

Background

Several biologics have demonstrated the efficacy in reducing relapses of neuromyelitis optica spectrum disorder (NMOSD) with aquaporin-4 immunoglobulin G (AQP4-IgG). However, real-world data on biologics for NMOSD are limited. We aimed to evaluate the efficacy and safety of biologics in clinical practice.

Methods

We retrospectively reviewed the medical records of 117 patients with AQP4-IgG-positive NMOSD in our hospitals between 2000 and 2024. Patients were classified into Biologics-1st and glucocorticoids/immunosuppressants (GC/IS)-1st by their first-line therapy, and then those who switched from GC/IS to biologics (Switched to Biologics). Annualized relapse rate (ARR) and changes in Expanded Disability Status Scale (EDSS) scores were analyzed, and the safety was assessed in all biologics-treated patients.

Results

Among 45 patients who switched to biologics, significant reductions were observed in ARR [median (interquartile range, IQR), 0.0 (0.0–0.0) vs. 0.4 (0.1–0.6), p < 0.0001] and annual changes in EDSS scores [median (IQR), 0.0 (0.0–0.0) vs. 0.1 (0.0–0.3), p < 0.0001] after switching. No relapses occurred during 24.3 patient-years in Biologics-1st group, while GC/IS-1st group had 330 relapses during 970.3 patient-years (p = 0.0031). The ARR was significantly lower in Biologics-1st than in GC/IS-1st [median (IQR), 0.00 (0.00–0.00) vs. 0.20 (0.10–0.50), p < 0.0001], while the EDSS score change was comparable. The safety profile of biologics was generally consistent with the clinical trial data.

