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Constitutive DAMPs in CNS injury: From preclinical insights to clinical perspectives 中枢神经系统损伤中的组成性 DAMPs:从临床前洞察到临床视角。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-31 DOI: 10.1016/j.bbi.2024.07.047

Damage-associated molecular patterns (DAMPs) are endogenous molecules released in tissues upon cellular damage and necrosis, acting to initiate sterile inflammation. Constitutive DAMPs (cDAMPs) have the particularity to be present within the intracellular compartments of healthy cells, where they exert diverse functions such as regulation of gene expression and cellular homeostasis. However, after injury to the central nervous system (CNS), cDAMPs are rapidly released by stressed, damaged or dying neuronal, glial and endothelial cells, and can trigger inflammation without undergoing structural modifications. Several cDAMPs have been described in the injured CNS, such as interleukin (IL)-1α, IL-33, nucleotides (e.g. ATP), and high-mobility group box protein 1. Once in the extracellular milieu, these molecules are recognized by the remaining surviving cells through specific DAMP-sensing receptors, thereby inducing a cascade of molecular events leading to the production and release of proinflammatory cytokines and chemokines, as well as cell adhesion molecules. The ensuing immune response is necessary to eliminate cellular debris caused by the injury, allowing for damage containment. However, seeing as some molecules associated with the inflammatory response are toxic to surviving resident CNS cells, secondary damage occurs, aggravating injury and exacerbating neurological and behavioral deficits. Thus, a better understanding of these cDAMPs, as well as their receptors and downstream signaling pathways, could lead to identification of novel therapeutic targets for treating CNS injuries such as SCI, TBI, and stroke. In this review, we summarize the recent literature on cDAMPs, their specific functions, and the therapeutic potential of interfering with cDAMPs or their signaling pathways.

损伤相关分子模式(DAMPs)是细胞损伤和坏死时在组织中释放的内源性分子,其作用是引发无菌性炎症。组成型 DAMPs(cDAMPs)存在于健康细胞的细胞内区室中,具有调节基因表达和细胞平衡等多种功能。然而,中枢神经系统(CNS)受伤后,受压、受损或死亡的神经元、神经胶质细胞和内皮细胞会迅速释放 cDAMPs,并在不改变结构的情况下引发炎症。一旦进入细胞外环境,这些分子就会被剩余的存活细胞通过特定的 DAMP 感受器识别,从而诱发一系列分子事件,导致促炎细胞因子和趋化因子以及细胞粘附分子的产生和释放。随之而来的免疫反应是消除损伤造成的细胞碎片所必需的,从而使损伤得到控制。然而,由于一些与炎症反应相关的分子对存活的中枢神经系统驻留细胞具有毒性,因此会造成二次损伤,加重损伤并加剧神经和行为障碍。因此,如果能更好地了解这些 cDAMPs 及其受体和下游信号通路,就能找到治疗 SCI、创伤性脑损伤和中风等中枢神经系统损伤的新型治疗靶点。在这篇综述中,我们总结了有关 cDAMPs、其特定功能以及干扰 cDAMPs 或其信号通路的治疗潜力的最新文献。
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引用次数: 0
18 kDa Translocator protein (TSPO) is upregulated in rat brain after peripheral nerve injury and downregulated by diroximel fumarate 转运蛋白 18 kDa(TSPO)在周围神经损伤后的大鼠脑中上调,并在富马酸双羟萘酸盐的作用下下调。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-31 DOI: 10.1016/j.bbi.2024.08.057

Neuroimmune signaling is a key process underlying neuropathic pain. Clinical studies have demonstrated that 18 kDa translocator protein (TSPO), a putative marker of neuroinflammation, is upregulated in discrete brain regions of patients with chronic pain. However, no preclinical studies have investigated TSPO dynamics in the brain in the context of neuropathic pain and in response to analgesic treatments. We used positron emission tomography-computed tomography (PET-CT) and [18F]-PBR06 radioligand to measure TSPO levels in the brain across time after chronic constriction injury (CCI) of the sciatic nerve in both male and female rats. Up to 10 weeks post-CCI, TSPO expression was increased in discrete brain regions, including medial prefrontal cortex, somatosensory cortex, insular cortex, anterior cingulate cortex, motor cortex, ventral tegmental area, amygdala, midbrain, pons, medulla, and nucleus accumbens. TSPO was broadly upregulated across these regions at 4 weeks post CCI in males, and 10 weeks in females, though there were regional differences between the sexes. Using immunohistochemistry, we confirmed TSPO expression in these regions. We further demonstrated that TSPO was upregulated principally in microglia in the nucleus accumbens core, and astrocytes and endothelial cells in the nucleus accumbens shell. Finally, we tested whether TSPO upregulation was sensitive to diroximel fumarate, a drug that induces endogenous antioxidants via nuclear factor E2-related factor 2 (Nrf2). Diroximel fumarate alleviated neuropathic pain and reduced TSPO upregulation. Our findings indicate that TSPO is upregulated over the course of neuropathic pain development and is resolved by an antinociceptive intervention in animals with peripheral nerve injury.

