66 results on '"Álvarez-Cermeño JC"'
Search Results
2. Lipid-specific immunoglobulin M bands in cerebrospinal fluid are associated with a reduced risk of developing progressive multifocal leukoencephalopathy during treatment with natalizumab
- Author
-
Villar LM, Costa-Frossard L, Masterman T, Fernandez O, Montalban X, Casanova B, Izquierdo G, Coret F, Tumani H, Saiz A, Arroyo R, Fink K, Leyva L, Espejo C, Simó-Castelló M, García-Sánchez MI, Lauda F, Llufriú S, Álvarez-Lafuente R, Olascoaga J, Prada A, Oterino A, de Andrés C, Tintoré M, Ramió-Torrentà L, Rodríguez-Martín E, Picón C, Comabella M, Quintana E, Agüera E, Díaz S, Fernandez-Bolaños R, García-Merino JA, Landete L, Menéndez-González M, Navarro L, Pérez D, Sánchez-López F, Serrano-Castro PJ, Tuñón A, Espiño M, Muriel A, Bar-Or A, Álvarez-Cermeño JC, Instituto de Salud Carlos III, and Ministerio de Economía y Competitividad (España)
- Subjects
Adult ,Male ,Risk ,Multiple Sclerosis ,Natalizumab ,Oligoclonal Bands ,Leukoencephalopathy, Progressive Multifocal ,Humans ,Female ,Middle Aged ,Antibodies, Monoclonal, Humanized ,JC Virus ,Biomarkers - Abstract
[Objective]: Progressive multifocal leukoencephalopathy (PML) is a serious side effect associated with natalizumab treatment in multiple sclerosis (MS). PML risk increases in individuals seropositive for anti–John Cunningham virus (JC) antibodies, with prolonged duration of natalizumab treatment, and with prior exposure to immunosuppressants. We explored whether the presence of lipid‐specific immunoglobulin M oligoclonal bands in cerebrospinal fluid (CSF; IgM bands), a recognized marker of highly inflammatory MS, may identify individuals better able to counteract the potential immunosuppressive effect of natalizumab and hence be associated with a reduced risk of developing PML. [Methods]: We studied 24 MS patients who developed PML and another 343 who did not suffer this opportunistic infection during natalizumab treatment. Patients were recruited at 25 university hospitals. IgM bands were studied by isoelectric focusing and immunodetection. CSF lymphocyte counts were explored in 151 MS patients recruited at Ramon y Cajal Hospital in Madrid, Spain. [Results]: IgM bands were independently associated with decreased PML risk (odds ratio [OR] = 45.9, 95% confidence interval [CI] = 5.9–339.3, p, This work was supported by grants; PI12–00239 from FIS; Instituto de Salud Carlos III; SAF 2012‐34670, and RD12/0032/0005 from the Spanish Ministry of Economy and Competitiveness; and BMBF grant KKNMS (Competence Net Multiple Sclerosis; H.T.).
- Published
- 2015
3. Review of the novelties presented at the 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) (I)
- Author
-
Fernández Ó, Álvarez-Cermeño JC, Arnal-García C, Arroyo-González R, Brieva L, Calles-Hernández MC, Casanova-Estruch B, Comabella M, García-Merino JA, Izquierdo G, Meca-Lallana J, Mendibe-Bilbao Mdel M, Muñoz-García D, Olascoaga J, Oliva-Nacarino P, Oreja-Guevara C, Prieto J, Ramió-Torrentà L, Romero-Pinel L, Saiz A, Rodríguez-Antigüedad A, and Grupo Post-ECTRIMS
- Subjects
Adult ,Male ,Multiple Sclerosis ,Oral drugs ,Multiple sclerosis ,Sex Factors ,Animals ,Humans ,Disease-modifying treatment ,Genetic Predisposition to Disease ,Child ,Gonadal Steroid Hormones ,Genetic Association Studies ,Inflammation ,Therapies, Investigational ,Tissue damage ,HLA-DR Antigens ,Congresses as Topic ,Oxidative Stress ,Virus Diseases ,Monoclonal antibodies ,Female ,Gene-Environment Interaction ,Epigenetics ,Sex ,Disease Susceptibility ,Biomarkers - Abstract
The most relevant data presented at the 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held in October 2013 in Denmark, were summarised at the sixth edition of the Post-ECTRIMS Expert Meeting, held in Madrid in October 2013, resulting in this review, to be published in three parts. This first part of the Post-ECTRIMS review presents an update on gender differences in multiple sclerosis (MS) as well as new evidence on the impact of sex hormones on the disease. We should consider that there is still much to discover with regard to the genetic components of the disease. Similarly, possible infections and lifestyle habits are added as triggers of the known environmental risk factors for MS. The interaction between genetics and the environment has been increasingly implicated as a cause of susceptibility to MS. With regard to the mechanisms of inflammation, axo-glial proteins, instead of myelin proteins, may be the early antigenic targets, and B cells have been implicated in the production of cytokines toxic to oligodendrocytes. Chitinase 3-like 1 (CHI3L1) is validated as a prognostic marker of conversion to MS, and immunoglobulin M oligoclonal bands and L-selectin could be incorporated as possible measures of the risk stratification strategy in patients treated with natalizumab.Revision de las novedades presentadas en el XXIX Congreso del Comite Europeo para el Tratamiento e Investigacion en Esclerosis Multiple (ECTRIMS) (I).Los datos mas relevantes presentados en la XXIX edicion del Congreso del Comite Europeo para el Tratamiento e Investigacion en Esclerosis Multiple (ECTRIMS), celebrado en octubre de 2013 en Dinamarca, se han resumido en la sexta edicion de la Reunion de Expertos Post-ECTRIMS celebrada en Madrid en octubre de 2013, fruto de la cual nace esta revision, que se publica en tres partes. Esta primera parte de la revision Post-ECTRIMS presenta una vision actualizada de las diferencias de genero en la esclerosis multiple (EM), asi como las nuevas evidencias sobre el impacto de las hormonas sexuales en la enfermedad. Podemos asumir que aun queda mucho por descubrir con relacion al componente genetico de la enfermedad. De la misma manera, a los ya conocidos factores ambientales de riesgo para la EM se unen posibles infecciones y habitos de vida como desencadenantes. La interaccion entre la genetica y el ambiente cada vez cobra mas fuerza como causa de susceptibilidad a la EM. En cuanto a los mecanismos de inflamacion, las proteinas del complejo axoglial pueden ser las dianas antigenicas iniciales en lugar de las proteinas de mielina, y las celulas B se han visto implicadas en la produccion de citocinas toxicas para los oligodendrocitos. La quitinasa 3-like 1 se valida como marcador pronostico de conversion a EM, y las bandas oligoclonales de inmunoglobulina M y la L-selectina podrian incorporarse como posibles medidas dentro de la estrategia de estratificacion del riesgo en pacientes tratados con natalizumab.
- Published
- 2014
4. Immunoglobulin M oligoclonal bands: biomarker of targetable inflammation in primary progressive multiple sclerosis
- Author
-
Villar LM, Casanova B, Ouamara N, Comabella M, Jalili F, Leppert D, de Andrés C, Izquierdo G, Arroyo R, Avsar T, Lapin SV, Johnson T, Montalbán X, Fernández O, Álvarez-Lafuente R, Masterman D, García-Sánchez MI, Coret F, Siva A, Evdoshenko E, Álvarez-Cermeño JC, and Bar-Or A
- Subjects
Adult ,Inflammation ,Male ,Cross-Sectional Studies ,Phenotype ,Immunoglobulin M ,Oligoclonal Bands ,Humans ,Female ,Longitudinal Studies ,Middle Aged ,Multiple Sclerosis, Chronic Progressive ,Biomarkers - Abstract
Objective: To identify a biomarker distinguishing patients who, despite a primary progressive multiple sclerosis (PPMS) clinical course, may nonetheless benefit from immune therapy. Methods: The presence or absence of both immunoglobulin (Ig) G and IgM oligoclonal bands (OCB) was blindly examined in paired cerebrospinal fluid (CSF) and serum samples from a large PPMS patient cohort, and related to clinical and imaging evidence of focal inflammatory disease activity. Results: Using both cross-sectional samples and serial sampling in a subgroup of patients followed prospectively as part of the placebo-controlled OLYMPUS study of rituximab in PPMS, we found that the presence of CSF-restricted IgM OCB (but not of IgG OCB) is associated with an active inflammatory disease phenotype in PPMS patients. This finding was confirmed in an independent, multicenter validation cohort. Interpretation: The presence of CSF IgM OCB may be a biomarker for a subset of PPMS patients with more active inflammatory disease, who may benefit from immune-directed treatments.
- Published
- 2013
5. Comment on the article by Stauch et al. ‘Intrathecal IgM synthesis in paediatric MS is not a negative prognostic marker of disease progression: quantitative versus qualitative IgM analysis’
- Author
-
Villar, LM, primary and Álvarez-Cermeño, JC, additional
- Published
- 2011
- Full Text
- View/download PDF
6. Influence of oligoclonal IgM specificity in multiple sclerosis disease course
- Author
-
Villar, LM, primary, García-Barragán, N., additional, Espiño, M., additional, Roldán, E., additional, Sádaba, MC, additional, Gómez-Rial, J., additional, González-Porqué, P., additional, and Álvarez-Cermeño, JC, additional
- Published
- 2007
- Full Text
- View/download PDF
7. Comment on the article by Stauch et al. ‘Intrathecal IgM synthesis in paediatric MS is not a negative prognostic marker of disease progression: quantitative versus qualitative IgM analysis’.
- Author
-
Villar, LM and Álvarez-Cermeño, JC
- Subjects
- *
LETTERS to the editor , *IMMUNOGLOBULIN M , *MULTIPLE sclerosis - Abstract
A letter to the editor is presented in response to the article about the intrathecal immunoglobulin M (IgM) synthesis in paediatric multiple sclerosis (MS) by C. Stauch and colleagues in the 2011 issue.
- Published
- 2012
- Full Text
- View/download PDF
8. Progressive multifocal leukoencephalopathy, natalizumab, and multiple sclerosis.
- Author
-
Berger T, Deisenhammer F, Álvarez-Cermeño JC, Masjuan J, Villar LM, Kleinschmidt-DeMasters BK, Tyler KL, Langer-Gould A, Atlas SW, and Pelletier D
- Published
- 2005
9. DRB1*03:01 Haplotypes: Differential Contribution to Multiple Sclerosis Risk and Specific Association with the Presence of Intrathecal IgM Bands
- Author
-
José C. Álvarez-Cermeño, Luisa M. Villar, M. Carmen Cénit, Rafael Arroyo, Laura Leyva, Elena Urcelay, Concepción Núñez, Oscar Fernandez, Emilio G. de la Concha, María L. Cavanillas, [Concha,E G de la, Cavanillas, ML, Cénit, MC, Ircelay, E, Núñez, C] Department of Clinical Immunology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. [Arroyo, R] Department of Neurology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain. [Fernández, O] Department of Neurology, Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain. [Álvarez-Cermeño, JC] Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain. [Leyva, L] Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya and Fundación IMABIS, Málaga, Spain. [Villar, LM] Department of Immunology, Hospital Ramón y Cajal, Madrid, Spain., and This work was supported by project PI10/1985 from ‘‘Fondo de Investigaciones Sanitarias’’. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
- Subjects
Inmunoglobulina M ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings] ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Genetic Techniques::Genetic Association Studies [Medical Subject Headings] ,Phenomena and Processes::Genetic Phenomena::Genotype::Haplotypes [Medical Subject Headings] ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Risk Factors ,Factores de Riesgo ,Genetics ,Multidisciplinary ,Cadenas HLA-DRB1 ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Case-Control Studies [Medical Subject Headings] ,Predisposición genética a la enfermedad ,Phenomena and Processes::Genetic Phenomena::Genotype::Genetic Predisposition to Disease [Medical Subject Headings] ,Humanos ,Neurology ,01 antigen [HLA-DRB1*03] ,Medicine ,Haplotipos ,Research Article ,Multiple Sclerosis ,Science ,Immunology ,Chemicals and Drugs::Biological Factors::Antigens::Isoantigens::Histocompatibility Antigens::HLA Antigens::HLA-D Antigens::HLA-DR Antigens::HLA-DR beta-Chains::HLA-DRB1 Chains [Medical Subject Headings] ,Human leukocyte antigen ,Biology ,Autoimmune Diseases ,Estudios caso-control ,medicine ,Humans ,Diseases::Nervous System Diseases::Demyelinating Diseases::Demyelinating Autoimmune Diseases, CNS::Multiple Sclerosis [Medical Subject Headings] ,Genetic Predisposition to Disease ,Allele ,Risk factor ,Genotyping ,Genetic Association Studies ,Evolutionary Biology ,Population Biology ,Estudios de asociación genética ,Multiple sclerosis ,Haplotype ,Case-control study ,Computational Biology ,Human Genetics ,medicine.disease ,Demyelinating Disorders ,01 [Antigeno HLA-DRB1*03] ,Haplotypes ,Immunoglobulin M ,Esclerosis Múltiple ,Case-Control Studies ,Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Proteins::Globulins::Serum Globulins::Immunoglobulins::Antibodies::Immunoglobulin Isotypes::Immunoglobulin M [Medical Subject Headings] ,biology.protein ,Clinical Immunology ,Population Genetics ,HLA-DRB1 Chains - Abstract
Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Multiple sclerosis (MS) is a multifactorial disease with a genetic basis. The strongest associations with the disease lie in the Human Leukocyte Antigen (HLA) region. However, except for the DRB1*15:01 allele, the main risk factor associated to MS so far, no consistent effect has been described for any other variant. One example is HLA-DRB1*03:01, with a heterogeneous effect across populations and studies. We postulate that those discrepancies could be due to differences in the diverse haplotypes bearing that allele. Thus, we aimed at studying the association of DRB1*03:01 with MS susceptibility considering this allele globally and stratified by haplotypes. We also evaluated the association with the presence of oligoclonal IgM bands against myelin lipids (OCMB) in cerebrospinal fluid. METHODS Genotyping of HLA-B, -DRB1 and -DQA1 was performed in 1068 MS patients and 624 ethnically matched healthy controls. One hundred and thirty-nine MS patients were classified according to the presence (M+, 58 patients)/absence (M-, 81 patients) of OCMB. Comparisons between groups (MS patients vs. controls and M+ vs. M-) were performed with the chi-square test or the Fisher exact test. RESULTS Association of DRB1*03:01 with MS susceptibility was observed but with different haplotypic contribution, being the ancestral haplotype (AH) 18.2 the one causing the highest risk. Comparisons between M+, M- and controls showed that the AH 18.2 was affecting only M+ individuals, conferring a risk similar to that caused by DRB1*15:01. CONCLUSIONS The diverse DRB1*03:01-containing haplotypes contribute with different risk to MS susceptibility. The AH 18.2 causes the highest risk and affects only to individuals showing OCMB. Yes
- Published
- 2012
10. Early beginning of alemtuzumab: Changing the multiple sclerosis treatment paradigm. Interim analysis of the LEMVIDA study.