Conclusions

Biologics were highly efficacious in preventing relapses of NMOSD with AQP4-IgG in real-world clinical practice.
背景:一些生物制剂已经证明了水通道蛋白-4免疫球蛋白G (AQP4-IgG)对减少视神经脊髓炎谱系障碍(NMOSD)复发的疗效。然而,关于NMOSD生物制剂的实际数据是有限的。我们的目的是在临床实践中评价生物制剂的有效性和安全性。方法:回顾性分析我院2000 ~ 2024年收治的117例aqp4 - igg阳性NMOSD患者的病历。根据患者的一线治疗情况,将患者分为生物制剂1级和糖皮质激素/免疫抑制剂(GC/IS) 1级,然后从GC/IS切换到生物制剂(切换到生物制剂)。分析了年复发率(ARR)和扩展残疾状态量表(EDSS)评分的变化,并评估了所有生物制剂治疗患者的安全性。结果:在45例改用生物制剂的患者中,ARR[中位数(四分位间距,IQR)显著降低,p = 1组为0.0 (0.0-0.0)vs. 0.4(0.1-0.6),而GC/ is -1组在970.3患者年期间有330次复发(p = 0.0031)。Biologics-1组的ARR明显低于GC/ is -1组[中位数(IQR), 0.00 (0.00-0.00) vs. 0.20 (0.10-0.50)], p结论:在实际临床实践中,Biologics-1对预防AQP4-IgG NMOSD的复发是非常有效的。
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引用次数: 0
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): Practical recommendations for diagnosis and management 髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD):诊断和管理的实用建议。
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-10-17 DOI: 10.1016/j.jneuroim.2025.578781
Elia Sechi , Matteo Gastaldi , Rosa Cortese , Alvino Bisecco , Alberto Vogrig , Maria Pia Giannoccaro , Luigi Zuliani , Marco Zoccarato , Silvia Casagrande , Stefano Sartori , Margherita Nosadini , Raffaele Iorio , Marianna Spatola , Valentina Damato , Sara Mariotto
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct antibody-mediated disease characterized by heterogeneous manifestations. Despite some overlap with other demyelinating CNS disorders, specific clinical-MRI features of MOGAD have been identified that facilitate early diagnosis. Paediatric and adult populations can be similarly affected but differ in the predominant clinical phenotypes, which include optic neuritis, myelitis, acute disseminated encephalomyelitis, brainstem/cerebellar syndromes, and cerebral cortical encephalitis.
Based on the recently international MOGAD panel proposed diagnostic criteria, a correct diagnosis of MOGAD relies on the detection of serum or CSF MOG antibodies (Abs) using cell-based assays in patients with compatible clinical-MRI phenotypes. Relapses occur in 40–80 % of cases with no single factor being able to reliably predict the disease course after onset, although monitoring antibody titers may offer some guidance. Intravenous steroids with subsequent tapering and rapid escalation to plasma exchange in case of incomplete recovery are usually administered in the acute stage, with intravenous immunoglobulins considered as a possible alternative. Chronic treatment should be administered in relapsing patients or in case of incomplete recovery from the presenting attack. In this review, we summarise the main features of MOGAD, with a focus on the clinical/imaging characteristics, diagnosis and treatment approach and propose practical recommendations for clinicians.
髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)是一种独特的抗体介导的疾病,其特点是表现不均匀。尽管与其他脱髓鞘性中枢神经系统疾病有一些重叠,但已经确定了MOGAD的特定临床mri特征,有助于早期诊断。儿童和成人人群可能受到类似的影响,但主要的临床表型不同,包括视神经炎、脊髓炎、急性播散性脑脊髓炎、脑干/小脑综合征和脑皮质脑炎。根据最近国际MOGAD小组提出的诊断标准,MOGAD的正确诊断依赖于在具有相容临床- mri表型的患者中使用基于细胞的检测血清或CSF MOG抗体(Abs)。40- 80%的病例出现复发,没有单一因素能够可靠地预测发病后的病程,尽管监测抗体滴度可能提供一些指导。急性期通常采用静脉注射类固醇,在恢复不完全的情况下,随后逐渐减量并迅速升级到血浆置换,静脉注射免疫球蛋白被认为是一种可能的替代方法。慢性治疗应给予复发的病人或在不完全恢复的情况下,从目前的攻击。在这篇综述中,我们总结了MOGAD的主要特征,重点是临床/影像学特征,诊断和治疗方法,并为临床医生提出了实用的建议。
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引用次数: 0
Neoehrlichiosis in patients with multiple sclerosis in Halmstad, Sweden: A case series 瑞典Halmstad多发性硬化症患者的新立毛体病:一个病例系列。
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-10-25 DOI: 10.1016/j.jneuroim.2025.578787
Elias Ditlevsen Regen , Daniel Victor , Tijn Hendrikx
