Search

Social interaction difficulties and loneliness as well as activation of immunological pathways and a status of low-grade immune-inflammation are thought to be associated with psychotic disorders. So far, a single biomarker that indicates disordered social interaction as part of psychotic disorders and immune-inflammation has yet to found but could be clinically useful. If low-grade immune-inflammation is a contributor to psychotic disorders, it raises the question where exactly, when and why it begins to negatively impact the human body? Deviant gut microbiota have been discussed in this context. Here, stress resulting from disordered social interaction may contribute to the disruption of the intestinal barrier. Lipopolysaccharides (LPS) from bacteria can enter the body leading to an activation of monocytes – among others – via the cluster of differentiation 14 (CD14) and further influencing central nervous structures. CD14 can be released by monocytes upon activation as a soluble form (sCD14). We hypothesize that sCD14 could be a useful biomarker to evaluate the consequences of disordered social interaction in psychotic patients including low-grade immune-inflammation via the gut-brain axis. This could be performed using an analysis of gut microbiota, flow cytometry and proteome analysis of blood and cerebrospinal fluid (CSF) and cerebral Magnetic Resonance Imaging (MRI) together with further systematic evaluations of social behavior. [ABSTRACT FROM AUTHOR]

• Even among MS patients considered mildly affected, most showed disease activity • Driven by MRI activity, loss of NEDA-3 was the most frequent marker of disease activity • PIRA occurred in 50% of patients and was often not accompanied by loss of NEDA-3 • MRI and clinical measurements often did not show disease activity simultaneously • Measuring different disease activity outcome measures could improve monitoring The current range of disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS) has placed more importance on the accurate monitoring of disease progression for timely and appropriate treatment decisions. With a rising number of measurements for disease progression, it is currently unclear how well these measurements or combinations of them can monitor more mildly affected RRMS patients. To investigate several composite measures for monitoring disease activity and their potential relation to the biomarker neurofilament light chain (NfL) in a clearly defined early RRMS patient cohort with a milder disease course. From a total of 301 RRMS patients, a subset of 46 patients being treated with a continuous first-line therapy was analyzed for loss of no evidence of disease activity (lo-NEDA-3) status, relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA), up to seven years after treatment initialization. Kaplan-Meier estimates were used for time-to-event analysis. Additionally, a Cox regression model was used to analyze the effect of NfL levels on outcome measures in this cohort. In this mildly affected cohort, both lo-NEDA-3 and PIRA frequently occurred over a median observational period of 67.2 months and were observed in 39 (84.8%) and 23 (50.0%) patients, respectively. Additionally, 12 out of 26 PIRA manifestations (46.2%) were observed without a corresponding lo-NEDA-3 status. Jointly, either PIRA or lo-NEDA-3 showed disease activity in all patients followed-up for at least the median duration (67.2 months). NfL values demonstrated an association with the occurrence of relapses and RAW. The complementary use of different disease progression measures helps mirror ongoing disease activity in mildly affected early RRMS patients being treated with continuous first-line therapy. [ABSTRACT FROM AUTHOR]

• In- and outpatient alemtuzumab infusion management in Germany is highly standardized and in accordance with recommendations by the summary of product characteristics. • Infusion-associated reactions (including headache, rash, and pyrexia) present the most common adverse events and are usually mild. • TSQM and MSIS-29 scores reveal high patient satisfaction and health-related quality of life among multiple sclerosis patients treated with alemtuzumab. Alemtuzumab is an anti-CD52 antibody approved for the treatment of relapsing remitting multiple sclerosis (RRMS). The summary of product characteristics (SmPC) provides recommendations on the administration of alemtuzumab to prevent or reduce the risk of serious side effects associated with alemtuzumab infusion, including myocardial ischemia, hemorrhagic stroke, arterial dissection, and pulmonary alveolar hemorrhage. However, real-world implementation of alemtuzumab infusion management recommendations has not been previously assessed. Here we provide a large-scale multi-center (in- and outpatient) observational study on alemtuzumab infusion management in daily clinical care in Germany (ALEMLL08025; INFUSE-MS; NIS-no. 364). Parameters of infusion management - including infusion administration, clinical and laboratory monitoring - were assessed, compared between study centers and the occurrence of infusion-associated reactions (IARs) was documented. Moreover, the TSQM and MSIS-29 questionnaires were used to quantify patient satisfaction and health-related quality of life. 140 RRMS patients were enrolled in this study. Alemtuzumab infusion regimes (treatment course 1 and 2) were comparable between infusion sites and in accordance with recommendations by the SmPC. Standardization of infusion management was associated with a satisfactory safety profile. IARs were usually mild, headache (13.6%), rash (10.7%), and pyrexia (6.4%) being the most common ones. TSQM and MSIS-29 scores denoted high patient satisfaction and health-related quality of life among RRMS patients treated with alemtuzumab. In conclusion, our results indicate that infusion management of alemtuzumab is highly standardized and in line with the SmPC. Alemtuzumab treatment and implementation of infusion management recommendations are associated with a satisfactory safety profile regarding the occurrence of IARs, a high patient satisfaction and health-related quality of life as important indicators for the quality of MS care. [ABSTRACT FROM AUTHOR]

Social interaction difficulties are a hallmark of psychotic disorders, which in some cases can be definitely traced back to autoimmunological causes. Interestingly, systemic and intrathecal inflammation have been shown to significantly influence social processing by increasing sensitivity to threatening social stimuli, which bears some resemblance to psychosis. In this article, we review evidence for the involvement of systemic and intrathecal inflammatory processes in psychotic disorders and how this might help to explain some of the social impairments associated with this group of disorders. Vice versa, we also discuss evidence for the immunomodulatory function of social interactions and their potential role for therapeutic interventions in psychotic disorders. • Deficits in social interaction could aggravate symptoms of psychotic disorders. • Psychotic disorders are associated, in some cases, with low-grade inflammation. • Inflammation influences social interaction in multiple and contradicting ways. • Diagnostic tools integrating inflammation/psychosis/social aspects are required. [ABSTRACT FROM AUTHOR]