- Author
-
Meca-Lallana JE, Álvarez-Cermeño JC, Casanova Estruch B, Izquierdo Ayuso G, Ortiz Castillo R, Rodríguez-Antigüedad A, and Calles Hernández C
- Subjects
- Humans, Female, Adult, Male, Prospective Studies, Middle Aged, Spain, Quality of Life, Immunologic Factors therapeutic use, Alemtuzumab therapeutic use, Multiple Sclerosis drug therapy
- Abstract
Introduction: LEMVIDA is a real-world prospective study of 3-year follow-up on quality of life of patients with multiple sclerosis (MS) receiving alemtuzumab in Spain., Methods: This is an interim analysis evaluating the baseline characteristics of patients who started alemtuzumab between October 2016-September 2018. For 3 additional subanalysis patients were categorised by baseline EDSS score; time of alemtuzumab initiation during the recruitment period (cohort 1: October 2016-March 2017, cohort 2: April-September 2017, cohort 3: October 2017-March 2018 and cohort 4: April-September 2018); and the presence of highly active MS criteria., Results: 161 patients were analysed: 67.1% female, age 38.7 ± 9.4 years, MS duration 8.5 ± 6.0 years, EDSS 3.3 ± 1.7 and number of relapses in the previous 2 years 1.8 ± 1.3. 48.3% of patients presented gadolinium-enhanced (Gd+) lesions (mean: 5.2 ± 6.9) and 63.1% had received prior treatment with fingolimod or natalizumab. Baseline EDSS scores and number of Gd+ lesions were higher in cohort 1 than in cohort 4 (4.1 ± 1.8 vs 3.2 ± 1.7; P = .040 and 10.9 ± 11.9 vs 4.5 ± 5.7; P = .020). The frequency of prior treatment with fingolimod and natalizumab was lower in cohort 4 (60.6%) than in cohort 1 (70.6%) (comparison between groups not analysed)., Conclusions: Unlike phase 3 studies of alemtuzumab, the patients included in LEMVIDA are older, have a longer duration of MS, higher disability and have received previous immunosuppressants. However, throughout the recruitment period, there is a tendency towards an early beginning of treatment with alemtuzumab, probably due to the evidence of higher effectiveness in the early stages of MS., (Copyright © 2023. Published by Elsevier España, S.L.U.)
- Published
- 2024
- Full Text
- View/download PDF
11. Association of Serum Neurofilament Light Chain Levels at Disease Onset With Disability Worsening in Patients With a First Demyelinating Multiple Sclerosis Event Not Treated With High-Efficacy Drugs.
- Author
-
Monreal E, Fernández-Velasco JI, García-Sánchez MI, Sainz de la Maza S, Llufriu S, Álvarez-Lafuente R, Casanova B, Comabella M, Ramió-Torrentà L, Martínez-Rodríguez JE, Brieva L, Saiz A, Eichau S, Cabrera-Maqueda JM, Villarrubia N, Espiño M, Pérez-Miralles F, Montalbán X, Tintoré M, Quiroga-Varela A, Domínguez-Mozo MI, Rodríguez-Jorge F, Chico-García JL, Lourido D, Álvarez-Cermeño JC, Masjuan J, Costa-Frossard L, and Villar LM
- Subjects
- Humans, Female, Adult, Cohort Studies, Intermediate Filaments, Treatment Outcome, Neurofilament Proteins, Biomarkers, Multiple Sclerosis drug therapy
- Abstract
Importance: The value of serum neurofilament light chain (sNfL) levels for predicting long-term disability in patients with multiple sclerosis (MS) remains controversial., Objective: To assess whether high sNfL values are associated with disability worsening in patients who underwent their first demyelinating MS event., Design, Setting, and Participants: This multicenter cohort study included patients who underwent their first demyelinating event suggestive of MS at Hospital Universitario Ramón y Cajal (development cohort; June 1, 1994, to September 31, 2021, with follow-up until August 31, 2022) and 8 Spanish hospitals (validation cohort; October 1, 1995, to August 4, 2020, with follow-up until August 16, 2022)., Exposures: Clinical evaluations at least every 6 months., Main Outcomes and Measures: The main outcomes were 6-month confirmed disability worsening (CDW) and an Expanded Disability Status Scale (EDSS) score of 3. Levels of sNfL were measured in blood samples obtained within 12 months after disease onset using a single molecule array kit. The cutoffs used were sNfL level of 10 pg/mL and a standardized score (z score) of 1.5. Multivariable Cox proportional hazards regression models were used to evaluate outcomes., Results: Of the 578 patients included in the study, 327 were in the development cohort (median age at sNfL analysis, 34.1 years [IQR, 27.2-42.7 years]; 226 female [69.1%]) and 251 patients were in the validation cohort (median age at sNfL analysis, 33.3 years [IQR, 27.4-41.5 years]; 184 female [73.3%]). The median follow-up was 7.10 years (IQR, 4.18-10.0 years). Levels of sNfL greater than 10 pg/mL were independently associated with higher risk of 6-month CDW and an EDSS of 3 in the development cohort (6-month CDW: hazard ratio [HR], 2.39; 95% CI, 1.39-4.12; P = .002; EDSS of 3: HR, 4.12; 95% CI, 2.18-7.77; P < .001) and the validation cohort (6-month CDW: HR, 1.61; 95% CI, 1.07-2.42; P = .02; EDSS of 3: HR, 2.03; 95% CI, 1.23-3.33; P = .005). Highly effective disease-modifying treatments were associated with lower risks of 6-month CDW and an EDSS of 3 in patients with high baseline sNfL values., Conclusions and Relevance: This cohort study found that high sNfL values obtained within the first year of disease were associated with long-term disability worsening in MS, suggesting that sNfL level measurement may help identify optimal candidates for highly effective disease-modifying treatments.
- Published
- 2023
- Full Text
- View/download PDF
12. Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.
- Author
-
Meca-Lallana JE, Fernández-Prada M, García Vázquez E, Moreno Guillén S, Otero Romero S, Rus Hidalgo M, Villar Guimerans LM, Eichau Madueño S, Fernández Fernández Ó, Izquierdo Ayuso G, Álvarez Cermeño JC, Arnal García C, Arroyo González R, Brieva Ruiz L, Calles Hernández C, García Merino A, González Plata M, Hernández Pérez MÁ, Moral Torres E, Olascoaga Urtaza J, Oliva-Nacarino P, Oreja-Guevara C, Ortiz Castillo R, Oterino A, Prieto González JM, Ramió-Torrentá L, Rodríguez-Antigüedad A, Saiz A, Tintoré M, and Montalbán Gairin X
- Subjects
- Alemtuzumab therapeutic use, Antibodies, Monoclonal, Humanized therapeutic use, Humans, Spain, Multiple Sclerosis drug therapy, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Introduction: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis., Objective: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain., Development: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group., Conclusion: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice., (Copyright © 2019 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
13. Four-year safety and effectiveness data from patients with multiple sclerosis treated with fingolimod: The Spanish GILENYA registry.
- Author
-
Meca-Lallana JE, Oreja-Guevara C, Muñoz D, Olascoaga J, Pato A, Ramió-Torrentà L, Meca-Lallana V, Hernández MA, Marzo ME, Álvarez-Cermeño JC, Rodríguez-Antigüedad A, Montalbán X, and Fernández O
- Subjects
- Adult, Female, Fingolimod Hydrochloride adverse effects, Humans, Immunosuppressive Agents adverse effects, Lymphopenia etiology, Male, Middle Aged, Recurrence, Registries, Retrospective Studies, Spain, Treatment Outcome, Fingolimod Hydrochloride therapeutic use, Immunosuppressive Agents therapeutic use, Multiple Sclerosis drug therapy
- Abstract
Objective: To describe the profile of patients with multiple sclerosis (MS) treated with fingolimod in Spain and to assess the effectiveness and safety of fingolimod after 4 years of inclusion in the Spanish Gilenya Registry., Methods: An observational, retrospective/prospective, multicenter case registry, including all patients with relapsing-remitting MS (RRMS) starting treatment with fingolimod in 43 centers in Spain. Analyses were performed in the overall population and in subgroups according to prior disease-modifying therapy (DMT): glatiramer acetate/interferon beta-1 (BRACE), natalizumab, other treatment, or naïve., Results: Six hundred and sixty-six evaluable patients were included (91.1% previously treated with at least one DMT). The mean annualized relapse rate (ARR) prior to fingolimod was 1.12, and the mean EDSS at fingolimod initiation was 3.03. Fingolimod reduced the ARR by 71.4%, 75%, 75.5%, and 80.3%, after 1, 2, 3 and 4 years, respectively (p<0.001). This significant reduction in the ARR continued to be observed in all subgroups. After 4 years, the EDSS showed a minimal deterioration, with the EDSS scores from year 1 to year 4 remaining mostly stable. The percentage of patients without T1 Gd+ lesions progressively increased from 45.6% during the year prior to fingolimod initiation to 88.2% at year 4. The proportion of patients free from new/enlarged T2 lesions after 4 years of fingolimod treatment was 80.3%. This trend in both radiological measures was also observed in the subgroups. Adverse events (AEs) were experienced by up to 41.6% of patients (most commonly: lymphopenia [12.5%] and urinary tract infection [3.7%]). Most AEs were mild in severity, 3.6% of patients had serious AEs., Conclusions: The patient profile was similar to other observational studies. The results obtained from the long-term use of fingolimod showed that it was effective, regardless of prior DMT, and it had adequate safety results, with a positive benefit-risk balance., Competing Interests: Meca‐Lallana [Biogen, Genzyme, Merck Serono, Novartis, Roche and TEVA], C. Oreja‐Guevara [Biogen‐Idec, Novartis, Merck‐Serono, Almirall, Teva and Genzyme], D. Muñoz [Merck,Biogen, Teva, Novartis and Genzyme], J. Olascoaga [Biogen Idec, Bayer‐Schering, Genzyme, Merck‐Serono, Novartis and Teva], A. Pato [Novartis, Biogen and Genzyme Almirall], L. Ramió [Biogen Idec, Novartis, Bayer, Merck‐Serono, Genzyme, Teva PharmaceuticalIndustries Ltd.], V. Meca‐Lallana [Almirall, Biogen Idec,Genzyme, Merck Serono, Novartis, Roche, Teva and Terumo], M.A. Hernández [Merck Serono, Novartis, Biogen, Genzyme, TEVA and Almirall ], M.E. Marzo [nothing to disclose ], J.C. Álvarez‐Cermeño [Bayer Schering Pharma, Merk Serono, Biogen‐Idec, Teva Pharmaceuticals, Sanofi‐Aventis, Genzyme, and Novartis ], A. Rodríguez‐Antigüedad [Biogen‐Idec, Novartis, Merck‐Serono, Teva and Genzyme. ], X. Montalbán [Biogen‐Idec, Bayer‐ Schering, Merck‐Serono, Teva, Novartis, and Sanofi‐Genzyme, Bayer‐Schering, Genzyme, Merck‐Serono, Teva, Novartis, Actelion, Almirall, Allergan and Roche.] Ó. Fernández [Biogen‐Idec, Bayer‐ Schering, Genzyme, Merck‐Serono, Teva, Novartis, Actelion, Almirall, Allergan and Roche.] The rest of investigators do not declare any competing interests related to this article.
- Published
- 2021
- Full Text
- View/download PDF
14. Predicting Aggressive Multiple Sclerosis With Intrathecal IgM Synthesis Among Patients With a Clinically Isolated Syndrome.