神经免疫信号转导是神经病理性疼痛的一个关键过程。临床研究表明,转运蛋白 18 kDa(TSPO)是神经炎症的一种假定标志物,在慢性疼痛患者的离散脑区上调。然而,还没有临床前研究调查过神经病理性疼痛时大脑中 TSPO 的动态变化以及对镇痛治疗的反应。我们使用正电子发射断层扫描-计算机断层扫描(PET-CT)和[18F]-PBR06放射性配体测量了雄性和雌性大鼠坐骨神经慢性收缩损伤(CCI)后大脑中不同时间的TSPO水平。CCI后10周内,TSPO在内侧前额叶皮层、躯体感觉皮层、岛叶皮层、前扣带回皮层、运动皮层、腹侧被盖区、杏仁核、中脑、脑桥、延髓和伏隔核等离散脑区的表达均有所增加。男性在CCI后4周、女性在CCI后10周时,TSPO在这些区域广泛上调,但男女之间存在区域差异。通过免疫组化,我们证实了 TSPO 在这些区域的表达。我们还进一步证实,TSPO 主要在累加核核心的小胶质细胞以及累加核外壳的星形胶质细胞和内皮细胞中上调。最后,我们测试了 TSPO 的上调是否对富马酸双嘧达莫敏感,富马酸双嘧达莫是一种通过核因子 E2 相关因子 2(Nrf2)诱导内源性抗氧化剂的药物。富马酸双嘧达莫能缓解神经病理性疼痛并降低 TSPO 的上调。我们的研究结果表明,TSPO在神经病理性疼痛的发展过程中上调,并通过对周围神经损伤动物进行抗痛觉干预而得到缓解。
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引用次数: 0
The role of cytokines in acute and chronic postsurgical pain after major musculoskeletal surgeries in a quaternary pediatric center 细胞因子在一家四级儿科中心重大肌肉骨骼手术后急性和慢性术后疼痛中的作用。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-31 DOI: 10.1016/j.bbi.2024.08.056
<div><h3>Study Objective</h3><p>To determine if baseline cytokines/chemokines and their changes over postoperative days 0–2 (POD0-2) predict acute and chronic postsurgical pain (CPSP) after major surgery.</p></div><div><h3>Design</h3><p>Prospective, observational, longitudinal nested study.</p></div><div><h3>Setting</h3><p>University-affiliated quaternary children’s hospital.</p></div><div><h3>Patients</h3><p>Subjects (≥8 years old) with idiopathic scoliosis undergoing spine fusion or pectus excavatum undergoing Nuss procedure.</p></div><div><h3>Measurements</h3><p>Demographics, surgical, psychosocial measures, pain scores, and opioid use over POD0-2 were collected. Cytokine concentrations were analyzed in serial blood samples collected before and up to two weeks after surgery, using Luminex bead arrays. After data preparation, relationships between pre- and post-surgical cytokine concentrations with acute (% time in moderate-severe pain over POD0-2) and chronic (pain score > 3/10 beyond 3 months post-surgery) post-surgical pain were analyzed using univariable and multivariable regression analyses with adjustment for covariates and mixed effects models were used to associate longitudinal cytokine concentrations with pain outcomes.</p></div><div><h3>Main Results</h3><p>Analyses included 3,164 repeated measures of 16 cytokines/chemokines from 112 subjects (median age 15.3, IQR 13.5–17.0, 54.5 % female, 59.8 % pectus). Acute postsurgical pain was associated with higher baseline concentrations of GM-CSF (β = 0.95, SE 0.31; <em>p</em> = 0.003), IL-1β (β = 0.84, SE 0.36; <em>p</em> = 0.02), IL-2 (β = 0.78, SE 0.34; <em>p</em> = 0.03), and IL-12 p70 (β = 0.88, SE 0.40; <em>p</em> = 0.03) and longitudinal postoperative elevations in GM-CSF (β = 1.38, SE 0.57; <em>p</em> = 0.03), IFNγ (β = 1.36, SE 0.6; <em>p</em> = 0.03), IL-1β (β = 1.25, SE 0.59; <em>p</em> = 0.03), IL-7 (β = 1.65, SE 0.7; <em>p</em> = 0.02), and IL-12 p70 (β = 1.17, SE 0.58; <em>p</em> = 0.04). In contrast, CPSP was associated with lower baseline concentration of IL-8 (β = -0.39, SE 0.17; <em>p</em> = 0.02), and the risk of developing CPSP was elevated in patients with lower longitudinal postoperative concentrations of IL-6 (β = -0.57, SE 0.26; <em>p</em> = 0.03), IL-8 (β = -0.68, SE 0.24; <em>p</em> = 0.006), and IL-13 (β = -0.48, SE 0.22; <em>p</em> = 0.03). Covariates female (vs. male) sex and surgery type (pectus surgery vs. spine) were associated with higher odds for CPSP in baseline adjusted cytokine-CPSP association models for IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNFα, and IL-8, IL-10, respectively.