1,720,993 research outputs found
People with MS should consume a low-salt diet - YES
Full text linkFil: Farez, Mauricio Franco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Correale, Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin
Food Allergies and Multiple Sclerosis
No full textThe evidence on the association between allergies and multiple sclerosis (MS)
disease activity is scarce. In this issue of JNNP, Fakih and colleagues report that
patients with MS and food allergies have a higher disease activity compared
with patients with no known allergies.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina
Salt intake in multiple sclerosis: Friend or foe?
Full text linkHigh sodium intake has been recently noted as a putative environmental factor linked to multiple sclerosis. In their JNNP publication, Nourbakhsh and colleagues1 report a multicentric study of patients with paediatric multiple sclerosis where no association was detected between sodium intake and time to relapse.Fil: Farez, Mauricio Franco. Instituto de Investigaciones Neurologicas Raul Carrera; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin
The Immune Response in Multiple Sclerosis
No full textMultiple sclerosis (MS) is a chronic autoimmune, inflammatory, and neurodegenerative disease that affects the central nervous system (CNS). MS is characterized by immune dysregulation, which results in the infiltration of the CNS by immune cells, triggering demyelination, axonal damage, and neurodegeneration. Although the exact causes of MS are not fully understood, genetic and environmental factors are thought to control MS onset and progression. In this article, we review the main immunological mechanisms involved in MS pathogenesis.Fil: Rodríguez Murúa, Sofía. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Quintana, Francisco J. Ann Romney Center for Neurologic Diseases; Estados Unidos
Cerebellar Ataxia With Extreme Photophobia Associated With Anti-SOX1 Antibodies
No full textAnti-SOX1 antibodies are associated with diverse neurological syndromes, targeting both the central (paraneoplastic cerebellar degeneration) and peripheral nervous systems (Lambert Eaton myasthenic syndrome, paraneoplastic neuropathy). Although the pathogenic role of these antibodies remains unclear, their strong association with underlying neoplastic disease (mainly small-cell lung cancer) has designated them as onconeural antibodies. Here, we present a case of cerebellar ataxia with marked photophobia, with severe atrophy of the cerebellum and brain stem, associated with anti-SOX1 antibodies without evidence of an underlying malignancy. Although anti-SOX1-associated cerebellar syndrome is infrequent, investigation of these antibodies should be considered as a part of the diagnostic algorithm if more common causes have been ruled out. Extensive brain stem lesions causing disruption of the trigeminal pathway and its connections with the pretectal area might explain the underlying mechanism of the associated photophobia. Early recognition of anti-SOX1 antibodies, exclusion of underlying neoplasm, and prompt initiation of immunotherapy are essential to achieve a better outcome.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Schachter, Daniel. Rush University Medical Center. Neurology Department; Estados Unidos.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Varela, Francisco José. Fleni. Departamento de Neurología; Argentina
The role of infections in multiple sclerosis
No full textSeveral lines of evidence suggest that multiple sclerosis (MS), like other autoimmune diseases, may be triggered by microbial infections. Pathogens associated with development or exacerbation of MS include bacteria, such as Chlamydia pneumoniae, Staphylococcus aureus-produced enterotoxins that function as superantigens, and viruses of the Herpesviridae (Epstein-Barr virus and human herpes virus 6) and human endogenous retrovirus families. However, to date, no single pathogen has been accepted as causal agent. In addition, common upper respiratory, gastrointestinal, and urogenital tract infections have also been associated with MS exacerbations. Although evidence of an infectious etiology as cause of MS in humans remains inconclusive, microbial agents may modulate the neuroimmunological system of genetically susceptible individuals. Decoding the epidemiological contribution of different microorganisms to MS, along with their pathogenic mechanisms, may help develop new treatment strategies and prevent relapses.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Alessandro, Lucas. Fleni. Departamento de Neurología; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentin
Environmental factors influencing multiple sclerosis in Latin America