- Author
-
Monreal E, Sainz de la Maza S, Costa-Frossard L, Walo-Delgado P, Zamora J, Fernández-Velasco JI, Villarrubia N, Espiño M, Lourido D, Lapuente P, Toboso I, Álvarez-Cermeño JC, Masjuan J, and Villar LM
- Subjects
- Adult, Biomarkers blood, Biomarkers cerebrospinal fluid, Female, Humans, Male, Multiple Sclerosis diagnosis, Multiple Sclerosis immunology, Oligoclonal Bands blood, Oligoclonal Bands cerebrospinal fluid, Prospective Studies, Sensitivity and Specificity, Immunoglobulin M blood, Immunoglobulin M cerebrospinal fluid, Multiple Sclerosis blood, Multiple Sclerosis cerebrospinal fluid
- Abstract
Objective: To determine the best method to measure intrathecal immunoglobulin (Ig) M synthesis (ITMS), a biomarker of worse prognosis in multiple sclerosis (MS). We compared the ability for predicting a poor evolution of 4 methods assessing ITMS (IgM oligoclonal bands [OCMBs], lipid-specific OCMBs [LS-OCMBs], Reibergram, and IgM index) in patients with a clinically isolated syndrome (CIS)., Methods: Prospective study with consecutive patients performed at a referral MS center. We used unadjusted and multivariate Cox regressions for predicting a second relapse, Expanded Disability Status Scale (EDSS) scores of 4 and 6, and development of secondary progressive MS (SPMS)., Results: A total of 193 patients were included, with a median (interquartile range) age of 31 (25-38) years and a median follow-up of 12.9 years. Among all methods, only OCMB, LS-OCMB, and Reibergram significantly identified patients at risk of some of the pre-established outcomes, being LS-OCMB the technique with the strongest associations. Adjusted hazard ratio (aHR) of LS-OCMB for predicting a second relapse was 2.50 (95% CI 1.72-3.64, p < 0.001). The risk of reaching EDSS scores of 4 and 6 and SPMS was significantly higher among patients with LS-OCMB (aHR 2.96, 95% CI 1.54-5.71, p = 0.001; aHR 4.96, 95% CI 2.22-11.07, p < 0.001; and aHR 2.31, 95% CI 1.08-4.93, p = 0.03, respectively)., Conclusions: ITMS predicts an aggressive MS at disease onset, especially when detected as LS-OCMB., Classification of Evidence: This study provides Class II evidence that lipid-specific IgM oligoclonal bands can predict progression from CIS to MS and a worse disease course over a follow-up of at least 2 years., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)
- Published
- 2021
- Full Text
- View/download PDF
15. Identification of the Immunological Changes Appearing in the CSF During the Early Immunosenescence Process Occurring in Multiple Sclerosis.
- Author
-
Picón C, Tejeda-Velarde A, Fernández-Velasco JI, Comabella M, Álvarez-Lafuente R, Quintana E, Sainz de la Maza S, Monreal E, Villarrubia N, Álvarez-Cermeño JC, Domínguez-Mozo MI, Ramió-Torrentà L, Rodríguez-Martín E, Roldán E, Aladro Y, Medina S, Espiño M, Masjuan J, Matute-Blanch C, Muñoz-San Martín M, Espejo C, Guaza C, Muriel A, Costa-Frossard L, and Villar LM
- Subjects
- Activins cerebrospinal fluid, Adolescent, Adult, Aged, Antibodies, Viral blood, B-Lymphocytes immunology, B7-H1 Antigen cerebrospinal fluid, Biomarkers cerebrospinal fluid, Chitinase-3-Like Protein 1 cerebrospinal fluid, Female, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, T-Lymphocytes immunology, Young Adult, Immunosenescence immunology, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis immunology, Multiple Sclerosis pathology, Oligoclonal Bands immunology
- Abstract
Patients with multiple sclerosis (MS) suffer with age an early immunosenescence process, which influence the treatment response and increase the risk of infections. We explored whether lipid-specific oligoclonal IgM bands (LS-OCMB) associated with highly inflammatory MS modify the immunological profile induced by age in MS. This cross-sectional study included 263 MS patients who were classified according to the presence (M+, n=72) and absence (M-, n=191) of LS-OCMB. CSF cellular subsets and molecules implicated in immunosenescence were explored. In M- patients, aging induced remarkable decreases in absolute CSF counts of CD4+ and CD8+ T lymphocytes, including Th1 and Th17 cells, and of B cells, including those secreting TNF-alpha. It also increased serum anti-CMV IgG antibody titers (indicative of immunosenescence) and CSF CHI3L1 levels (related to astrocyte activation). In contrast, M+ patients showed an age-associated increase of TIM-3 (a biomarker of T cell exhaustion) and increased values of CHI3L1, independently of age. Finally, in both groups, age induced an increase in CSF levels of PD-L1 (an inductor of T cell tolerance) and activin A (part of the senescence-associated secretome and related to inflammaging). These changes were independent of the disease duration. Finally, this resulted in augmented disability. In summary, all MS patients experience with age a modest induction of T-cell tolerance and an activation of the innate immunity, resulting in increased disability. Additionally, M- patients show clear decreases in CSF lymphocyte numbers, which could increase the risk of infections. Thus, age and immunological status are important for tailoring effective therapies in MS., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Picón, Tejeda-Velarde, Fernández-Velasco, Comabella, Álvarez-Lafuente, Quintana, Sainz de la Maza, Monreal, Villarrubia, Álvarez-Cermeño, Domínguez-Mozo, Ramió-Torrentà, Rodríguez-Martín, Roldán, Aladro, Medina, Espiño, Masjuan, Matute-Blanch, Muñoz-San Martín, Espejo, Guaza, Muriel, Costa-Frossard and Villar.)
- Published
- 2021
- Full Text
- View/download PDF
16. Predictive factors and early biomarkers of response in multiple sclerosis patients treated with natalizumab.
- Author
-
Dominguez-Mozo MI, Perez-Perez S, Villar LM, Oliver-Martos B, Villarrubia N, Matesanz F, Costa-Frossard L, Pinto-Medel MJ, García-Sánchez MI, Ortega-Madueño I, Lopez-Lozano L, Garcia-Martinez A, Izquierdo G, Fernández Ó, Álvarez-Cermeño JC, Arroyo R, and Alvarez-Lafuente R
- Subjects
- Adult, Antibody Formation, Biomarkers, Pharmacological blood, Capsid Proteins analysis, Capsid Proteins immunology, Disease Progression, Epstein-Barr Virus Infections immunology, Epstein-Barr Virus Nuclear Antigens analysis, Female, HLA Antigens analysis, Herpesvirus 4, Human immunology, Herpesvirus 6, Human immunology, Humans, Immunoglobulin G analysis, Longitudinal Studies, Male, Middle Aged, Multiple Sclerosis immunology, Natalizumab metabolism, Prognosis, Recurrence, Retrospective Studies, Spain, Biomarkers, Pharmacological analysis, Multiple Sclerosis drug therapy, Natalizumab therapeutic use
- Abstract
There are an increasing number of treatments available for multiple sclerosis (MS). The early identification of optimal responders to individual treatments is important to achieve individualized therapy. With this aim, we performed a multicenter retrospective longitudinal study including 186 MS patients treated with natalizumab who were followed for 2 years. We analyzed the following variables at recruitment: sex, current age, age at disease onset, disease duration, EDSS, number of T2 and Gd + lesions, IgG and IgM oligoclonal bands, HLA class II (DR, DRB, DQA, DQB, and DRB1*15:01), IgG and IgM antibody titers against human herpesvirus 6 (HHV-6) and the antibody response to Epstein-Barr virus (EBV) through the measurement of the anti-EBNA-1 and anti-VCA IgG titers, in relation to clinical response (no relapses or disability progression), and to NEDA-3 (no evidence of disease activity in terms of clinical response and no changes in MRI scans either) after 2-years follow-up. Baseline EDSS score, baseline EBNA-1 IgG titers and percentage change of HHV6 IgG titers between baseline and 6 month visits were significantly different in clinical responders and in NEDA-3 status (all of them remained significant in the multivariate analysis). We identified three variables for the early identification of natalizumab optimal responders in a rapid and cost-effective approach.
- Published
- 2020
- Full Text
- View/download PDF
17. A pharmacogenetic study implicates NINJ2 in the response to Interferon-β in multiple sclerosis.
- Author
-
Peroni S, Sorosina M, Malhotra S, Clarelli F, Osiceanu AM, Ferrè L, Roostaei T, Rio J, Midaglia L, Villar LM, Álvarez-Cermeño JC, Guaschino C, Radaelli M, Citterio L, Lechner-Scott J, Spataro N, Navarro A, Martinelli V, Montalban X, Weiner HL, de Jager P, Comi G, Esposito F, Comabella M, and Martinelli-Boneschi F
- Subjects
- Endothelial Cells, Humans, Interferons, Pharmacogenomic Testing, Cell Adhesion Molecules, Neuronal metabolism, Interferon-beta therapeutic use, Multiple Sclerosis drug therapy, Multiple Sclerosis genetics
- Abstract
Background: Multiple sclerosis (MS) is a disease in which biomarker identification is fundamental to predict response to treatments and to deliver the optimal drug to patients. We previously found an association between rs7298096, a polymorphism upstream to the NINJ2 gene, and the 4-year response to interferon-β (IFNβ) treatment in MS patients., Objectives: To analyse the association between rs7298096 and time to first relapse (TTFR) during IFNβ therapy in MS patients and to better investigate its functional role., Methods: Survival analysis was applied in three MS cohorts from different countries ( n = 1004). We also studied the role of the polymorphism on gene expression using GTEx portal and a luciferase assay. We interrogated GEO datasets to explore the relationship between NINJ2 expression, IFNβ and TTFR., Results: Rs7298096
AA patients show a shorter TTFR than rs7298096G -carriers (Pmeta-analysis = 3 × 10-4 , hazard ratio = 1.41). Moreover, rs7298096AA is associated with a higher NINJ2 expression in blood ( p = 7.0 × 10-6 ), which was confirmed in vitro ( p = 0.009). Finally, NINJ2 expression is downregulated by IFNβ treatment and related to TTFR., Conclusions: Rs7298096 could influence MS disease activity during IFNβ treatment by modulating NINJ2 expression in blood. The gene encodes for an adhesion molecule involved in inflammation and endothelial cells activation, supporting its role in MS.- Published
- 2020
- Full Text
- View/download PDF
18. Focused ultrasound thalamotomy for multiple sclerosis-associated tremor.
- Author
-
Máñez-Miró JU, Martínez-Fernández R, Del Alamo M, Pineda-Pardo JA, Fernández-Rodríguez B, Alonso-Frech F, Álvarez-Cermeño JC, and Obeso JA
- Subjects
- Adult, Female, Humans, Magnetic Resonance Imaging, Multiple Sclerosis complications, Thalamus surgery, Tremor etiology, Tremor therapy, Ultrasonic Therapy
- Abstract
Multiple sclerosis (MS)-related tremor is frequent and can often be refractory to medical treatment, which makes it a potential source of major disability. Functional neurosurgery approaches such as thalamic deep brain stimulation (DBS) or radiofrequency thalamotomy are proven to be effective, but the application of invasive techniques in MS tremor has so far been limited. Magnetic resonance (MR)-guided focused ultrasound thalamotomy, which has already been approved for treating essential and parkinsonian tremor, provides a minimally invasive approach that could be useful in the management of MS tremor. We report for the first time a patient with medically refractory MS-associated tremor successfully treated by focused ultrasound thalamotomy.
- Published
- 2020
- Full Text
- View/download PDF
19. Consensus statement on the use of alemtuzumab in daily clinical practice in Spain.
- Author
-
Meca-Lallana JE, Fernández-Prada M, García Vázquez E, Moreno Guillén S, Otero Romero S, Rus Hidalgo M, Villar Guimerans LM, Eichau Madueño S, Fernández Fernández Ó, Izquierdo Ayuso G, Álvarez Cermeño JC, Arnal García C, Arroyo González R, Brieva Ruiz L, Calles Hernández C, García Merino A, González Platas M, Hernández Pérez MÁ, Moral Torres E, Olascoaga Urtaza J, Oliva-Nacarino P, Oreja-Guevara C, Ortiz Castillo R, Oterino A, Prieto González JM, Ramió-Torrentá L, Rodríguez-Antigüedad A, Saiz A, Tintoré M, and Montalbán Gairin X
- Abstract
Introduction: Alemtuzumab is a highly effective drug approved by the European Medicines Agency as a disease-modifying drug for the treatment of relapsing-remitting multiple sclerosis., Objective: A consensus document was drafted on the management of alemtuzumab in routine clinical practice in Spain., Development: A group of multiple sclerosis specialists reviewed articles addressing treatment with alemtuzumab in patients with multiple sclerosis and published before December 2017. The included studies assessed the drug's efficacy, effectiveness, and safety; screening for infections and vaccination; and administration and monitoring aspects. The initial proposed recommendations were developed by a coordinating group and based on the available evidence and their clinical experience. The consensus process was carried out in 2 stages, with the initial threshold percentage for group agreement established at 80%. The final document with all the recommendations agreed by the working group was submitted for external review and the comments received were considered by the coordinating group., Conclusion: The present document is intended to be used as a tool for optimising the management of alemtuzumab in routine clinical practice., (Copyright © 2019 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
20. Effectiveness of Fingolimod versus Natalizumab as Second-Line Therapy for Relapsing-Remitting Multiple Sclerosis in Spain: Second-Line GATE Study.