</p></div><div><h3>Conclusion</h3><p>We identified pro-inflammatory cytokine profiles associated with higher risk of acute postoperative pain. Interestingly, pleiotropic cytokine IL-6, chemokine IL-8 (which promotes neutrophil infiltration and monocyte differentiation), and monocyte-released anti-inflammatory cytokine IL-13, were associated with lower CPSP risk. Our results suggest
研究目的确定基线细胞因子/凝血因子及其在术后第 0-2 天(POD0-2)的变化是否可预测大手术后的急性和慢性术后疼痛(CPSP):设计:前瞻性、观察性、纵向嵌套研究:地点:大学附属四级儿童医院:受试者:特发性脊柱侧凸患者(≥8 岁),接受脊柱融合术或鸡胸症患者,接受 Nuss 手术:收集人口统计学资料、手术资料、社会心理测量资料、疼痛评分以及POD0-2期间阿片类药物的使用情况。使用Luminex珠阵列分析手术前和手术后两周内采集的连续血样中细胞因子的浓度。数据准备完成后,使用单变量和多变量回归分析法分析了手术前和手术后细胞因子浓度与手术后急性疼痛(POD0-2期间中度-重度疼痛时间百分比)和慢性疼痛(手术后3个月后疼痛评分>3/10)之间的关系,并对协变量进行了调整,使用混合效应模型将纵向细胞因子浓度与疼痛结果联系起来:分析包括 112 名受试者(中位年龄为 15.3 岁,IQR 为 13.5-17.0 岁,54.5% 为女性,59.8% 为贲门失弛缓症患者)的 16 种细胞因子/凝血因子的 3,164 个重复测量值。急性术后疼痛与较高的 GM-CSF 基线浓度(β = 0.95,SE 0.31;p = 0.003)、IL-1β(β = 0.84,SE 0.36;p = 0.02)、IL-2(β = 0.78,SE 0.34;p = 0.03)和 IL-12 p70(β = 0.88,SE 0.40;p = 0.03)有关,术后纵向疼痛与较高的 GM-CSF 基线浓度(β = 0.95,SE 0.31;p = 0.003)和 IL-1β 基线浓度(β = 0.84,SE 0.36;p = 0.02)有关。03)以及术后 GM-CSF (β = 1.38,SE 0.57;p = 0.03)、IFNγ (β = 1.36,SE 0.6;p = 0.03)、IL-1β (β = 1.25,SE 0.59;p = 0.03)、IL-7 (β = 1.65,SE 0.7;p = 0.02)和 IL-12 p70 (β = 1.17,SE 0.58;p = 0.04)的纵向升高。相反,CPSP 与 IL-8 的基线浓度较低有关(β = -0.39,SE 0.17;p = 0.02),术后 IL-6 (β = -0.57,SE 0.26;p = 0.03)、IL-8 (β = -0.68,SE 0.24;p = 0.006)和 IL-13 (β = -0.48,SE 0.22;p = 0.03)纵向浓度较低的患者发生 CPSP 的风险升高。在IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、TNFα和IL-8、IL-10的基线调整细胞因子-CPSP关联模型中,女性(与男性)性别和手术类型(贲门手术与脊柱手术)等相关变量分别与较高的CPSP几率相关:我们发现了与较高术后急性疼痛风险相关的促炎细胞因子特征。有趣的是,多效细胞因子 IL-6、趋化因子 IL-8(促进中性粒细胞浸润和单核细胞分化)和单核细胞释放的抗炎细胞因子 IL-13 与较低的 CPSP 风险相关。我们的研究结果表明,细胞因子/趋化因子信号传导的不同结果既能促进也能防止手术后疼痛。它们可作为手术后疼痛结果的预测和预后生物标志物。
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引用次数: 0
Accentuate the positive: Cultivating positive affect during treatment for stimulant use disorder can regulate the immune system 强调积极的一面:在治疗兴奋剂使用障碍期间培养积极情绪可以调节免疫系统。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-30 DOI: 10.1016/j.bbi.2024.08.058
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引用次数: 0
Herpes simplex virus type 1, dorsal root ganglia and fibromyalgia 1 型单纯疱疹病毒、背根神经节和纤维肌痛。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-30 DOI: 10.1016/j.bbi.2024.08.052
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引用次数: 0
Microglia depletion and repopulation do not alter the effects of cranial irradiation on hippocampal neurogenesis 小胶质细胞耗竭和重新填充不会改变颅脑照射对海马神经发生的影响。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-30 DOI: 10.1016/j.bbi.2024.08.055