Neoehrlichiosis is an emerging tick-borne infection. The documented cases of human infection demonstrate a varying symptomatology, diagnostic difficulties, a lacking clinical awareness of the condition and a considerable diagnostic delay. A high prevalence of the causative pathogen has been found in ticks in large parts of Europe, and there is believed to be a significant underdiagnosis. B-cell targeting therapy has been found a significant risk factor both for symptomatic and severe infection. However, the number of reports of neoehrlichiosis in multiple sclerosis (MS) patients is scarce, with only four documented cases to date. This case series portrays seven cases of neoehrlichiosis in six MS patients in southern Sweden, yielding a greater understanding of the infection in this patient group. The cases illustrate the elusive symptomatology of neoehrlichiosis, resulting in a diagnostic delay. The findings show that testing for neoehrlichiosis must be considered in patients with B-cell modifying therapy both in the case of fever, but also other suggestive symptoms, and disregarding season and recollection of tick bite. All patients were under active treatment with rituximab, but with significant differences in treatment duration, total accumulated dose and duration since last dose. No correlation was seen to decreased levels of immunoglobulin G (IgG), but rather to B-cell depletion. This illustrates the need to monitor CD19 and CD20 levels when assessing risk for neoehrlichiosis, and to consider screening for infection before onset of B-cell modifying therapy.
新立克体病是一种新出现的蜱传感染。记录在案的人感染病例表现出不同的症状、诊断困难、缺乏对该病的临床认识和相当大的诊断延误。在欧洲大部分地区的蜱虫中发现了高流行率的致病病原体,并且据信存在严重的诊断不足。b细胞靶向治疗已被发现是症状性和重度感染的重要危险因素。然而,多发性硬化症(MS)患者中新毛囊病的报道数量很少,迄今为止只有4例记录在案。本病例系列描述了瑞典南部6例多发性硬化症患者的7例新埃利希体病,对该患者组的感染有了更深入的了解。这些病例说明了新毛体病难以捉摸的症状,导致诊断延迟。研究结果表明,在接受b细胞修饰治疗的患者中,无论是在发烧的情况下,还是在其他暗示症状的情况下,无论季节和蜱叮咬的回忆,都必须考虑对新毛体病进行检测。所有患者均在积极接受利妥昔单抗治疗,但在治疗时间、总累积剂量和自上次给药后持续时间方面存在显著差异。与免疫球蛋白G (IgG)水平下降没有相关性,而与b细胞耗竭有关。这说明在评估新毛体病风险时需要监测CD19和CD20水平,并在开始b细胞修饰治疗前考虑筛查感染。
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引用次数: 0
Wash-out duration and lymphocyte count in switching from fingolimod to ofatumumab: A case report and literature review 从fingolimod切换到ofatumumab的洗脱期和淋巴细胞计数:一个病例报告和文献综述
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-11-17 DOI: 10.1016/j.jneuroim.2025.578808
Assunta Bianco , Rosellina Russo , Alessandra Cicia , Sofia Marini , Matteo Lucchini , Massimiliano Mirabella
Transitioning from sphingosine-1-phosphate modulators, such as fingolimod, to anti-CD20 therapies is common in patients with multiple sclerosis due to suboptimal disease control, progression, or family planning. However, the optimal washout period remains unclear, and cases of disease activity rebound following discontinuation of fingolimod have been documented. We present the case of a 43-year-old woman who developed severe rebound disease activity after transitioning from fingolimod to ofatumumab, despite a washout period of 28 days. The patient experienced a new lesion and neuropsychological impairment, which improved after treatment with high-dose methylprednisolone. Literature review highlights the complexity of factors influencing rebound, including washout duration, lymphocyte count, and disease control during fingolimod therapy. Evidence suggests that initiating ofatumumab treatment without a prolonged washout period may mitigate rebound risk.
从鞘氨醇-1-磷酸调节剂(如fingolimod)过渡到抗cd20治疗在由于疾病控制欠佳、进展或计划生育的多发性硬化症患者中很常见。然而,最佳的洗脱期仍然不清楚,并且疾病活动在停药后反弹的病例已被记录。我们报告了一名43岁女性的病例,尽管有28天的洗脱期,但她在从芬戈莫德过渡到ofatumumab后出现了严重的反弹性疾病活动。患者出现了新的病变和神经心理障碍,在大剂量甲基强的松龙治疗后有所改善。文献综述强调影响反弹因素的复杂性,包括洗脱期、淋巴细胞计数和芬戈莫治疗期间的疾病控制。有证据表明,在没有延长洗脱期的情况下开始使用阿图单抗治疗可能会减轻反弹风险。
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引用次数: 0
Neurosarcoidosis masquerading as recurrent tumefactive demyelinating-appearing brain lesions: An 8-year diagnostic odyssey 神经结节病伪装为复发性肿瘤性脱髓鞘脑病变:8年诊断奥德赛。
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-11-08 DOI: 10.1016/j.jneuroim.2025.578802
Nirmalya Ray , Russoti Das , Mithun Sekhar , Debraj Jash , Shramana Deb , Ritwick Mondal , Jayanta Roy , Julián Benito-León