- Author
-
Meca-Lallana J, Ayuso T, Martínez-Yelamos S, Durán C, Contreras Martín Y, Herrera Navarro N, Pérez Sempere A, Álvarez-Cermeño JC, Millán Pascual J, Meca-Lallana V, Romero Sevilla R, and Ricart J
- Subjects
- Adult, Disease Progression, Female, Humans, Male, Middle Aged, Recurrence, Retrospective Studies, Spain, Fingolimod Hydrochloride therapeutic use, Immunosuppressive Agents therapeutic use, Multiple Sclerosis, Relapsing-Remitting drug therapy, Natalizumab therapeutic use
- Abstract
Background: There is a lack of head-to-head studies comparing the efficacy of fingolimod (FIN) and natalizumab (NTZ) as second-line therapy for relapsing-remitting multiple sclerosis (RRMS)., Methods: Multicenter, observational study, in which, information of 388 patients randomly selected and treated with FIN or NTZ in routine clinical practice was retrospectively collected with the main objective of comparing the annualized relapse rate (ARR) over the first year, after FIN or NTZ treatment initiation., Results: Mean ARR during the first year of treatment was 0.28 in FIN group and 0.12 in NTZ group (p = 0.0064); nevertheless, the difference between groups lost statistical significance when the propensity score analysis was performed. Time to disability -progression was similar in both treatment groups (12.3 ± 6.7 months in FIN, and 12.8 ± 0.1 months in NTZ; p = 0.4654). Treatment persistence after the first year of treatment was higher in patients treated with FIN (95%) than in those treated with NTZ (84%; p = 0.0014)., Conclusions: After 12 months of treatment, both FIN and NTZ reduced the ARR, but ARR percent reduction was significantly higher with NTZ. Treatment persistence was higher in patients receiving FIN., (The Author(s). Published by S. Karger AG, Basel.)
- Published
- 2020
- Full Text
- View/download PDF
21. [Recommendations for the use of cladribine tablets in recurring multiple sclerosis].
- Author
-
Oreja-Guevara C, García-Merino JA, Saiz A, Rodríguez-Antigüedad A, Álvarez-Cermeño JC, Estrada-Pérez V, Izquierdo G, and Fernández O
- Subjects
- Cladribine adverse effects, Humans, Immunosuppressive Agents adverse effects, Practice Guidelines as Topic, Recurrence, Tablets, Treatment Outcome, Cladribine therapeutic use, Immunosuppressive Agents therapeutic use, Multiple Sclerosis drug therapy
- Abstract
Introduction: Cladribine is a prodrug, a synthetic analogue of deoxyadenosine, approved for use as selective immune reconstitution therapy in very active recurring multiple sclerosis in adults., Aims: To review the development of the drug, its mechanism of action and the efficacy and safety data obtained to date, as well as to establish recommendations of Spanish experts for its use in clinical practice., Development: The treatment of multiple sclerosis has been simplified with cladribine tablets, and two short courses of administration for two consecutive years (maximum 20 days) are needed to maintain an efficacy of up to four years after the first dose. Results of clinical trials have demonstrated the safety, tolerability and long-term efficacy of cladribine tablets in patients with recurring multiple sclerosis. Thus, patients treated with cladribine presented a significant reduction in the rate of flare-ups, in the risk of disability progression and in the development of new lesions in magnetic resonance imaging compared to those treated with placebo. In terms of safety, the treated patients had a higher frequency of lymphopenia, in relation to its mechanism of action, and of infections by herpes zoster virus. Long-term results with eight years' follow-up have shown that treated patients are not at greater risk of developing serious events, such as malignant neoplasms or opportunistic infections., Conclusions: Cladribine is the first short-course oral therapy that has been shown to be effective and safe in patients with very active recurring multiple sclerosis, and with a sustained effect over time. The recommendations of Spanish experts on its usage are a fundamental complement to the considerations described by the regulatory agencies.
- Published
- 2019
- Full Text
- View/download PDF
22. Cerebrospinal fluid mitochondrial DNA levels in patients with multiple sclerosis.
- Author
-
Fissolo N, Cervera-Carles L, Villar Guimerans LM, Lleó A, Clarimón J, Drulovic J, Dujmovic I, Voortman M, Khalil M, Gil E, Navarro L, Álvarez-Cermeño JC, Montalban X, and Comabella M
- Subjects
- Adult, Case-Control Studies, Demyelinating Diseases cerebrospinal fluid, Female, Humans, Male, Middle Aged, Polymerase Chain Reaction, DNA, Mitochondrial cerebrospinal fluid, Multiple Sclerosis, Chronic Progressive cerebrospinal fluid, Multiple Sclerosis, Relapsing-Remitting cerebrospinal fluid
- Abstract
The role of cerebrospinal fluid (CSF) mitochondrial DNA (mtDNA) levels as biomarker in multiple sclerosis (MS) is unknown. We determined CSF mtDNA levels in a cohort of 237 individuals, including patients with MS and clinically isolated syndrome (CIS), inflammatory and non-inflammatory neurological controls, and cognitively healthy controls (HC). mtDNA concentration was measured by droplet digital polymerase chain reaction. CSF mtDNA levels were increased in all pathological conditions compared with HC, though no differences were observed between relapse-onset and progressive MS clinical forms, CIS patients and neurological controls. These findings do not support the determination of CSF mtDNA levels as a useful biomarker in MS clinical practice.
- Published
- 2019
- Full Text
- View/download PDF
23. Manipulation of Gut Microbiota Influences Immune Responses, Axon Preservation, and Motor Disability in a Model of Progressive Multiple Sclerosis.
- Author
-
Mestre L, Carrillo-Salinas FJ, Mecha M, Feliú A, Espejo C, Álvarez-Cermeño JC, Villar LM, and Guaza C
- Subjects
- Animals, Cells, Cultured, Disease Models, Animal, Disease Progression, Humans, Immunity, Lymphocyte Activation, Mice, Motor Disorders drug therapy, Multiple Sclerosis drug therapy, Anti-Bacterial Agents therapeutic use, Axons pathology, B-Lymphocytes immunology, Cardiovirus Infections immunology, Gastrointestinal Microbiome immunology, Motor Disorders immunology, Multiple Sclerosis immunology, Probiotics therapeutic use, T-Lymphocytes immunology, Theilovirus physiology
- Abstract
Gut microbiota dysbiosis has been implicated in MS and other immune diseases, although it remains unclear how manipulating the gut microbiota may affect the disease course. Using a well-established model of progressive MS triggered by intracranial infection with Theiler's murine encephalomyelitis virus (TMEV), we sought to determine whether dysbiosis induced by oral antibiotics (ABX) administered on pre-symptomatic and symptomatic phases of the disease influences its course. We also addressed the effects of microbiota recolonization after ABX withdrawn in the presence or absence of probiotics. Central and peripheral immunity, plasma acetate and butyrate levels, axon damage and motor disability were evaluated. The cocktail of ABX prevented motor dysfunction and limited axon damage in mice, which had fewer CD4
+ and CD8+ T cells in the CNS, while gut microbiota recolonization worsened motor function and axonal integrity. The underlying mechanisms of ABX protective effects seem to involve CD4+ CD39+ T cells and CD5+ CD1d+ B cells into the CNS. In addition, microglia adopted a round amoeboid morphology associated to an anti-inflammatory gene profile in the spinal cord of TMEV mice administered ABX. The immune changes in the spleen and mesenteric lymph nodes were modest, yet ABX treatment of mice limited IL-17 production ex vivo . Collectively, our results provide evidence of the functional relevance of gut microbiota manipulation on the neurodegenerative state and disease severity in a model of progressive MS and reinforce the role of gut microbiota as target for MS treatment.- Published
- 2019
- Full Text
- View/download PDF
24. Factors associated with dimethyl fumarate-induced lymphopenia.
- Author
-
Sainz de la Maza S, Medina S, Villarrubia N, Costa-Frossard L, Monreal E, Tejeda-Velarde A, Rodríguez-Martín E, Roldán E, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adult, Female, Humans, Leukocytes drug effects, Leukocytes metabolism, Longitudinal Studies, Lymphocyte Count methods, Lymphopenia diagnosis, Male, Middle Aged, Prospective Studies, Dimethyl Fumarate adverse effects, Immunosuppressive Agents adverse effects, Lymphocytes drug effects, Lymphocytes metabolism, Lymphopenia blood, Lymphopenia chemically induced
- Abstract
Background: Lymphopenia is a major concern in MS patients treated with dimethyl-fumarate (DMF) as it increases the risk of progressive multifocal leukoencephalopathy., Objective: To identify factors associated with lymphopenia in DMF-treated patients and explore changes in blood lymphocyte subsets associated with DMF-induced lymphopenia., Methods: Prospective longitudinal study including 106 patients initiating DMF treatment followed for a median time of 24.67 months. Blood lymphocyte subsets were studied in 64 patients by flow cytometry at baseline and 6 months after., Results: Mean absolute lymphocyte counts (ALCs) decreased by 29% during the first year of DMF-treatment. Patients developing lymphopenia showed a faster decline within the three first months. A reduction of ALCs higher than 38% at this time was associated to subsequent development of grade 2-3 lymphopenia (OR = 5.93, 95% CI: 1.9-18.6, p = 0.002). All patients showed a significant decrease in different T and B lymphocyte subsets upon DMF therapy. In addition, lymphopenic patients experienced a selective decrease in natural killer T (NKT) cell percentages (p = 0.01), and a high drop in NKT total counts (p < 0.0001)., Conclusions: Patients who experience a drop in ALCs by >38% at three months of DMF-treatment are about 6-times more likely to develop significant lymphopenia. This decrease is clearly associated with a considerable loss of NKT cells., (Copyright © 2019 Elsevier B.V. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
25. Teriflunomide induces a tolerogenic bias in blood immune cells of MS patients.
- Author
-
Medina S, Sainz de la Maza S, Villarrubia N, Álvarez-Lafuente R, Costa-Frossard L, Arroyo R, Monreal E, Tejeda-Velarde A, Rodríguez-Martín E, Roldán E, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adult, B-Lymphocytes drug effects, B-Lymphocytes immunology, B7-H1 Antigen drug effects, CD8-Positive T-Lymphocytes immunology, Female, Humans, Hydroxybutyrates, Leukocytes, Mononuclear immunology, Lymphocyte Activation drug effects, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting drug therapy, Nitriles, Programmed Cell Death 1 Receptor drug effects, Programmed Cell Death 1 Receptor metabolism, T-Lymphocyte Subsets drug effects, T-Lymphocyte Subsets immunology, B7-H1 Antigen metabolism, Crotonates pharmacology, Leukocytes, Mononuclear drug effects, Multiple Sclerosis drug therapy, Toluidines pharmacology
- Abstract
Objectives: Teriflunomide, a disease-modifying treatment approved for multiple sclerosis (MS), inhibits reversibly dihydroorotate dehydrogenase, an enzyme involved in de novo pyrimidine biosynthesis and down-regulates proliferation of activated lymphocytes. We aimed to study the impact of this drug in the lymphocyte profiles of MS patients., Methods: Fifty-five patients with relapsing-remitting MS who initiated teriflunomide treatment were included in the study. We studied peripheral blood mononuclear cells obtained before and 6 months after treatment initiation and explored effector, memory, and regulatory cells by flow cytometry. Wilcoxon matched pair tests were used to assess differences between basal and 6 months after treatment results. P -values were corrected with Bonferroni test., Results: When explored T and B cell subsets, we observed a decrease in the percentages of terminally differentiated CD4+ T cells ( P = 0.001) and plasmablasts ( P < 0.0001) after 6 months of treatment. These results were confirmed with the total cell number. When studied immunomodulatory cells, we observed a clear increase of monocytes expressing programmed death-ligand 1 (PD-L1) ( P = 0.005), which correlated negatively with all effector CD8+ T cell subsets. We also observed an increase in the percentage of CD8+ T cells ( P = 0.028) and monocytes ( P = 0.04) producing IL-10., Conclusions: Teriflunomide induces a specific reduction in effector T and B cells that have shown to play a role in MS course and an increase in immunomodulatory cells. Particularly, this drug induces the expression of PD-L1, a molecule involved in tolerance to autoantigens, which can contribute to inhibit the abnormal immune response taking place in MS., Competing Interests: None declared.