Cranial radiotherapy can cause lifelong cognitive complications in childhood brain tumor survivors, and reduced hippocampal neurogenesis is hypothesized to contribute to this. Following irradiation (IR), microglia clear dead neural progenitors and give rise to a neuroinflammatory microenvironment, which promotes a switch in surviving progenitors from neuronal to glial differentiation. Recently, depletion and repopulation of microglia were shown to promote neurogenesis and ameliorate cognitive deficits in various brain injury models. In this study, we utilized the Cx3cr1CreERt2-YFP/+Rosa26DTA/+ transgenic mouse model to deplete microglia in the juvenile mouse brain before subjecting them to whole-brain IR and investigated the short- and long-term effects on hippocampal neurogenesis. Within the initial 24 h after IR, the absence of microglia led to an accumulation of dead cells in the subgranular zone, and 50-fold higher levels of the chemokine C-C motif ligand 2 (CCL2) in sham brains and 7-fold higher levels after IR. The absence of microglia, and the subsequent repopulation within 10 days, did neither affect the loss of proliferating or doublecortin-positive cells, nor the reduced growth of the granule cell layer. Our results argue against a role for a pro-inflammatory microenvironment in the dysregulation of hippocampal neurogenesis and suggest that the observed reduction of neurogenesis was solely due to IR.