Background

Neurosarcoidosis is a rare inflammatory condition that can occasionally present with recurrent tumefactive lesions resembling those of idiopathic demyelinating diseases. Diagnosis is frequently delayed because clinical and radiological features overlap with demyelinating disorders, and systemic signs may initially be absent.

Case presentation

We report a woman who first presented at 23 years of age with a tumefactive demyelinating-appearing brain lesion and, eight years later, experienced recurrence with new involvement of the brain and spinal cord. The second episode featured a new tumefactive demyelinating-appearing brain lesion, longitudinally extensive transverse myelitis, vertebral enhancement, and systemic manifestations. Imaging revealed mediastinal lymphadenopathy and multiple hypodense lesions in the liver and spleen, while histopathologic examination of a mediastinal lymph node demonstrated noncaseating granulomas, confirming sarcoidosis.

Conclusion

To our knowledge, this is the first detailed report of neurosarcoidosis evolving from an initially isolated tumefactive demyelinating-appearing brain lesion to a later episode characterized by recurrent brain involvement with simultaneous spinal and systemic disease after a prolonged asymptomatic interval. Clinicians should consider neurosarcoidosis in the differential diagnosis of tumefactive demyelinating-appearing brain lesions, particularly when an initially isolated presentation is followed by subsequent brain, spinal, and systemic involvement, even in young patients without systemic features at onset.
背景:神经结节病是一种罕见的炎症性疾病,偶尔会出现类似特发性脱髓鞘疾病的复发性肿瘤病变。由于临床和放射学特征与脱髓鞘疾病重叠,并且最初可能没有全身性体征,因此诊断经常延迟。病例介绍:我们报告了一位23岁时首次出现肿瘤性脱髓鞘样脑病变的女性,8年后复发并累及大脑和脊髓。第二次发作表现为新的膨胀性脱髓鞘,表现为脑损伤,纵向广泛的横向脊髓炎,椎体增强和全身表现。影像学显示纵隔淋巴结病变,肝脏和脾脏多发低密度病变,而组织病理学检查显示纵隔淋巴结非干酪化肉芽肿,证实结节病。结论:据我们所知,这是首次详细报道神经结节病从最初孤立的肿瘤性脱髓鞘脑病变发展到后来的发作,其特征是在长时间无症状间隔后复发性脑受累并同时伴有脊柱和全身性疾病。临床医生在鉴别诊断肿瘤性脱髓鞘性脑病变时应考虑神经结节病,特别是当最初的孤立表现随后累及大脑、脊柱和全身时,即使是发病时没有全身特征的年轻患者。
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引用次数: 0
Genetically reduced MTHFR activity confers protection against multiple sclerosis 基因上减少MTHFR活性可以预防多发性硬化症
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-10-30 DOI: 10.1016/j.jneuroim.2025.578784
Iyas Daghlas , John V. Pluvinage , Dipender Gill

Objectives

Methylenetetrahydrofolate reductase (MTHFR) generates the active form of folate required for homocysteine metabolism. The C677T variant in MTHFR reduces enzymatic activity, increases homocysteine levels, and is associated with risk of several neurological diseases. However, its link to multiple sclerosis (MS) risk remains uncertain. We therefore investigated the association of this variant with risk and severity of MS.

Methods

We obtained genetic associations of C677T with homocysteine levels (n = 1210), MS risk (meta-analysis of three datasets: 43,069 cases), and MS severity (12,584 cases). We report associations of the C677T variant with MS risk and severity, and performed sensitivity analyses to assess genetic confounding.

Results

There was strong statistical evidence for an association of the C677T variant with risk of MS (pooled odds ratio [OR] of MS per homocysteine-raising allele 0.91, 95 % confidence interval [CI] 0.89–0.93, P = 7.59 × 10−14). The OR when scaled to an SD increase in genetically determined homocysteine levels due to MTHFR perturbation was 0.73 (95 % CI 0.66–0.79, P = 7.27 × 10−14). Colocalization analyses supported C677T as a shared causal variant for MS and homocysteine levels at the MTHFR locus. By contrast, no association was found between C677T and MS severity (P = 0.92).