- Published
- 2019
- Full Text
- View/download PDF
26. Circulating EZH2-positive T cells are decreased in multiple sclerosis patients.
- Author
-
Malhotra S, Villar LM, Costa C, Midaglia L, Cubedo M, Medina S, Fissolo N, Río J, Castilló J, Álvarez-Cermeño JC, Sánchez A, Montalban X, and Comabella M
- Subjects
- Adult, Animals, Cohort Studies, Cytokines immunology, Cytokines metabolism, Disease Models, Animal, Encephalomyelitis, Autoimmune, Experimental etiology, Encephalomyelitis, Autoimmune, Experimental pathology, Enhancer of Zeste Homolog 2 Protein genetics, Female, Freund's Adjuvant toxicity, Humans, Leukocytes, Mononuclear classification, Male, Mice, Mice, Inbred C57BL, MicroRNAs metabolism, Middle Aged, Multiple Sclerosis, Chronic Progressive immunology, Multiple Sclerosis, Relapsing-Remitting immunology, Myelin-Oligodendrocyte Glycoprotein toxicity, Peptide Fragments toxicity, Proto-Oncogene Proteins c-vav genetics, Proto-Oncogene Proteins c-vav metabolism, T-Lymphocyte Subsets, Talin genetics, Talin metabolism, Young Adult, Enhancer of Zeste Homolog 2 Protein metabolism, Leukocytes, Mononuclear metabolism, Multiple Sclerosis, Chronic Progressive pathology, Multiple Sclerosis, Relapsing-Remitting pathology
- Abstract
Background: Recent studies in experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis (MS), suggest an involvement of the histone methyltransferase enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) in important processes such as cell adhesion and migration., Methods: Here, we aimed to expand these initial observations by investigating the role of EZH2 in MS. mRNA expression levels for EZH2 were measured by real-time PCR in peripheral blood mononuclear cells (PBMC) from 121 MS patients (62 untreated and 59 receiving treatment) and 24 healthy controls., Results: EZH2 expression levels were decreased in PBMC from untreated patients compared to that from controls, and treatment significantly upregulated EZH2 expression. Expression of miR-124 was increased in MS patients compared to controls. Blood immunophenotyping revealed EZH2 expression mostly restricted to CD4+ and CD8+ T cells, and circulating EZH2+ CD4+ and CD8+ T cells were decreased in untreated MS patients compared to controls. CD8+ T cells expressing EZH2 exhibited a predominant central memory phenotype, whereas EZH2+ CD4+ T cells were of effector memory nature, and both T cell subsets produced TNF-α. EZH2+ T cells were enriched in the cerebrospinal fluid compartment compared to blood and were found in chronic active lesions from MS patients. EZH2 inhibition and microarray analysis in PBMC was associated with significant downregulation of key T cell adhesion molecules., Conclusion: These findings suggest a role of EZH2 in the migration of T cells in MS patients. The observation of TNF-α expression by CD4+ and CD8+ T cells expressing EZH2 warrants additional studies to explore more in depth the pathogenic potential of EZH2+-positive cells in MS.
- Published
- 2018
- Full Text
- View/download PDF
27. NLRP3 polymorphisms and response to interferon-beta in multiple sclerosis patients.
- Author
-
Malhotra S, Sorosina M, Río J, Peroni S, Midaglia L, Villar LM, Álvarez-Cermeño JC, Schroeder I, Esposito F, Clarelli F, Zettl UK, Lechner-Scott J, Spataro N, Navarro A, Comi G, Montalban X, Martinelli-Boneschi F, and Comabella M
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Genotype, Polymorphism, Single Nucleotide, Immunologic Factors therapeutic use, Interferon-beta therapeutic use, Multiple Sclerosis drug therapy, Multiple Sclerosis genetics, NLR Family, Pyrin Domain-Containing 3 Protein genetics
- Abstract
We aimed to investigate whether NLR family, pyrin domain containing 3 (NLRP3) polymorphisms are associated with the response to interferon-beta (IFNβ) in multiple sclerosis (MS) patients. A total of 14 NLRP3 polymorphisms were genotyped in a cohort of 665 relapsing-remitting MS patients recruited across 5 centers and classified into responders and non-responders according to clinical-radiological criteria after 1 year of IFNβ treatment. A meta-analysis failed to demonstrate significant associations between the response to IFNβ and NLRP3 polymorphisms. These findings do not support a role of polymorphisms located in the NLRP3 gene and the response to IFNβ in MS patients.
- Published
- 2018
- Full Text
- View/download PDF
28. Optimal response to dimethyl fumarate associates in MS with a shift from an inflammatory to a tolerogenic blood cell profile.
- Author
-
Medina S, Villarrubia N, Sainz de la Maza S, Lifante J, Costa-Frossard L, Roldán E, Picón C, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adult, B-Lymphocyte Subsets drug effects, Female, Humans, Immune Tolerance drug effects, Immune Tolerance immunology, Inflammation immunology, Male, T-Lymphocyte Subsets drug effects, Young Adult, B-Lymphocyte Subsets immunology, Dimethyl Fumarate therapeutic use, Immunosuppressive Agents therapeutic use, Multiple Sclerosis drug therapy, Multiple Sclerosis immunology, T-Lymphocyte Subsets immunology
- Abstract
Background: The precise mechanism of action of dimethyl fumarate (DMF) treatment in MS remains unknown., Objective: To identify the changes in the blood lymphocyte profile of MS patients predicting no evidence of disease activity (NEDA) status after DMF treatment., Methods: We studied blood lymphocyte subsets of 64 MS patients treated with DMF at baseline and after 6 months of treatment by flow cytometry. NEDA (41 patients) or ongoing disease activity (ODA, 23 patients) were monitored after a year of follow-up., Results: During treatment, all patients experienced an increase in the naive T cells and a decrease in effector memory ones. However, only NEDA patients showed a significant reduction in central memory CD4+ and CD8+ T cells, memory B cells, CD4+ T cells producing interferon (IFN)-gamma, CD8+ T cells producing tumor necrosis factor-alpha (TNF-alpha), and IFN-gamma and B cells producing TNF-alpha. Additionally, they had an increase in regulatory CD56bright cells not observed in ODA group. After treatment, there was a negative correlation between CD56bright cells and CD8+ T cells producing IFN-gamma and TNF-alpha., Conclusion: A pro-tolerogenic shift in the blood leukocyte profile associates with an optimal response to DMF in MS.
- Published
- 2018
- Full Text
- View/download PDF
29. Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients.
- Author
-
Casanova B, Lacruz L, Villar ML, Domínguez JA, Gadea MC, Gascón F, Mallada J, Hervás D, Simó-Castelló M, Álvarez-Cermeño JC, Calles C, Olascoaga J, Ramió-Torrentà L, Alcalá C, Cervelló A, Boscá I, Pérez-Mirallles FC, and Coret F
- Subjects
- Adult, Female, Follow-Up Studies, Humans, Male, Multiple Sclerosis, Relapsing-Remitting cerebrospinal fluid, Oligoclonal Bands, Prospective Studies, Retrospective Studies, Treatment Outcome, Glatiramer Acetate therapeutic use, Immunoglobulin M cerebrospinal fluid, Immunologic Factors therapeutic use, Interferon-beta therapeutic use, Multiple Sclerosis, Relapsing-Remitting immunology, Multiple Sclerosis, Relapsing-Remitting therapy
- Abstract
Objective: To study the efficacy of interferon beta (IFNβ) and glatiramer acetate (GA) related to the presence of oligoclonal M bands (OCMB) in the cerebrospinal fluid in relapsing-remitting multiple sclerosis (RRMS)., Method: This is an observational, multicenter and retrospective study with prospectively collected data of patients that started treatment with IFNβ or GA. Treatment decision was made blinded to the OCMB status. Time to first attack after starting therapy was compared by using Kaplan-Meier curves, and adjustment by Cox regression analysis was performed., Results: Two hundred and fifty-six patients entered in the study (141-55% received IFNβ; 115-45% received GA). After a mean follow-up of 41 and 65 months, 54.7% of patients remained free from further attacks (RF). The proportion of RF patients was higher in the GA group than in the IFNβ group (72.2 vs. 40.4%, p < 0.001). The IFNβ patients with OCMB+ presented the poorest response, 31.3% RF vs. 48.1% in IFNβ without OCMB, p = 0.03., Conclusion: OCMB in CSF could be a biomarker of treatment response in multiple sclerosis.
- Published
- 2018
- Full Text
- View/download PDF
30. A guide to treating gait impairment with prolonged-release fampridine (Fampyra ® ) in patients with multiple sclerosis.
- Author
-
Ramió-Torrentà L, Álvarez-Cermeño JC, Arroyo R, Casanova-Estruch B, Fernández O, García-Merino JA, Hernández MA, Izquierdo G, Martínez-Yélamos S, Meca J, Moral E, Olascoaga J, Prieto JM, and Saiz A
- Subjects
- Adult, Humans, Quality of Life, Spain, Treatment Outcome, 4-Aminopyridine therapeutic use, Gait Disorders, Neurologic drug therapy, Multiple Sclerosis complications, Potassium Channel Blockers therapeutic use
- Abstract
Introduction: Gait impairment, a frequent sign in multiple sclerosis (MS), places a major burden on patients since it results in progressive loss of personal and social autonomy, along with work productivity. This guide aims to provide recommendations on how to evaluate gait impairment and use prolonged-release fampridine (PR-fampridine) as treatment for MS patients with gait impairment in Spain., Development: PR-fampridine dosed at 10mg every 12hours is currently the only drug approved to treat gait impairment in adults with MS. Additionally, PR-fampridine has been shown in clinical practice to significantly improve quality of life (QoL) in patients who respond to treatment. Treatment response can be assessed with the Timed 25-Foot Walk (T25FW) or the 12-item MS Walking Scale (MSWS-12); tests should be completed before and after starting treatment. The minimum time recommended for evaluating treatment response is 2 weeks after treatment onset. Patients are considered responders and permitted to continue the treatment when they demonstrate a decrease in their T25FW time or an increase in MSWS-12 scores. A re-evaluation is recommended at least every 6 months. The SF-36 (Short Form-36) and the MSIS-29 (MS Impact Scale-29) tests are recommended for clinicians interested in performing a detailed QoL assessment. This drug is generally well-tolerated and has a good safety profile. It should be taken on an empty stomach and renal function must be monitored regularly., Conclusions: These recommendations will help ensure safer and more efficient prescription practices and easier management of PR-fampridine as treatment for gait impairment in Spanish adults with MS., (Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
31. Clinical usefulness of prognostic biomarkers in optic neuritis.
- Author
-
Tejeda-Velarde A, Costa-Frossard L, Sainz de la Maza S, Carrasco Á, Espiño M, Picón C, Toboso I, Walo PE, Lourido D, Muriel A, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adult, Biomarkers, Cohort Studies, Disease Progression, Female, Follow-Up Studies, Humans, Immunoglobulin G cerebrospinal fluid, Immunoglobulin M cerebrospinal fluid, Magnetic Resonance Imaging, Male, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis diagnosis, Multiple Sclerosis diagnostic imaging, Neurofilament Proteins cerebrospinal fluid, Oligoclonal Bands, Optic Neuritis cerebrospinal fluid, Optic Neuritis diagnostic imaging, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Assessment, Treatment Outcome, Optic Neuritis diagnosis
- Abstract
Background and Purpose: Different biological and radiological biomarkers predict clinical conversion to multiple sclerosis (MS) after a clinically isolated syndrome (CIS). The aim was to explore their role in predicting the outcome of patients with optic neuritis (ON), a CIS considered to have a benign prognosis., Methods: Sixty-eight consecutive ON patients were followed prospectively. Magnetic resonance imaging (MRI) and cerebrospinal fluid studies including oligoclonal immunoglobulin G (IgG) bands (OCGBs), lipid-specific oligoclonal IgM bands (LS-OCMBs) and neurofilament light chain quantification were performed at disease onset. Conversion to clinically definite MS (CDMS) was monitored., Results: The mean time of follow-up of our series was 46.4 months. Twenty-five patients (36.7%) developed CDMS during follow-up. Neurofilament light chain levels did not predict clinical conversion. By contrast, an abnormal MRI increased the risk of CDMS [hazard ratio (HR) 12.5, P = 0.013]. The clearest association was found in patients with more than three T2 lesions. OCGBs also predicted the onset of CDMS (HR 21.3, P = 0.003) and LS-OCMBs were associated with a shorter time to CDMS (HR = 116.6, P < 0.001)., Conclusions: Magnetic resonance imaging and OCGBs predicted conversion to CDMS after an ON episode. In addition, LS-OCMBs identified the ON patients more likely to develop MS early. These results, applicable to the everyday clinical setting, may be of interest for therapeutic decisions., (© 2017 EAN.)