颅脑放疗可导致儿童脑肿瘤幸存者出现终身认知并发症,而海马神经发生的减少被认为是造成这种情况的原因之一。辐照(IR)后,小胶质细胞会清除死亡的神经祖细胞,并产生神经炎症微环境,从而促进存活的祖细胞从神经元分化到胶质细胞分化。最近的研究表明,小胶质细胞的耗竭和重新填充可促进神经发生,改善各种脑损伤模型的认知缺陷。在本研究中,我们利用 Cx3cr1CreERt2-YFP/+Rosa26DTA/+ 转基因小鼠模型,在对幼鼠进行全脑红外照射前耗尽其脑中的小胶质细胞,并研究其对海马神经发生的短期和长期影响。在红外照射后的最初 24 小时内,小胶质细胞的缺失导致粒细胞下区死亡细胞的积累,趋化因子 C-C motif ligand 2(CCL2)的水平比假脑高出 50 倍,而在红外照射后则高出 7 倍。小胶质细胞的缺失以及随后在 10 天内的重新增殖既不会影响增殖细胞或双皮质素阳性细胞的丢失,也不会影响颗粒细胞层生长的减少。我们的研究结果否定了促炎症微环境在海马神经发生失调中的作用,并表明所观察到的神经发生减少完全是由红外引起的。
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引用次数: 0
Can you outrun a headache? 你能跑得过头痛吗?
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-30 DOI: 10.1016/j.bbi.2024.08.037
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引用次数: 0
Mapping prenatal predictors and neurobehavioral outcomes of an epigenetic marker of neonatal inflammation – A longitudinal population-based study 绘制新生儿炎症表观遗传标记的产前预测因素和神经行为结果图--基于人群的纵向研究
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-29 DOI: 10.1016/j.bbi.2024.08.053
<div><h3>Background</h3><p>DNA methylation levels at specific sites can be used to proxy C-reactive protein (CRP) levels, providing a potentially more stable and accurate indicator of sustained inflammation and associated health risk. However, its use has been primarily limited to adults or preterm infants, and little is known about determinants for − or offspring outcomes of − elevated levels of this epigenetic proxy in cord blood. The aim of this study was to comprehensively map prenatal predictors and long-term neurobehavioral outcomes of neonatal inflammation, as assessed with an epigenetic proxy of inflammation in cord blood, in the general pediatric population.</p></div><div><h3>Methods</h3><p>Our study was embedded in the prospective population-based Generation R Study (n = 2,394). We created a methylation profile score of CRP (MPS-CRP) in cord blood as a marker of neonatal inflammation and validated it against serum CRP levels in mothers during pregnancy, as well as offspring at birth and in childhood. We then examined (i) which factors (previously associated with sustained inflammation) explain variability in MPS-CRP at birth, including a wide range of prenatal lifestyle and clinical conditions, pro-inflammatory exposures, as well as child genetic liability to elevated CRP levels; and (ii) whether MPS-CRP at birth associates with child neurobehavioral outcomes, including global structural MRI and DTI measures (child mean age 10 and 14 years) as well as psychiatric symptoms over time (Child Behavioral Checklist, at mean age 1.5, 3, 6, 10 and 14 years).</p></div><div><h3>Results</h3><p>MPS-CRP at birth was validated with serum CRP in cord blood (cut-off > 1 mg/L) (AUC = 0.72). Prenatal lifestyle pro-inflammatory factors explained a small part (i.e., < 5%) of the variance in the MPS-CRP at birth. No other prenatal predictor or the polygenic score of CRP in the child explained significant variance in the MPS-CRP at birth. The MPS-CRP at birth prospectively associated with a reduction in global fractional anisotropy over time on mainly a nominal threshold (β = -0.014, SE = 0.007, p = 0.032), as well as showing nominal associations with structural differences (amygdala [(β = 0.016, SE = 0.006, p = 0.010], cerebellum [(β = -0.007, SE = 0.003, p = 0.036]). However, no associations with child psychiatric symptoms were observed.</p></div><div><h3>Conclusion</h3><p>Prenatal exposure to lifestyle-related pro-inflammatory factors was the only prenatal predictor that accounted for some of the individual variability in MPS-CRP levels at birth. Further, while the MPS-CRP prospectively associated with white matter alterations over time, no associations were observed at the behavioral level. Thus, the relevance and potential utility of using epigenetic data as a marker of neonatal inflammation in the general population remain unclear. In the future, the use of epigenetic proxies for a wider range of immune markers may lend further insights into the
背景DNA特定位点的甲基化水平可用于替代C反应蛋白(CRP)水平,为持续炎症和相关健康风险提供一个潜在的更稳定、更准确的指标。然而,该方法的使用主要局限于成人或早产儿,而对于脐带血中这种表观遗传学替代物水平升高的决定因素或后代的结果却知之甚少。本研究的目的是在普通儿科人群中全面绘制新生儿炎症的产前预测因素和长期神经行为结果图,并用脐带血中炎症的表观遗传替代物进行评估。我们创建了脐带血中 CRP(MPS-CRP)的甲基化图谱评分,作为新生儿炎症的标志物,并将其与妊娠期母亲以及出生时和儿童期后代的血清 CRP 水平进行了比对验证。然后,我们研究了(i) 哪些因素(以前与持续炎症相关)可解释出生时 MPS-CRP 的变化,包括各种产前生活方式和临床状况、促炎症暴露以及儿童对 CRP 水平升高的遗传易感性;(ii) 出生时 MPS-CRP 是否与儿童神经行为结果相关,包括整体结构 MRI 和 DTI 测量(儿童平均年龄为 10 岁和 14 岁)以及随时间变化的精神症状(儿童行为检查表,平均年龄为 1.结果出生时的MPS-CRP与脐带血中的血清CRP(临界值为1毫克/升)进行了验证(AUC = 0.72)。产前生活方式促炎因素解释了出生时 MPS-CRP 变异的一小部分(即 5%)。没有其他产前预测因素或儿童 CRP 的多基因评分能解释出生时 MPS-CRP 的显著差异。随着时间的推移,出生时的MPS-CRP与全局分数各向异性的降低呈前瞻性关联,主要是名义阈值(β = -0.014,SE = 0.007,p = 0.032),并与结构差异(杏仁核[(β = 0.016,SE = 0.006,p = 0.010],小脑[(β = -0.007,SE = 0.003,p = 0.036])呈名义关联。结论产前暴露于与生活方式相关的促炎因素是唯一能解释出生时 MPS-CRP 水平个体差异的产前预测因素。此外,虽然 MPS-CRP 随着时间的推移会与白质改变产生前瞻性关联,但在行为水平上却未观察到任何关联。因此,使用表观遗传学数据作为普通人群新生儿炎症的标志物的相关性和潜在效用仍不清楚。未来,使用表观遗传学替代物来衡量更广泛的免疫标记物,可能会让人们进一步了解普通儿科人群中新生儿炎症与不良神经发育之间的关系。
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引用次数: 0
Long-term survival of participants in a phase II randomized trial of RNS60 in amyotrophic lateral sclerosis 肌萎缩性脊髓侧索硬化症 RNS60 II 期随机试验参与者的长期生存情况。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-28 DOI: 10.1016/j.bbi.2024.08.044