Discussion

These results support a novel biological hypothesis linking impaired MTHFR function to protection from MS. Further research is needed to elucidate the underlying mechanism and explore potential therapeutic implications.
目的亚甲基四氢叶酸还原酶(MTHFR)产生同型半胱氨酸代谢所需的活性叶酸。MTHFR中的C677T变异降低酶活性,增加同型半胱氨酸水平,并与几种神经系统疾病的风险相关。然而,它与多发性硬化症(MS)风险的关系仍不确定。因此,我们研究了该变异与多发性硬化症风险和严重程度的关系。方法我们获得了C677T与同型半胱氨酸水平(n = 1210)、多发性硬化症风险(三个数据集的荟萃分析:43,069例)和多发性硬化症严重程度(12,584例)的遗传关联。我们报告了C677T变异与MS风险和严重程度的关联,并进行了敏感性分析以评估遗传混淆。结果C677T变异与多发性硬化症(MS /同型半胱氨酸升高等位基因的合并优势比[OR]为0.91,95%可信区间[CI] 0.89-0.93, P = 7.59 × 10−14)相关。由于MTHFR扰动,基因决定的同型半胱氨酸水平按SD增加的OR为0.73 (95% CI 0.66-0.79, P = 7.27 × 10−14)。共定位分析支持C677T作为MS和MTHFR位点同型半胱氨酸水平的共同因果变异。相比之下,C677T与MS严重程度无相关性(P = 0.92)。这些结果支持了一种新的生物学假设,即MTHFR功能受损与ms的保护有关,需要进一步的研究来阐明潜在的机制并探索潜在的治疗意义。
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引用次数: 0
A Neuroimmunological Axis between systemic autoimmunity and Parkinson's disease following long-COVID: A case series 长期covid后系统性自身免疫与帕金森病之间的神经免疫轴:一个病例系列
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-10-29 DOI: 10.1016/j.jneuroim.2025.578795
Esra Demir Unal

Background

Long COVID, a multisystemic syndrome following SARS-CoV-2 infection characterized by persistent immune dysregulation, systemic inflammation, and neuroimmune dysfunction, is a significant area of investigation in the neurological sciences. The hypothesis that this pathophysiological state can trigger de novo autoimmune diseases and potentially accelerate underlying neurodegenerative processes is gaining traction. This case series aims to illuminate the potential neuroimmunological link between these conditions by presenting the patients who developed de novo Crohn's disease (CD) and ankylosing spondylitis (AS) following Long COVID and were subsequently diagnosed with post-COVID Parkinson's Disease (PD).

Case presentations

The first case is a 50-year-old female who developed de novo CD six months after COVID-19 pneumonia, managed with the TNF-α inhibitor. Eighteen months later, she presented with parkinsonian motor deficits. The post-COVID PD diagnosis was supported by susceptibility-weighted MRI showing loss of nigrosome-1 and DAT-SPECT revealing a presynaptic dopaminergic deficit. The second case is a 48-year-old female who was diagnosed with de novo AS eight months post-COVID, treated with adalimumab. Twenty-six months later, she developed progressive bradykinesia and rigidity. Neuroimaging confirmed post-COVID PD with corresponding loss of nigrosome-1 and a presynaptic dopaminergic deficit on DAT-SPECT. In both genetically negative cases, dopaminergic therapy led to substantial motor improvement, with Unified Parkinson's Disease Rating Scale (UPDRS) Part IIIscores decreasing from 8 to 3 and 14 to 4, respectively.