- Published
- 2018
- Full Text
- View/download PDF
32. Neurofilament light chain and oligoclonal bands are prognostic biomarkers in radiologically isolated syndrome.
- Author
-
Matute-Blanch C, Villar LM, Álvarez-Cermeño JC, Rejdak K, Evdoshenko E, Makshakov G, Nazarov V, Lapin S, Midaglia L, Vidal-Jordana A, Drulovic J, García-Merino A, Sánchez-López AJ, Havrdova E, Saiz A, Llufriu S, Alvarez-Lafuente R, Schroeder I, Zettl UK, Galimberti D, Ramió-Torrentà L, Robles R, Quintana E, Hegen H, Deisenhammer F, Río J, Tintoré M, Sánchez A, Montalban X, and Comabella M
- Subjects
- Adult, Cohort Studies, Europe, Female, Humans, Male, Middle Aged, Prognosis, Statistics, Nonparametric, Biomarkers cerebrospinal fluid, Chitinase-3-Like Protein 1 cerebrospinal fluid, Demyelinating Diseases cerebrospinal fluid, Demyelinating Diseases diagnosis, Neurofilament Proteins cerebrospinal fluid, Oligoclonal Bands cerebrospinal fluid
- Abstract
The prognostic role of cerebrospinal fluid molecular biomarkers determined in early pathogenic stages of multiple sclerosis has yet to be defined. In the present study, we aimed to investigate the prognostic value of chitinase 3 like 1 (CHI3L1), neurofilament light chain, and oligoclonal bands for conversion to clinically isolated syndrome and to multiple sclerosis in 75 patients with radiologically isolated syndrome. Cerebrospinal fluid levels of CHI3L1 and neurofilament light chain were measured by enzyme-linked immunosorbent assay. Uni- and multivariable Cox regression models including as covariates age at diagnosis of radiologically isolated syndrome, number of brain lesions, sex and treatment were used to investigate associations between cerebrospinal fluid CHI3L1 and neurofilament light chain levels and time to conversion to clinically isolated syndrome and multiple sclerosis. Neurofilament light chain levels and oligoclonal bands were independent risk factors for the development of clinically isolated syndrome (hazard ratio = 1.02, P = 0.019, and hazard ratio = 14.7, P = 0.012, respectively) and multiple sclerosis (hazard ratio = 1.03, P = 0.003, and hazard ratio = 8.9, P = 0.046, respectively). The best cut-off to classify cerebrospinal fluid neurofilament light chain levels into high and low was 619 ng/l, and high neurofilament light chain levels were associated with a trend to shorter time to clinically isolated syndrome (P = 0.079) and significant shorter time to multiple sclerosis (P = 0.017). Similarly, patients with radiologically isolated syndrome presenting positive oligoclonal bands converted faster to clinically isolated syndrome and multiple sclerosis (P = 0.005 and P = 0.008, respectively). The effects of high neurofilament light chain levels shortening time to clinically isolated syndrome and multiple sclerosis were more pronounced in radiologically isolated syndrome patients with ≥37 years compared to younger patients. Cerebrospinal fluid CHI3L1 levels did not influence conversion to clinically isolated syndrome and multiple sclerosis in radiologically isolated syndrome patients. Overall, these findings suggest that cerebrospinal neurofilament light chain levels and oligoclonal bands are independent predictors of clinical conversion in patients with radiologically isolated syndrome. The association with a faster development of multiple sclerosis reinforces the importance of cerebrospinal fluid analysis in patients with radiologically isolated syndrome.
- Published
- 2018
- Full Text
- View/download PDF
33. Correction to: Blood lymphocyte subsets identify optimal responders to IFN-beta in MS.
- Author
-
Alenda R, Costa-Frossard L, Alvarez-Lafuente R, Espejo C, Rodríguez-Martín E, Sainz de la Maza S, Villarrubia N, Río J, Domínguez-Mozo MI, Montalban X, Álvarez-Cermeño JC, and Villar LM
- Abstract
The author claims that his name is incorrectly listed on PubMed. It seems that the first and last name has been mixed up.
- Published
- 2018
- Full Text
- View/download PDF
34. Blood lymphocyte subsets identify optimal responders to IFN-beta in MS.
- Author
-
Alenda R, Costa-Frossard L, Alvarez-Lafuente R, Espejo C, Rodríguez-Martín E, de la Maza SS, Villarrubia N, Río J, Domínguez-Mozo MI, Montalban X, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adult, Antibodies blood, Antigens, CD metabolism, Cohort Studies, Cytokines metabolism, Disability Evaluation, Female, Flow Cytometry, Humans, Interferon-beta immunology, Lymphocyte Count, Magnetic Resonance Imaging, Male, Multiple Sclerosis blood, Multiple Sclerosis diagnostic imaging, Perforin metabolism, Statistics, Nonparametric, Treatment Outcome, Immunologic Factors therapeutic use, Interferon-beta therapeutic use, Lymphocyte Subsets drug effects, Multiple Sclerosis drug therapy
- Abstract
Response to interferon-beta (IFN-beta) treatment is heterogeneous in multiple sclerosis (MS). We aimed to search for biomarkers predicting no evidence of disease activity (NEDA) status upon IFN-beta treatment in MS. 119 patients with relapsing-remitting MS (RRMS) initiating IFN-beta treatment were included in the study, and followed prospectively for 2 years. Neutralizing antibodies (NAb) were explored in serum samples obtained after 6 and 12 months of IFN-beta treatment. Soluble cytokines and blood lymphocytes were studied in basal samples by ELISA and flow cytometry, respectively. 9% of patients developed NAb. These antibodies were more frequent in patients receiving IFN-beta 1b than in those treated subcutaneous (p = 0.008) or intramuscular (p < 0.0001) IFN-beta 1a. No patient showing NAb remained NEDA during follow-up. Basal immunological variables are also associated with patient response. Percentages below 3% of CD19 + CD5 + cells (AUC 0.74, CI 0.63-0.84; OR 10.68, CI 3.55-32.15, p < 0.0001; Likelihood ratio 4.28) or above 2.6% of CD8 + perforin + T cells (AUC 0.79, CI 0.63-0.96; OR 6.11, CI 2.0-18.6, p = 0.0009; Likelihood ratio 5.47) increased the probability of achieving NEDA status during treatment. Basal blood immune cell subsets contribute to identify MS patients with a high probability of showing an optimal response to IFN-beta.
- Published
- 2018
- Full Text
- View/download PDF
35. Multimarker risk stratification approach at multiple sclerosis onset.
- Author
-
Fernández-Paredes L, Casrouge A, Decalf J, de Andrés C, Villar LM, Pérez de Diego R, Alonso B, Álvarez Cermeño JC, Arroyo R, Tejera-Alhambra M, Navarro J, Oreja-Guevara C, López Trascasa M, Seyfferth A, García Martínez MA, Álvarez Lafuente R, Albert ML, and Sánchez-Ramón S
- Subjects
- Area Under Curve, Biomarkers blood, Biomarkers cerebrospinal fluid, Case-Control Studies, Chemokine CCL11, Chemokine CCL2, Chemokine CCL4, Chemokine CCL5, Chemokine CXCL10 blood, Chemokine CXCL10 cerebrospinal fluid, Chemokine CXCL9 blood, Chemokine CXCL9 cerebrospinal fluid, Decision Trees, Dipeptidyl Peptidase 4 blood, Dipeptidyl Peptidase 4 cerebrospinal fluid, Early Diagnosis, Epidermal Growth Factor, Fibroblast Growth Factor 2 blood, Fibroblast Growth Factor 2 cerebrospinal fluid, Hepatocyte Growth Factor, Humans, Interleukin 1 Receptor Antagonist Protein blood, Interleukin 1 Receptor Antagonist Protein cerebrospinal fluid, Interleukin-7 blood, Interleukin-7 cerebrospinal fluid, Multiple Sclerosis, Chronic Progressive blood, Multiple Sclerosis, Chronic Progressive cerebrospinal fluid, Multiple Sclerosis, Relapsing-Remitting blood, Multiple Sclerosis, Relapsing-Remitting cerebrospinal fluid, Multivariate Analysis, Nervous System Diseases blood, Nervous System Diseases cerebrospinal fluid, Nervous System Diseases diagnosis, Prognosis, Risk Assessment, Multiple Sclerosis, Chronic Progressive diagnosis, Multiple Sclerosis, Relapsing-Remitting diagnosis
- Abstract
Delay in the diagnosis of multiple sclerosis (MS) stems from the lack of specific clinical and analytical markers to assist in the early diagnosis and prediction of progressive course. We propose a decision-tree model that better defines early at onset MS patients and those with the progressive form by analysing a 12-biomarkers panel in serum and CSF samples of patients with MS, other neurological diseases (OND) and healthy contols. Thus, patients at onset of neurological disease were first classified by serum IL-7 levels <141pg/ml (OR=6.51, p<0.001). Combination of IL-7 and CXCL10 indicated risk for a specific MS clinical form, where IL-7<141 and CXCL10<570pg/ml were associated with the highest risk for PP-MS (OR=22, p=0.01). Unexpectedly, both PP-MS and RR-MS patients shared significantly decreased prototypical biomarkers of inflammation and tissue regeneration in CSF than OND suggesting a defective intrinsic immune response playing a role at the beginning of the disease., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
36. Gut dysbiosis and neuroimmune responses to brain infection with Theiler's murine encephalomyelitis virus.
- Author
-
Carrillo-Salinas FJ, Mestre L, Mecha M, Feliú A, Del Campo R, Villarrubia N, Espejo C, Montalbán X, Álvarez-Cermeño JC, Villar LM, and Guaza C
- Subjects
- Animals, Brain microbiology, Brain physiopathology, Brain virology, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Dysbiosis microbiology, Dysbiosis pathology, Dysbiosis virology, Humans, Lymph Nodes immunology, Lymph Nodes microbiology, Lymph Nodes virology, Lymphocyte Activation immunology, Mice, Multiple Sclerosis microbiology, Multiple Sclerosis pathology, Multiple Sclerosis virology, Neuroimmunomodulation, Spinal Cord immunology, Spinal Cord microbiology, Spinal Cord pathology, Spinal Cord virology, Theilovirus immunology, Theilovirus pathogenicity, Brain immunology, Dysbiosis immunology, Gastrointestinal Microbiome immunology, Multiple Sclerosis immunology
- Abstract
Recent studies have begun to point out the contribution of microbiota to multiple sclerosis (MS) pathogenesis. Theiler's murine encephalomyelitis virus induced demyelinating disease (TMEV-IDD) is a model of progressive MS. Here, we first analyze the effect of intracerebral infection with TMEV on commensal microbiota and secondly, whether the early microbiota depletion influences the immune responses to TMEV on the acute phase (14 dpi) and its impact on the chronic phase (85 dpi). The intracranial inoculation of TMEV was associated with a moderate dysbiosis. The oral administration of antibiotics (ABX) of broad spectrum modified neuroimmune responses to TMEV dampening brain CD4
+ and CD8+ T infiltration during the acute phase. The expression of cytokines, chemokines and VP2 capsid protein was enhanced and accompanied by clusters of activated microglia disseminated throughout the brain. Furthermore, ABX treated mice displayed lower levels of CD4+ and CD8+ T cells in cervical and mesenteric lymph nodes. Increased mortality to TMEV was observed after ABX cessation at day 28pi. On the chronic phase, mice that survived after ABX withdrawal and recovered microbiota diversity showed subtle changes in brain cell infiltrates, microglia and gene expression of cytokines. Accordingly, the surviving mice of the group ABX-TMEV displayed similar disease severity than TMEV mice.- Published
- 2017
- Full Text
- View/download PDF
37. Chitinase 3-like 1 is associated with the response to interferon-beta treatment in multiple sclerosis.
- Author
-
Matute-Blanch C, Río J, Villar LM, Midaglia L, Malhotra S, Álvarez-Cermeño JC, Vidal-Jordana A, Montalban X, and Comabella M
- Subjects
- Adult, Biomarkers blood, Cohort Studies, Female, Follow-Up Studies, Glatiramer Acetate pharmacology, Glatiramer Acetate therapeutic use, Humans, Male, Middle Aged, Multiple Sclerosis, Relapsing-Remitting diagnosis, Prospective Studies, Treatment Outcome, Young Adult, Chitinase-3-Like Protein 1 blood, Interferon-beta therapeutic use, Multiple Sclerosis, Relapsing-Remitting blood, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Chitinase 3-like 1 (CHI3L1) plays a prognostic role in patients with multiple sclerosis (MS). Here, we investigated a potential association between CHI3L1 and the response to interferon-beta (IFNβ) and glatiramer acetate (GA). Serum CHI3L1 levels were measured by ELISA in 117 relapsing-remitting MS (RRMS) patients, 76 IFNβ-treated and 41 GA-treated patients. CHI3L1 levels were increased by GA (p=0.014) but unchanged by IFNβ (p=0.830). CHI3L1 was associated with IFNβ response and levels were higher in non-responder group (p=0.020), while GA showed no responder effect (p=0.943). These results suggest a role for CHI3L1 as response biomarker to IFNβ in RRMS patients., (Copyright © 2016 Elsevier B.V. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
38. Anti-SPAG16 antibodies in primary progressive multiple sclerosis are associated with an elevated progression index.
- Author
-
de Bock L, Fraussen J, Villar LM, Álvarez-Cermeño JC, Van Wijmeersch B, van Pesch V, Stinissen P, and Somers V
- Subjects
- Adult, Biomarkers blood, Enzyme-Linked Immunosorbent Assay, Female, Humans, Male, Middle Aged, Autoantibodies blood, Disease Progression, Microtubule-Associated Proteins immunology, Multiple Sclerosis, Chronic Progressive blood, Multiple Sclerosis, Relapsing-Remitting blood
- Abstract
Background and Purpose: Sperm-associated antigen 16 (SPAG16), a sperm protein which is upregulated in reactive astrocytes in multiple sclerosis (MS) lesions, has recently been identified as a novel autoantibody target in MS. The aim of this study was to investigate whether anti-SPAG16 antibody levels differ between MS subtypes (relapsing-remitting, RR; primary or secondary progressive, PP, SP) and whether antibody positivity is associated with clinical characteristics., Methods: Plasma anti-SPAG16 antibody levels were determined by recombinant protein enzyme-linked immunosorbent assay (ELISA) in 374 MS patients (274 RRMS, 39 SPMS and 61 PPMS) and 106 healthy controls., Results: Significantly elevated anti-SPAG16 antibodies were found in 22% of MS patients with 93% specificity. Anti-SPAG16 seropositivity was associated with an increased Expanded Disability Status Scale (EDSS) in overall MS. A higher proportion of PPMS patients showed anti-SPAG16 antibody reactivity (34%) compared to RRMS (19%) and SPMS (26%), and presented with higher anti-SPAG16 antibody levels. Seropositive PPMS patients had a significantly increased progression index compared to seronegative patients., Conclusions: Anti-SPAG16 antibodies are associated with an increased EDSS in overall MS, indicating that they are linked to a worse MS disease outcome. Moreover, the presence of anti-SPAG16 antibodies may be a biomarker for a more severe disease in PPMS patients, as indicated by an increased progression index., (© 2015 EAN.)