Background

Positive effects of RNS60 on respiratory and bulbar function were observed in a phase 2 randomized, placebo-controlled trial in people with amyotrophic lateral sclerosis (ALS). Objective: to investigate the long-term survival of trial participants and its association with respiratory status and biomarkers of neurodegeneration and inflammation.

Study design and settings

A randomized, double blind, phase 2 clinical trial was conducted. Trial participants were enrolled at 22 Italian Expert ALS Centres from May 2017 to January 2020. Vital status of all participants was ascertained thirty-three months after the trial’s last patient last visit (LPLV). Participants were patients with Amyotrophic Lateral Sclerosis, classified as slow or fast progressors based on forced vital capacity (FVC) slope during trial treatment. Demographic, clinical, and biomarker levels and their association with survival were also evaluated.

Results

Mean duration of follow-up was 2.8 years. Long-term median survival was six months longer in the RNS60 group (p = 0.0519). Baseline FVC, and rates of FVC decline during the first 4 weeks of trial participation, were balanced between the active and placebo treatment arms. After 6 months of randomized, placebo-controlled treatment, FVC decline was significantly slower in the RNS60 group compared to the placebo group. Rates of FVC progression during the treatment were strongly associated with long-term survival (median survival: 3.7 years in slow FVC progressors; 1.6 years in fast FVC progressors). The effect of RNS60 in prolonging long-term survival was higher in participants with low neurofilament light chain (NfL) (median survival: >4 years in low NfL − RNS60 group; 3.3 years in low NfL − placebo group; 1.9 years in high NfL − RNS60 group; 1.8 years in high NfL − placebo group) and Monocyte Chemoattractant Protein-1 (MCP-1) (median survival: 3.7 years in low MCP-1 − RNS60 group; 2.3 years in low MCP-1 − placebo group; 2.8 years in high MCP-1 − RNS60 group; 2.6 years in high MCP-1 − placebo group) levels at baseline.

Conclusions and relevance

In this post-hoc analysis, long term survival was longer in participants randomized to RNS60 compared with those randomized to placebo and was correlated with slower FVC progression rates, suggesting that longer survival may be mediated by the drug’s effect on respiratory function. In these post-hoc analyses, the beneficial effect of RNS60 on survival was most pronounced in participants with low NfL and MCP-1 levels at study entry, suggesting that this could be a subgroup to target in future studies investigating the effects of RNS60 on survival.

Trial registration

Study preregistered on 13/Jan/2017 in EUDRA-CT (2016-002382-62). The study was also registered at ClinicalTrials.gov number NCT03456882.