Full text linkIt is generally accepted that autoimmune diseases like multiple sclerosis (MS) arise from complex interactions between genetic susceptibility and environmental factors. Genetic variants confer predis- position to develop MS, but cannot be therapeutically modified. On the other hand, several studies have shown that different lifestyle and environmental factors influence disease development, as well as activity levels and progression. Unlike genetic risk factors, these can be modified, with potential for prevention, particularly in high-risk populations. Most studies identifying particular lifestyle and environmental factors have been carried out in Caucasian patients with MS. Little or no data is available on the behavior of these factors in Latin American populations. Ethnic and geographic differences between Latin America and other world regions suggest potential regional variations in MS, at least with respect to some of these factors. Furthermore, particular environmental characteristics observed more frequently in Latin America could explain regional differences in MS prevalence. Site-specific studies exploring influences of local environmental factors are warranted.Fil: Correale, Jorge. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Farez, Mauricio Franco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Gaitán, María Inés. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin
Human MAIT Cell Response Shows Subset Diversity in Multiple Sclerosis (P2.2-089)
No full textObjective: To investigate cytotoxic activity heterogeneity in MAIT cell populations from MS patients
Background: MAIT cells are a subset of innate T lymphocytes characterized by expression of an invariant TCR α-chain (Vα7.2-Jα33) paired with a limited number of Vβ chains. They recognize riboflavin metabolites from a range of microbes presented by MR1, a MHC-class 1-related molecule. We recently demonstrated how MAIT cell presence correlated with MS disease activity. The association recently described between MS development and the microbiome, also make MAIT cells a potentially interesting therapeutic target.
Design/Methods: Forty peripheral blood MAIT cell clones isolated from 12 relapsing remitting MS patients were studied. TCRα and β-chains were characterized using high-throughput RNA sequencing. TCCs were stimulated with 5-OE-RU, 5-OP-RU (both riboflavin derivatives), as well as with E. Coli, or Candida albicans. Cytotoxicity was measured by fatal assay, and granzyme B and perforin by ELISA. Flow cytometry was used to detect activation markers CD25 and CD69 and the degranulation marker, CD107a.
Results: MR1-restricted MAIT cells with particular TCRβ-chains reacted specifically with different types of riboflavin metabolite-derived antigens. Higher cytotoxicity magnitude and sensitivity were found for non-pathogenic E. Coli, compared to the opportunistic fungal pathogen C. albicans. MAIT cells expressing Vβ8 and Vβ13.6 were hyporesponsive to E. Coli, expressing fewer activation markers and showing less cytotoxic effect compared to MAIT cell clusters expressing different Vβ chains. Interestingly, MAIT cell response to C. albicans presented a Vβ bias, in which Vβ 13.2 MAIT cells displayed higher cytotoxic activity.
Conclusions: 1) MAIT cells display microbe-specific cytotoxic responses, indicating functional heterogeneity, despite the highly conserved nature of MR1; 2) MAIT cell TCR Vβ-chain activity influences response to specific MR1-presented antigens; 3) MAIT cell repertoire may expand depending on their response to microbial challenge, ultimately influencing the course of MS.
Disclosure: Dr. Correale has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Argentina, Teva Argentina, Novartis Argentina and MERCK Argentina, and Merck/Serono Argentina and Novartis Argentina. Dr. Carnero Contentti has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen-Idec, Genzyme, Merck-Serono, Novartis, Teva, Roche and Bayer. Dr. Farez has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with TEVA, Merck-Serono, Biogen-Idec, and Novartis.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina.Fil: Carnero Contentti, Edgar. Hospital Alemán. Departamento de Neurociencias; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina
Differential Diagnosis in Late Onset Multiple Sclerosis
No full textObjective: To identify clinical-radiological characteristics of patients consulting with suspected Late Onset Multiple Sclerosis (LOMS).
Background: LOMS is defined by clinical presentation after 50 years of age, being less than 12% of MS population. Diagnosis is challenging considering the broad spectrum of differential diagnoses proposed for white matter lesions in this subgroup of patients; thus, misdiagnosis is frequent. Finally, there is scarce evidence about prognosis and treatment of these patients.
Design/Methods: Patients presenting first symptoms after 50 years of age, consulting in a tertiary neurological center in Buenos Aires, Argentina, from January/2011 to September/2018 referred with previous diagnosis of MS, white matter lesions or demyelinating disorders, were included. Demographic, clinical MRI and oligoclonal-bands (OCB) characteristics were analyzed with parametric and non-parametric tests.