- Published
- 2016
- Full Text
- View/download PDF
39. Intrathecal lipid-specific oligoclonal IgM synthesis associates with retinal axonal loss in multiple sclerosis.
- Author
-
Álvarez-Cermeño JC, Muñoz-Negrete FJ, Costa-Frossard L, Sainz de la Maza S, Villar LM, and Rebolleda G
- Subjects
- Adult, Cross-Sectional Studies, Humans, Middle Aged, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis immunology, Nerve Fibers pathology, Retina pathology, White Matter immunology, White Matter pathology, Axons pathology, Immunoglobulin M cerebrospinal fluid, Multiple Sclerosis pathology, Oligoclonal Bands cerebrospinal fluid, Retinal Neurons pathology
- Abstract
Objective: It has been suggested that autoantibodies may induce axonal damage in multiple sclerosis (MS). Optical coherence tomography (OCT) showed that thinning of peripapillary retinal nerve fiber layer (RNFL) and ganglion cell layer/inner plexiform (GCIPL) measurements reflect axonal loss in the disease. We investigated whether the intrathecal synthesis of lipid-specific oligoclonal IgM bands (LS-OCMB) associates with thinning of these structures in MS patients., Methods: 58 consecutive MS patients and 70 age-matched healthy controls were assessed. LS-OCMB was studied in cerebrospinal fluid by isoelectric focusing and immunoblotting. RNFL and GCIPL imaging were quantified by spectral domain OCT., Results: RNFL and GCIPL were significantly reduced in MS patients compared to controls (p<0.01). RNFL thickness was further reduced in LS-OCMB positive MS patients compared to LS-OCMB negative MS subjects mainly in papillomacular bundle (p<0.05), temporal and inferior quadrants (p<0.05) and inferotemporal sector (p=0.01)., Conclusions: The presence of LS-OCMB associates with increased retinal axonal loss in MS. This reinforces the relationship found between the intrathecal synthesis of IgM and the axonal damage observed in immunological and pathological studies even in normal-appearing white matter. OCT seems an optimal tool to monitor axonal damage in LS-OCMB positive patients, relevant for therapeutic decisions and quantification of the effects of new neuroprotective treatments., (Copyright © 2015 Elsevier B.V. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
40. Protein-Based Classifier to Predict Conversion from Clinically Isolated Syndrome to Multiple Sclerosis.
- Author
-
Borràs E, Cantó E, Choi M, Maria Villar L, Álvarez-Cermeño JC, Chiva C, Montalban X, Vitek O, Comabella M, and Sabidó E
- Subjects
- Adipokines cerebrospinal fluid, Amino Acid Sequence, Chitinase-3-Like Protein 1, Diagnosis, Differential, Dipeptidases cerebrospinal fluid, Disease Progression, Humans, Lectins cerebrospinal fluid, Mass Spectrometry methods, Molecular Sequence Data, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis diagnosis, Nervous System Diseases cerebrospinal fluid, Nervous System Diseases diagnosis, Peptides cerebrospinal fluid, Peptides metabolism, Prognosis, Proteome classification, Reproducibility of Results, Sensitivity and Specificity, Syndrome, Multiple Sclerosis metabolism, Nervous System Diseases metabolism, Proteome metabolism, Proteomics methods
- Abstract
Multiple sclerosis is an inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. In most patients, the disease initiates with an episode of neurological disturbance referred to as clinically isolated syndrome, but not all patients with this syndrome develop multiple sclerosis over time, and currently, there is no clinical test that can conclusively establish whether a patient with a clinically isolated syndrome will eventually develop clinically defined multiple sclerosis. Here, we took advantage of the capabilities of targeted mass spectrometry to establish a diagnostic molecular classifier with high sensitivity and specificity able to differentiate between clinically isolated syndrome patients with a high and a low risk of developing multiple sclerosis. Based on the combination of abundances of proteins chitinase 3-like 1 and ala-β-his-dipeptidase in cerebrospinal fluid, we built a statistical model able to assign to each patient a precise probability of conversion to clinically defined multiple sclerosis. Our results are of special relevance for patients affected by multiple sclerosis as early treatment can prevent brain damage and slow down the disease progression., (© 2016 by The American Society for Biochemistry and Molecular Biology, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
41. A functional variant that affects exon-skipping and protein expression of SP140 as genetic mechanism predisposing to multiple sclerosis.
- Author
-
Matesanz F, Potenciano V, Fedetz M, Ramos-Mozo P, Abad-Grau Mdel M, Karaky M, Barrionuevo C, Izquierdo G, Ruiz-Peña JL, García-Sánchez MI, Lucas M, Fernández Ó, Leyva L, Otaegui D, Muñoz-Culla M, Olascoaga J, Vandenbroeck K, Alloza I, Astobiza I, Antigüedad A, Villar LM, Álvarez-Cermeño JC, Malhotra S, Comabella M, Montalban X, Saiz A, Blanco Y, Arroyo R, Varadé J, Urcelay E, and Alcina A
- Subjects
- Case-Control Studies, Exons, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Linkage Disequilibrium, Multiple Sclerosis blood, Quantitative Trait Loci, Sequence Analysis, RNA, Antigens, Nuclear blood, Antigens, Nuclear genetics, Multiple Sclerosis genetics, Polymorphism, Single Nucleotide, Transcription Factors blood, Transcription Factors genetics
- Abstract
Several variants in strong linkage disequilibrium (LD) at the SP140 locus have been associated with multiple sclerosis (MS), Crohn's disease (CD) and chronic lymphocytic leukemia (CLL). To determine the causal polymorphism, we have integrated high-density data sets of expression quantitative trait loci (eQTL), using GEUVADIS RNA sequences and 1000 Genomes genotypes, with MS-risk variants of the high-density Immunochip array performed by the International Multiple Sclerosis Genetic Consortium (IMSGC). The variants most associated with MS were also correlated with a decreased expression of the full-length RNA isoform of SP140 and an increase of an isoform lacking exon 7. By exon splicing assay, we have demonstrated that the rs28445040 variant was the causal factor for skipping of exon 7. Western blots of peripheral blood mononuclear cells from MS patients showed a significant allele-dependent reduction of the SP140 protein expression. To confirm the association of this functional variant with MS and to compare it with the best-associated variant previously reported by GWAS (rs10201872), a case-control study including 4384 MS patients and 3197 controls was performed. Both variants, in strong LD (r(2) = 0.93), were found similarly associated with MS [P-values, odds ratios: 1.9E-9, OR = 1.35 (1.22-1.49) and 4.9E-10, OR = 1.37 (1.24-1.51), respectively]. In conclusion, our data uncover the causal variant for the SP140 locus and the molecular mechanism associated with MS risk. In addition, this study and others previously reported strongly suggest that this functional variant may be shared with other immune-mediated diseases as CD and CLL., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
42. A new risk variant for multiple sclerosis at the immunoglobulin heavy chain locus associates with intrathecal IgG, IgM index and oligoclonal bands.
- Author
-
Delgado-García M, Matesanz F, Alcina A, Fedetz M, García-Sánchez MI, Ruiz-Peña JL, Fernández Ó, Pinto Medel MJ, Leyva L, Arnal C, Delgado C, López Guerrero JA, González-Pérez A, Sáez ME, Villar LM, Álvarez-Cermeño JC, Picón C, Arroyo R, Varadé J, Urcelay E, Izquierdo G, and Lucas M
- Subjects
- Adult, Female, Genetic Loci, Genotype, Humans, Immunoglobulin G cerebrospinal fluid, Immunoglobulin M cerebrospinal fluid, Isoelectric Focusing, Male, Middle Aged, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis immunology, Oligoclonal Bands cerebrospinal fluid, Polymorphism, Single Nucleotide, Genes, Immunoglobulin Heavy Chain genetics, Genetic Predisposition to Disease genetics, Multiple Sclerosis genetics
- Abstract
Background: Recent findings have shown a correlation between the intrathecal IgG index and variants at the immunoglobulin heavy chain (IGHC) locus in patients with multiple sclerosis (MS)., Objectives: The objective of this paper is to analyse the association of the locus with MS susceptibility and its relationship with intrathecal immunoglobulin (Ig) parameters., Methods: We genotyped the rs11621145 variant, located at the IGHC locus, in 2726 patients with MS and 2133 healthy controls. Associations of intrathecal IgG and IgM indexes with rs11621145 were analysed by linear regression analysis in 538 MS patients., Results: We found that rs11621145 showed statistically significant evidence for association with susceptibility to MS (odds ratio = 0.69, p = 1.053E-09), though validation of this result in additional cohorts would be desirable. We confirmed the association between the IgG index and the rs11621145 (p = 6.85E-07, Beta = 0.207). Furthermore, rs11621145 was inversely correlated with IgM index (p = 7.24E-04, Beta = -0.277), and therefore marks a decreased likelihood of presenting IgM oligoclonal bands (odds ratio = 0.38, p = 2.35E-06)., Conclusions: Our results suggest that the polymorphism of the IGHC locus could be altering the switching of the Ig isotype in B cells and it may be interfering with T-dependent and T-independent antibody responses., (© The Author(s), 2014.)
- Published
- 2015
- Full Text
- View/download PDF
43. Cerebrospinal fluid immunological biomarkers associated with axonal damage in multiple sclerosis.
- Author
-
Villar LM, Picón C, Costa-Frossard L, Alenda R, García-Caldentey J, Espiño M, Muriel A, and Álvarez-Cermeño JC
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Axons pathology, Biomarkers cerebrospinal fluid, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis immunology, Multiple Sclerosis pathology, Neurofilament Proteins cerebrospinal fluid, Oligoclonal Bands immunology
- Abstract
Background and Purpose: Cerebrospinal fluid (CSF) neurofilament light protein (NFL) is a promising biomarker of axonal injury and neurodegeneration. Here CSF lymphocyte subpopulations and antibodies, potential players of neurodegeneration, are examined in relation to CSF NFL shedding in MS., Methods: Cerebrospinal fluid NFL from 127 consecutive untreated MS patients was analysed. Samples from 37 age-matched patients with other central nervous system non-inflammatory neurological diseases (NIND) were also assessed. CD4+, CD8+, CD56+ and CD19+ cell subsets were studied by flow cytometry. Oligoclonal IgG and IgM bands (OCMB) against lipids were studied by isoelectric focusing and immunoblotting. These data were analysed in relation to clinical and magnetic resonance imaging features., Results: A CSF NFL cut-off value of 900 ng/l (mean + 3 SD of NIND values) was calculated. MS patients with increased NFL values showed significantly higher Multiple Sclerosis Severity Score and magnetic resonance imaging lesion number. The presence of OCMB (P < 0.0001) and elevated T and B lymphocyte counts was associated with increased levels of CSF NFL., Conclusions: High CSF NFL levels are associated with elevated CSF lymphocyte cell counts and intrathecal synthesis of IgM against lipids. These findings support a role for OCMB in the axonal damage of MS offering a rationale for the association of these antibodies with disability and brain atrophy progression in MS., (© 2014 EAN.)