背景:目的:调查试验参与者的长期存活率及其与呼吸状况、神经变性和炎症生物标志物的关系:进行了一项随机、双盲、2 期临床试验。2017年5月至2020年1月期间,22家意大利ALS专家中心招募了试验参与者。所有参与者的生命体征均在试验最后一次患者访视(LPLV)后33个月确定。参与者均为肌萎缩侧索硬化症患者,根据试验治疗期间的强迫生命容量(FVC)斜率分为进展缓慢型和进展快速型。此外,还对人口统计学、临床和生物标志物水平及其与生存的关系进行了评估:平均随访时间为 2.8 年。RNS60 组的长期中位生存期延长了 6 个月(p = 0.0519)。积极治疗组和安慰剂治疗组的基线 FVC 和试验前 4 周的 FVC 下降率是平衡的。经过 6 个月的随机安慰剂对照治疗后,RNS60 组的 FVC 下降速度明显慢于安慰剂组。治疗期间 FVC 的进展率与长期生存率密切相关(FVC 进展慢者的中位生存期为 3.7 年;FVC 进展快者的中位生存期为 1.6 年)。在低神经丝蛋白轻链(NfL)参与者中,RNS60 延长长期生存期的效果更高(中位生存期:低 NfL - RNS60 组 >4 年;低 NfL - 安慰剂组 3.3 年;高 NfL - RNS60 组 1.9 年;高 NfL - 安慰剂组 1.8年)和单核细胞趋化蛋白-1(MCP-1)(中位生存期:低MCP-1-RNS60组3.7年;低MCP-1-安慰剂组2.3年;高MCP-1-RNS60组2.8年;高MCP-1-安慰剂组2.6年)基线水平:在这项事后分析中,与随机接受安慰剂治疗的患者相比,随机接受 RNS60 治疗的患者的长期生存期更长,并且与 FVC 进展速度更慢相关,这表明更长的生存期可能是由药物对呼吸功能的影响介导的。在这些事后分析中,RNS60对生存期的有利影响在研究开始时NfL和MCP-1水平较低的参与者中最为明显,这表明在未来调查RNS60对生存期影响的研究中,这可能是一个目标亚组:该研究于2017年1月13日在EUDRA-CT(2016-002382-62)进行了预注册。该研究还在ClinicalTrials.gov注册,编号为NCT03456882。
{"title":"Long-term survival of participants in a phase II randomized trial of RNS60 in amyotrophic lateral sclerosis","authors":"","doi":"10.1016/j.bbi.2024.08.044","DOIUrl":"10.1016/j.bbi.2024.08.044","url":null,"abstract":"<div><h3>Background</h3><p>Positive effects of RNS60 on respiratory and bulbar function were observed in a phase 2 randomized, placebo-controlled trial in people with amyotrophic lateral sclerosis (ALS). Objective: to investigate the long-term survival of trial participants and its association with respiratory status and biomarkers of neurodegeneration and inflammation.</p></div><div><h3>Study design and settings</h3><p>A randomized, double blind, phase 2 clinical trial was conducted. Trial participants were enrolled at 22 Italian Expert ALS Centres from May 2017 to January 2020. Vital status of all participants was ascertained thirty-three months after the trial’s last patient last visit (LPLV). Participants were patients with Amyotrophic Lateral Sclerosis, classified as slow or fast progressors based on forced vital capacity (FVC) slope during trial treatment. Demographic, clinical, and biomarker levels and their association with survival were also evaluated.</p></div><div><h3>Results</h3><p>Mean duration of follow-up was 2.8 years. Long-term median survival was six months longer in the RNS60 group (p = 0.0519). Baseline FVC, and rates of FVC decline during the first 4 weeks of trial participation, were balanced between the active and placebo treatment arms. After 6 months of randomized, placebo-controlled treatment, FVC decline was significantly slower in the RNS60 group compared to the placebo group. Rates of FVC progression during the treatment were strongly associated with long-term survival (median survival: 3.7 years in slow FVC progressors; 1.6 years in fast FVC progressors). The effect of RNS60 in prolonging long-term survival was higher in participants with low neurofilament light chain (NfL) (median survival: &gt;4 years in low NfL − RNS60 group; 3.3 years in low NfL − placebo group; 1.9 years in high NfL − RNS60 group; 1.8 years in high NfL − placebo group) and Monocyte Chemoattractant Protein-1 (MCP-1) (median survival: 3.7 years in low MCP-1 − RNS60 group; 2.3 years in low MCP-1 − placebo group; 2.8 years in high MCP-1 − RNS60 group; 2.6 years in high MCP-1 − placebo group) levels at baseline.</p></div><div><h3>Conclusions and relevance</h3><p>In this post-hoc analysis, long term survival was longer in participants randomized to RNS60 compared with those randomized to placebo and was correlated with slower FVC progression rates, suggesting that longer survival may be mediated by the drug’s effect on respiratory function. In these post-hoc analyses, the beneficial effect of RNS60 on survival was most pronounced in participants with low NfL and MCP-1 levels at study entry, suggesting that this could be a subgroup to target in future studies investigating the effects of RNS60 on survival.</p></div><div><h3>Trial registration</h3><p>Study preregistered on 13/Jan/2017 in EUDRA-CT (2016-002382-62). The study was also registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> number NCT03456882.</p></div>","PeriodicalId":9199,"journal":{"name":"Brain, Behavior, and Immunity","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055012","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}
引用次数: 0
Microbiome-derived indole-3-lactic acid reduces amyloidopathy through aryl-hydrocarbon receptor activation 微生物衍生的吲哚-3-乳酸通过激活芳香烃受体减轻淀粉样变性。
IF 8.8 2区 医学 Q1 IMMUNOLOGY Pub Date : 2024-08-27 DOI: 10.1016/j.bbi.2024.08.051