Conclusion

This case series proposes a pathogenic cascade wherein SARS-CoV-2 infection acts as an environmental trigger, initiating a Long COVID-associated immune dysregulation that first precipitates a systemic autoimmune disorder. We hypothesize that this sustained inflammatory milieu subsequently accelerates the dysfunction of the dopaminergic system in predisposed individuals, thereby unmasking the clinical phenotype of post-COVID PD. This novel association highlights a potential nexus between virally-induced autoimmunity and subsequent neurodegeneration, offering a new perspective in the field of neuroimmunology.
背景:长冠状病毒是SARS-CoV-2感染后出现的一种多系统综合征,其特征是持续的免疫失调、全身炎症和神经免疫功能障碍,是神经科学研究的一个重要领域。这种病理生理状态可能引发自身免疫性疾病的新生,并可能加速潜在的神经退行性过程的假说正在获得关注。本病例系列旨在通过介绍长期COVID后发展为新发克罗恩病(CD)和强直性脊柱炎(AS)并随后被诊断为COVID后帕金森病(PD)的患者,阐明这些疾病之间潜在的神经免疫学联系。病例介绍:第一个病例是一名50岁的女性,她在COVID-19肺炎后6个月出现了新发CD,使用TNF-α抑制剂进行治疗。18个月后,她出现了帕金森运动障碍。敏感性加权MRI显示黑体-1缺失,DAT-SPECT显示突触前多巴胺能缺陷,支持covid - PD后诊断。第二个病例是一名48岁的女性,她在covid后8个月被诊断为新发AS,接受了阿达木单抗治疗。26个月后,她出现了进行性运动迟缓和僵硬。神经影像学证实covid - PD后出现相应的黑素体-1缺失和突触前多巴胺能缺陷。在这两种基因阴性的病例中,多巴胺能治疗导致了显著的运动改善,统一帕金森病评定量表(UPDRS)第三部分评分分别从8分降至3分和14分降至4分。结论:该病例系列提出了一个致病级联反应,其中SARS-CoV-2感染作为环境触发因素,启动与covid - 19相关的长期免疫失调,首先引发系统性自身免疫性疾病。我们假设这种持续的炎症环境随后加速了易感个体多巴胺能系统的功能障碍,从而揭示了covid - 19后PD的临床表型。这种新的关联强调了病毒诱导的自身免疫和随后的神经退行性变之间的潜在联系,为神经免疫学领域提供了新的视角。
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引用次数: 0
Neurological adverse events of immune checkpoint inhibitors: A practical guide to diagnosis with a focus on neuroimaging findings 免疫检查点抑制剂的神经系统不良事件:一个实用的诊断指南,重点是神经影像学的发现
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-11-21 DOI: 10.1016/j.jneuroim.2025.578816
Simone Rossi , Alberto Vogrig , Laura Fionda , Valentina Damato , Luca Spinardi , Maria Guarino
The use of immune checkpoint inhibitors (ICIs), a class of oncologic therapies that enhance anti-tumor immunity, may be complicated by the occurrence of neurologic immune-related adverse events (n-irAEs). ICI-induced neurotoxicities predominantly affect the peripheral nervous system, manifesting as myositis, polyradiculoneuropathies and cranial neuropathies and, less frequently, involve the central nervous system, typically as encephalitis or myelitis. The diagnosis of n-irAEs relies on the exclusion of alternative etiologies – such as cancer dissemination, chemotherapy-induced neurotoxicities, and neuroinfections – and the recognition of specific clinical syndromes.
Neuroradiological investigations, particularly magnetic resonance imaging (MRI), play a crucial role in ruling out differential diagnosis, mainly cancer dissemination. Furthermore, MRI can support the clinical suspicious of an immune-mediated process by demonstrating indirect signs of neuroinflammation, including tissue edema and gadolinium enhancement. Nuclear medicine techniques, such as position emission tomography and scintigraphy, may also aid in the assessment of ICI-induced encephalitis and parkinsonism.
Despite the recognized clinical relevance of imaging investigations in the diagnosis of n-irAEs, a detailed characterization of neuroradiological features of ICI-induced neurotoxicities remains limited. In this Review, we provide a comprehensive description of the imaging findings associated with n-irAEs and summarize the diagnostic work-up of these challenging disorders, emphasizing the central role of neuroimaging in their evaluation.
免疫检查点抑制剂(ICIs)是一类增强抗肿瘤免疫的肿瘤疗法,其使用可能会因神经免疫相关不良事件(n-irAEs)的发生而复杂化。ici诱导的神经毒性主要影响周围神经系统,表现为肌炎、多根神经病变和颅神经病变,很少累及中枢神经系统,典型表现为脑炎或脊髓炎。n-irAEs的诊断依赖于排除其他病因,如癌症扩散、化疗引起的神经毒性和神经感染,以及对特定临床综合征的识别。神经放射学检查,特别是磁共振成像(MRI),在排除鉴别诊断(主要是癌症扩散)方面起着至关重要的作用。此外,MRI可以通过显示神经炎症的间接迹象(包括组织水肿和钆增强)来支持免疫介导过程的临床怀疑。核医学技术,如位置发射断层扫描和闪烁成像,也可以帮助评估脑损伤引起的脑炎和帕金森病。尽管公认影像学检查在诊断n-irAEs中的临床相关性,但ici诱导的神经毒性的神经放射学特征的详细表征仍然有限。在这篇综述中,我们提供了与n-irAEs相关的影像学发现的全面描述,并总结了这些具有挑战性的疾病的诊断工作,强调了神经影像学在其评估中的核心作用。
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引用次数: 0
Wearable-based physiological monitoring and brain magnetic resonance imaging metrics in multiple sclerosis: A feasibility study 多发性硬化症的可穿戴生理监测和脑磁共振成像指标:可行性研究
IF 2.5 4区 医学 Q3 IMMUNOLOGY Pub Date : 2026-01-15 Epub Date: 2025-11-22 DOI: 10.1016/j.jneuroim.2025.578819
Yusei Miyazaki , Hiroaki Yokote , Juichi Fujimori , Kenzo Sakurai , Akifumi Hagiwara , Satoshi Fujino , Toshikazu Fukami , Eri Takahashi , Mai Miyagishi , Megumi Uwatoko , Yoko Sugimura , Itaru Amino , Sachiko Akimoto , Keisuke Izumi , Kazumichi Minato , Naoya Minami , Masaaki Niino