- Published
- 2015
- Full Text
- View/download PDF
44. Spanish consensus on the use of natalizumab (Tysabri®)-2013.
- Author
-
Fernández O, García-Merino JA, Arroyo R, Álvarez-Cermeño JC, Izquierdo G, Saiz A, Olascoaga J, Rodríguez-Antigüedad A, Prieto JM, Oreja-Guevara C, Hernández MA, Moral E, Meca J, and Montalbán X
- Subjects
- Adult, Antibodies, Monoclonal, Humanized therapeutic use, Humans, Immunologic Factors adverse effects, Leukoencephalopathy, Progressive Multifocal chemically induced, Natalizumab adverse effects, Practice Guidelines as Topic, Risk Factors, Spain, Immunologic Factors therapeutic use, Multiple Sclerosis, Relapsing-Remitting drug therapy, Natalizumab therapeutic use
- Abstract
Introduction: Natalizumab treatment has been shown to be very efficacious in clinical trials and very effective in clinical practice in patients with relapsing-remitting multiple sclerosis, by reducing relapses, slowing disease progression, and improving magnetic resonance imaging patterns. However, the drug has also been associated with a risk of progressive multifocal leukoencephalopathy (PML). The first consensus statement on natalizumab use, published in 2011, has been updated to include new data on diagnostic procedures, monitoring for patients undergoing treatment, PML management, and other topics of interest including the management of patients discontinuing natalizumab., Material and Methods: This updated version followed the method used in the first consensus. A group of Spanish experts in multiple sclerosis (the authors of the present document) reviewed all currently available literature on natalizumab and identified the relevant topics would need updating based on their clinical experience. The initial draft passed through review cycles until the final version was completed., Results and Conclusions: Studies in clinical practice have demonstrated that changing to natalizumab is more effective than switching between immunomodulators. They favour early treatment with natalizumab rather than using natalizumab in a later stage as a rescue therapy. Although the drug is very effective, its potential adverse effects need to be considered, with particular attention to the patient's likelihood of developing PML. The neurologist should carefully explain the risks and benefits of the treatment, comparing them to the risks of multiple sclerosis in terms the patient can understand. Before treatment is started, laboratory tests and magnetic resonance images should be available to permit proper follow-up. The risk of PML should be stratified as high, medium, or low according to presence or absence of anti-JC virus antibodies, history of immunosuppressive therapy, and treatment duration. Although the presence of anti-JC virus antibodies is a significant finding, it should not be considered an absolute contraindication for natalizumab. This update provides general recommendations, but neurologists must use their clinical expertise to provide personalised follow-up for each patient., (Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
45. Multiple sclerosis: Genetic variability affects CNS IgG production in MS.
- Author
-
Álvarez-Cermeño JC and Villar LM
- Subjects
- Female, Humans, Male, Genetic Variation, Immunoglobulin G cerebrospinal fluid, Major Histocompatibility Complex genetics, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis genetics, Polymorphism, Single Nucleotide genetics
- Published
- 2015
- Full Text
- View/download PDF
46. Natural killer cell subsets in cerebrospinal fluid of patients with multiple sclerosis.
- Author
-
Rodríguez-Martín E, Picón C, Costa-Frossard L, Alenda R, Sainz de la Maza S, Roldán E, Espiño M, Villar LM, and Álvarez-Cermeño JC
- Subjects
- CD56 Antigen cerebrospinal fluid, CD56 Antigen immunology, Female, Flow Cytometry, Humans, Lymphocyte Count, Male, Killer Cells, Natural immunology, Killer Cells, Natural pathology, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis immunology, Multiple Sclerosis pathology, Natural Killer T-Cells immunology, Natural Killer T-Cells pathology
- Abstract
Changes in blood natural killer (NK) cells, important players of the immune innate system, have been described in multiple sclerosis (MS). We studied percentages and total cell counts of different effector and regulatory NK cells in cerebrospinal fluid (CSF) of MS patients and other neurological diseases to gain clearer knowledge of the role of these cells in neuroinflammation. NK cell subsets were assessed by flow cytometry in CSF of 85 consecutive MS patients (33 with active disease and 52 with stable MS), 16 with other inflammatory diseases of the central nervous system (IND) and 17 with non-inflammatory neurological diseases (NIND). MS patients showed a decrease in percentages of different CSF NK subpopulations compared to the NIND group. However, absolute cell counts showed a significant increase of all NK subsets in MS and IND patients, revealing that the decrease in percentages does not reflect a real reduction of these immune cells. Remarkably, MS patients showed a significant increase of regulatory/effector (CD56(bright) /CD56(dim) ) NK ratio compared to IND and NIND groups. In addition, MS activity associated with an expansion of NK T cells. These data show that NK cell subsets do not increase uniformly in all inflammatory neurological disease and suggest strongly that regulatory CD56(bright) and NK T cells may arise in CSF of MS patients as an attempt to counteract the CNS immune activation characteristic of the disease., (© 2015 British Society for Immunology.)
- Published
- 2015
- Full Text
- View/download PDF
47. Chitinase 3-like 1: prognostic biomarker in clinically isolated syndromes.
- Author
-
Cantó E, Tintoré M, Villar LM, Costa C, Nurtdinov R, Álvarez-Cermeño JC, Arrambide G, Reverter F, Deisenhammer F, Hegen H, Khademi M, Olsson T, Tumani H, Rodríguez-Martín E, Piehl F, Bartos A, Zimova D, Kotoucova J, Kuhle J, Kappos L, García-Merino JA, Sánchez AJ, Saiz A, Blanco Y, Hintzen R, Jafari N, Brassat D, Lauda F, Roesler R, Rejdak K, Papuc E, de Andrés C, Rauch S, Khalil M, Enzinger C, Galimberti D, Scarpini E, Teunissen C, Sánchez A, Rovira A, Montalban X, and Comabella M
- Subjects
- Adipokines biosynthesis, Adult, Aged, Aged, 80 and over, Biomarkers cerebrospinal fluid, Brain metabolism, Brain pathology, Chitinase-3-Like Protein 1, Female, Follow-Up Studies, Humans, Lectins biosynthesis, Male, Middle Aged, Prognosis, Young Adult, Adipokines cerebrospinal fluid, Demyelinating Diseases cerebrospinal fluid, Demyelinating Diseases diagnosis, Lectins cerebrospinal fluid
- Abstract
Chitinase 3-like 1 (CHI3L1) has been proposed as a biomarker associated with the conversion to clinically definite multiple sclerosis in patients with clinically isolated syndromes, based on the finding of increased cerebrospinal fluid CHI3L1 levels in clinically isolated syndrome patients who later converted to multiple sclerosis compared to those who remained as clinically isolated syndrome. Here, we aimed to validate CHI3L1 as a prognostic biomarker in a large cohort of patients with clinically isolated syndrome. This is a longitudinal cohort study of clinically isolated syndrome patients with clinical, magnetic resonance imaging, and cerebrospinal fluid data prospectively acquired. A total of 813 cerebrospinal fluid samples from patients with clinically isolated syndrome were recruited from 15 European multiple sclerosis centres. Cerebrospinal fluid CHI3L1 levels were measured by enzyme-linked immunosorbent assay. Multivariable Cox regression models were used to investigate the association between cerebrospinal fluid CHI3L1 levels and time to conversion to multiple sclerosis and time to reach Expanded Disability Status Scale 3.0. CHI3L1 levels were higher in patients who converted to clinically definite multiple sclerosis compared to patients who continued as clinically isolated syndrome (P = 8.1 × 10(-11)). In the Cox regression analysis, CHI3L1 levels were a risk factor for conversion to multiple sclerosis (hazard ratio = 1.7; P = 1.1 × 10(-5) using Poser criteria; hazard ratio = 1.6; P = 3.7 × 10(-6) for McDonald criteria) independent of other covariates such as brain magnetic resonance imaging abnormalities and presence of cerebrospinal fluid oligoclonal bands, and were the only significant independent risk factor associated with the development of disability (hazard ratio = 3.8; P = 2.5 × 10(-8)). High CHI3L1 levels were associated with shorter time to multiple sclerosis (P = 3.2 × 10(-9) using Poser criteria; P = 5.6 × 10(-11) for McDonald criteria) and more rapid development of disability (P = 1.8 × 10(-10)). These findings validate cerebrospinal fluid CHI3L1 as a biomarker associated with the conversion to multiple sclerosis and development of disability and reinforce the prognostic role of CHI3L1 in patients with clinically isolated syndrome. We propose that determining cerebrospinal fluid chitinase 3-like 1 levels at the time of a clinically isolated syndrome event will help identify those patients with worse disease prognosis., (© The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
48. Guidelines for uniform reporting of body fluid biomarker studies in neurologic disorders.
- Author
-
Gnanapavan S, Hegen H, Khalil M, Hemmer B, Franciotta D, Hughes S, Hintzen R, Jeromin A, Havrdova E, Tumani H, Bertolotto A, Comabella M, Frederiksen J, Álvarez-Cermeño JC, Villar L, Galimberti D, Myhr KM, Dujmovic I, Fazekas F, Ionete C, Menge T, Kuhle J, Keir G, Deisenhammer F, Teunissen C, and Giovannoni G
- Subjects
- Biomarkers analysis, Body Fluids metabolism, Humans, Biomedical Research standards, Body Fluids chemistry, Nervous System Diseases, Practice Guidelines as Topic standards, Research Report standards
- Abstract
Objective: The aim of these guidelines is to make the process of reporting body fluid biomarker studies in neurologic disorders more uniform and transparent, in line with existing standards for reporting research in other biomedical areas. Although biomarkers have been around for decades, there are concerns over the high attrition rate of promising candidate biomarkers at later phases of development., Methods: BioMS-eu consortium, a collaborative network working toward improving the quality of biomarker research in neurologic disorders, discussed the merits of standardizing the reporting of body fluid biomarker research. A checklist of items integrating the results of other published guidances, literature, conferences, regulatory opinion, and personal expertise was created to ultimately form a structured summary guidance incorporating the key features., Results: The summary guidance is comprised of a 10-point uniform reporting format ranging from introduction, materials and methods, through to results and discussion. Each item is discussed in detail in the guidance report., Conclusions: To enhance the future development of body fluid biomarkers, it will be important to standardize the reporting of studies. This guideline by the BioMS-eu consortium is aimed at setting a standard for the reporting of future body fluid biomarker research studies in neurologic disorders. We anticipate that following these guidelines will help to accelerate the selection of biomarkers for clinical development., (© 2014 American Academy of Neurology.)
- Published
- 2014
- Full Text
- View/download PDF
49. Identification of the major HHV-6 antigen recognized by cerebrospinal fluid IgG in multiple sclerosis.
- Author
-
Alenda R, Álvarez-Lafuente R, Costa-Frossard L, Arroyo R, Mirete S, Álvarez-Cermeño JC, and Villar LM
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Immunoglobulin G cerebrospinal fluid, Male, Middle Aged, Multiple Sclerosis cerebrospinal fluid, Multiple Sclerosis virology, Young Adult, Antigens, Viral immunology, Capsid Proteins immunology, Herpesvirus 6, Human immunology, Immunoglobulin G immunology, Multiple Sclerosis immunology
- Abstract
Background and Purpose: Different data show an association between human herpesvirus 6 (HHV-6) and multiple sclerosis (MS). Intrathecal anti-HHV-6 immunoglobulin G (IgG) was detected in MS patients, but the antigen recognized by cerebrospinal fluid (CSF) IgG has not been characterized yet. Our objective was to identify the HHV-6 antigens recognized by IgG present in the CSF of patients with MS., Methods: Cerebrospinal fluid IgG of 15 MS patients and eight patients with other neurological diseases was purified on protein G Sepharose columns. Purified IgG from every patient was linked to a CNBr-activated Sepharose 4B column. Fifty micrograms of viral extract was applied to each column. Bound proteins were eluted and analysed by SDS-PAGE and silver staining. The viral protein was characterized by mass spectrometry., Results: A protein of 150 kD was eluted from CSF IgG columns of three of eight patients with primary progressive MS and one of seven with relapsing-remitting MS. After digestion and mass spectrometry analysis 10 peptides were found with 100% homology with the major capsid protein of the HHV-6A., Discussion: These findings confirm the presence of anti-HHV-6 IgG in CSF of MS patients, particularly in progressive forms, and identify major capsid protein as the major antigen recognized by CSF IgG from MS patients., (© 2014 The Author(s) European Journal of Neurology © 2014 EAN.)
- Published
- 2014
- Full Text
- View/download PDF
50. Immunoglobulin M oligoclonal bands: biomarker of targetable inflammation in primary progressive multiple sclerosis.
- Author
-
Villar LM, Casanova B, Ouamara N, Comabella M, Jalili F, Leppert D, de Andrés C, Izquierdo G, Arroyo R, Avşar T, Lapin SV, Johnson T, Montalbán X, Fernández O, Álvarez-Lafuente R, Masterman D, García-Sánchez MI, Coret F, Siva A, Evdoshenko E, Álvarez-Cermeño JC, and Bar-Or A
- Subjects
- Adult, Biomarkers cerebrospinal fluid, Cross-Sectional Studies, Female, Humans, Inflammation cerebrospinal fluid, Inflammation immunology, Longitudinal Studies, Male, Middle Aged, Multiple Sclerosis, Chronic Progressive cerebrospinal fluid, Phenotype, Immunoglobulin M cerebrospinal fluid, Multiple Sclerosis, Chronic Progressive immunology, Oligoclonal Bands cerebrospinal fluid
- Abstract
Objective: To identify a biomarker distinguishing patients who, despite a primary progressive multiple sclerosis (PPMS) clinical course, may nonetheless benefit from immune therapy., Methods: The presence or absence of both immunoglobulin (Ig) G and IgM oligoclonal bands (OCB) was blindly examined in paired cerebrospinal fluid (CSF) and serum samples from a large PPMS patient cohort, and related to clinical and imaging evidence of focal inflammatory disease activity., Results: Using both cross-sectional samples and serial sampling in a subgroup of patients followed prospectively as part of the placebo-controlled OLYMPUS study of rituximab in PPMS, we found that the presence of CSF-restricted IgM OCB (but not of IgG OCB) is associated with an active inflammatory disease phenotype in PPMS patients. This finding was confirmed in an independent, multicenter validation cohort., Interpretation: The presence of CSF IgM OCB may be a biomarker for a subset of PPMS patients with more active inflammatory disease, who may benefit from immune-directed treatments., (© 2014 American Neurological Association.)
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.