Alzheimer’s disease (AD) pathogenesis has been associated with the gut microbiome and its metabolites, though the specific mechanisms have remained unclear. In our study, we used a multi-omics approach to identify specific microbial strains and metabolites that could potentially mitigate amyloidopathy in 5xFAD mice, a widely used model for AD research. Among the microbial strains tested, three showed promising results in reducing soluble amyloid-beta (Aβ) levels. Plasma metabolomics analysis revealed an enrichment of tryptophan (Trp) and indole-3-lactic acid (ILA) in mice with reduced soluble Aβ levels, suggesting a potential preventative role. The administration of a combined treatment of Trp and ILA prevented both Aβ accumulation and cognitive impairment in the 5xFAD mice. Our investigation into the mechanism revealed that ILA’s effect on reducing Aβ levels was mediated through the activation of microglia and astrocytes, facilitated by the aryl hydrocarbon receptor (AhR) signaling pathway. These mechanisms were verified through experiments in 5xFAD mice that included an additional group with the administration of ILA alone, as well as in vitro experiments using an AhR inhibitor. Clinical data analysis revealed a greater abundance of Lactobacillus reuteri in the gut of healthy individuals compared to those at early stages of Aβ accumulation or with mild cognitive impairment. Additionally, human post-mortem brain analyses showed an increased expression of genes associated with the AhR signaling pathway in individuals without AD, suggesting a protective effect against AD progression. Our results indicate that ILA from gut microbes could inhibit the progression of amyloidopathy in 5xFAD mice through activation of AhR signaling in the brain.

阿尔茨海默病(AD)的发病机制与肠道微生物组及其代谢物有关,但具体机制仍不清楚。在我们的研究中,我们采用了一种多组学方法来鉴定特定的微生物菌株和代谢物,它们有可能减轻 5xFAD 小鼠的淀粉样变性,5xFAD 小鼠是一种被广泛应用于阿兹海默症研究的模型。在测试的微生物菌株中,有三种在降低可溶性淀粉样蛋白-β(Aβ)水平方面表现出了良好的效果。血浆代谢组学分析表明,在可溶性 Aβ 水平降低的小鼠体内,色氨酸(Trp)和吲哚-3-乳酸(ILA)富集,这表明它们具有潜在的预防作用。联合使用 Trp 和 ILA 可以防止 5xFAD 小鼠的 Aβ 积累和认知障碍。我们对其机制的研究发现,ILA降低Aβ水平的作用是通过激活小胶质细胞和星形胶质细胞,并通过芳基烃受体(AhR)信号通路介导的。这些机制通过在 5xFAD 小鼠中进行的实验以及使用 AhR 抑制剂进行的体外实验得到了验证。临床数据分析显示,与 Aβ 早期积累或患有轻度认知障碍的人相比,健康人的肠道中含有更多的芦特氏乳杆菌。此外,人类死后脑部分析表明,在无注意力缺失症的个体中,与 AhR 信号通路相关的基因表达量增加,这表明对注意力缺失症的发展具有保护作用。我们的研究结果表明,肠道微生物中的 ILA 可通过激活大脑中的 AhR 信号传导,抑制 5xFAD 小鼠淀粉样变性的进展。
{"title":"Microbiome-derived indole-3-lactic acid reduces amyloidopathy through aryl-hydrocarbon receptor activation","authors":"","doi":"10.1016/j.bbi.2024.08.051","DOIUrl":"10.1016/j.bbi.2024.08.051","url":null,"abstract":"<div><p>Alzheimer’s disease (AD) pathogenesis has been associated with the gut microbiome and its metabolites, though the specific mechanisms have remained unclear. In our study, we used a multi-omics approach to identify specific microbial strains and metabolites that could potentially mitigate amyloidopathy in 5xFAD mice, a widely used model for AD research. Among the microbial strains tested, three showed promising results in reducing soluble amyloid-beta (Aβ) levels. Plasma metabolomics analysis revealed an enrichment of tryptophan (Trp) and indole-3-lactic acid (ILA) in mice with reduced soluble Aβ levels, suggesting a potential preventative role. The administration of a combined treatment of Trp and ILA prevented both Aβ accumulation and cognitive impairment in the 5xFAD mice. Our investigation into the mechanism revealed that ILA’s effect on reducing Aβ levels was mediated through the activation of microglia and astrocytes, facilitated by the aryl hydrocarbon receptor (AhR) signaling pathway. These mechanisms were verified through experiments in 5xFAD mice that included an additional group with the administration of ILA alone, as well as in vitro experiments using an AhR inhibitor. Clinical data analysis revealed a greater abundance of <em>Lactobacillus reuteri</em> in the gut of healthy individuals compared to those at early stages of Aβ accumulation or with mild cognitive impairment. Additionally, human post-mortem brain analyses showed an increased expression of genes associated with the AhR signaling pathway in individuals without AD, suggesting a protective effect against AD progression. Our results indicate that ILA from gut microbes could inhibit the progression of amyloidopathy in 5xFAD mice through activation of AhR signaling in the brain.</p></div>","PeriodicalId":9199,"journal":{"name":"Brain, Behavior, and Immunity","volume":null,"pages":null},"PeriodicalIF":8.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142092319","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}
引用次数: 0
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Brain, Behavior, and Immunity
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