Results: We included 153 patients with late onset symptoms: 85 were MS and 67 had other differential diagnosis. The most frequent diagnosis was demyelinating disorders not MS or NMOSD (n=30), followed by microvascular damage due to unspecific white matter lesions (n=25).
26 patients (36%) were previously misdiagnosed with MS diagnosis (not fulfilling MS criteria) and 7 patients were already on disease modifying drugs. The cost of mistreated patients was estimated in USD 7.184.200.
Among the patients who met criteria for the diagnosis of LOMS myelitis was the most frequent presentation (37%).
On MRI analysis, corpus callosum lesions and periventricular demyelinating plaques (“Dawsonfinger signs supported MS diagnosis”) were the only specific findings bringing statistically significant information to differentiate MS from other diagnosis. Positive OCB were useful to differentiate demyelinating disorders from non-demyelinating etiologies.
Conclusions: LOMS diagnosis is challenging, being necessary a detailed clinical history, physical exam and MRI description, in order to avoid misdiagnosis and unnecessary treatment.
This is the largest LOMS specific case series from Latin-America, bringing important information about this subgroup of patients, applicability of MS diagnostic criteria and differential diagnosis.
Disclosure: Dr. Yorio has nothing to disclose. Dr. Marrodan has nothing to disclose. Dr. Farez has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with TEVA, Merck-Serono, Biogen-Idec, and Novartis. Dr. Correale has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen Argentina, Teva Argentina, Novartis Argentina and MERCK Argentina, and Merck/Serono Argentina and Novartis Argentina.Fil: Yorio, Florencia. Fleni. Departamento de Neurología; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología; Argentina.Fil: Farez, Mauricio Franco. Fleni. Departamento de Neurología; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentin
The Natural History of Primary Progressive Multiple Sclerosis in Buenos Aires, Argentina (P4.2-070)
Full text linkObjective: To assess if clinical relapses and radiological disease activity correlates with neurological disability in primary progressive multiple sclerosis (PPMS), and to determine if there is any correlation between lesional load, cortical atrophy and time to disability. Furthermore, to expand PPMS natural history knowledge.
Background: PPMS has a distinct clinical phenotype representing10–15% of MS cases, characterized by disease progression from onset, leading to cumulative disability; although acute clinical or radiological relapses may occur.
Actually, there is lack of evidence to support that disease activity clearly impacts in PPMS prognosis and data from Latin American is scarce.
Design/Methods: Patients with PPMS diagnosed from January/2007 to October/2018 in a referral tertiary center in Buenos Aires, Argentina, were included. Demographic and clinical features were analyzed. Brain and spinal cord MRI were evaluated.
Volumetric lesion load and cortical atrophy were determined by automated software. Disease activity was defined by clinical relapses or imaging(gadolinium-enhancing lesions, new or unequivocally enlarging T2-lesions)
Results: Were included 105 patients (M:F=1:1.6, median age at diagnosis 48 (18–75 range). Most frequent initial symptom was myelitis 70%. Oligoclonal bands were positive (type II or III) in 84% of patients.
17% of patients presented clinical relapses and 48% had radiological activity. Median times to EDSS 4, 6 and 8 were 71 (0–444), 84 (9–408), and 114 (36–300) months respectively.
When patients with active disease were compared against the rest of patients, no statistical differences were found; neither in volumetric brain MRI analysis (lesion load and cortical atrophy), statistical differences in could be found.
Conclusions: This is the first specific PPMS case series from Latin America, which support that clinical and radiological phenotype is similar than those previously published from North America and Western Europe, and brings contribution to PPMS knowledge.
Even being a small cohort; we did not found significant differences in our primary outcomes.Fil: Bensi, Catalina. Fleni. Departamento de Neurología; Argentina.Fil: Correale, Jorge. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Marrodán, Mariano. Fleni. Departamento de Neurología. Servicio de Neuroinmunología y Enfermedades Desmielinizantes; Argentina.Fil: Farez, Mauricio Franco. Fleni. Centro para la Investigación de Enfermedades Neuroinmunológicas; Argentina
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