Background

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). Physiological monitoring may be useful for monitoring the progression of MS and its underlying neurodegenerative processes

Objective

This cross-sectional study evaluated the feasibility of assessing associations of physiological parameters measured by a wearable sensor with CNS atrophy and lesion burden in individuals with MS.

Methods

Thirty MS patients (relapsing-remitting [n = 23], secondary progressive [n = 5], primary progressive [n = 2]) were monitored using a wrist-worn sensor (Fitbit inspire 3) for up to 30 days, and 29 physiological parameters were obtained. Global and regional brain volumes, T2 lesion volume (T2LV), and C2/3 cervical spinal cord cross-sectional area (C2/3 CSA) were analyzed based on brain MRI. Associations between sensor-derived parameters and neuroimaging measures were assessed using correlation analyses adjusted for age and gender

Results

The proportion of deep sleep was associated with T2LV (partial spearman's ρ [ρpartial] = −0.46, 95 % confidence interval [−0.74, −0.04]) and C2/3 CSA (ρpartial = 0.59 [0.32, 0.76]). The coefficient of variation of RR intervals during sleep was associated with normalized brain volume (ρpartial = 0.41 [0.00, 0.74]). The minimum (ρpartial = −0.44 [−0.72, −0.04]) and range of heart rate (ρpartial = 0.41 [0.08, 0.68]) during daytime, step counts (ρpartial = 0.64 [0.40, 0.82]), and total metabolic equivalents (ρpartial = 0.54 [0.18, 0.79]) were associated with C2/3 CSA

Conclusion

The findings suggest the feasibility of using wearable sensors to detect physiological parameters reflective of neuropathology in patients with MS.
背景:多发性硬化症(MS)是一种中枢神经系统(CNS)的慢性炎症性疾病。生理监测可能有助于监测多发性硬化症的进展及其潜在的神经退行性过程。目的:本横断面研究评估可穿戴传感器测量的生理参数与多发性硬化症患者中枢神经系统萎缩和病变负担之间相关性的可行性。使用腕戴式传感器(Fitbit inspire 3)监测原发性进行性[n = 2]患者长达30天,获得29项生理参数。基于脑MRI分析脑整体和局部体积、T2病变体积(T2LV)和C2/3颈脊髓横截面积(C2/3 CSA)。结果深睡眠比例与T2LV(部分spearman ρ [ρ偏]= - 0.46,95%可信区间[- 0.74,- 0.04])和C2/3 CSA (ρ偏= 0.59[0.32,0.76])相关。睡眠期间RR间隔变异系数与归一化脑容量相关(ρpartial = 0.41[0.00, 0.74])。白天最小值(ρ偏=−0.44[−0.72,−0.04])和心率范围(ρ偏= 0.41[0.08,0.68])、步数(ρ偏= 0.64[0.40,0.82])和总代谢当量(ρ偏= 0.54[0.18,0.79])与csac2相关。结论可穿戴传感器检测MS患者神经病理生理参数的可行性。
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引用次数: 0
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Journal of neuroimmunology
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