Aylin Yaman

Ischemia modified albumin is an indicator of oxidative stress in multiple sclerosis.

Introduction: Oligodendrocytes need iron in processes of energy generation and myelination. However, excessive levels of iron may exert iron induced oxidative stress and thus lead to tissue degeneration. Monitoring oxidative stress will be of paramount importance in follow-up of patients with many diseases including multiple sclerosis (MS). The aim of this study was to measure total anti-oxidative status (TAS), total oxidative status (TOS) and ischemia modified albumin (IMA) in stable relapse remitting MS (RRMS) patients. Materials and methods: Thirty-five RRMS patients (15 males and 20 females; median age 42 (20–55) years) and thirty-five age-sex matched healthy controls (13 males and 22 females; median age 37 (21–60) years) were included in this study. All patients were diagnosed with MS according to the criteria of McDonald. Results: IMA levels were significantly higher in RRMS patients (P < 0.001), while TAS and TOS did not show any significant difference between groups (P = 0.870 and P = 0.460, respectively). Conclusions: Our results suggest IMA as a more efficient serum marker than TAS and TOS in detecting the oxidative stress in MS patients. Serum oxidative stress markers should be included in future study protocols besides clinical and radiological parameters.

Evaluation of optical coherence tomography angiographic findings in Alzheimer’s type dementia

Background/Aims To identify the retinal vascular pathologies in patients with Alzheimer’s type dementia (ATD) through optical coherence tomography angiography (OCTA) imaging. Methods Our study included 26 patients in the patient group, and age-matched and sex-matched 26 subjects in the control group. A detailed ophthalmological and neurological examination was performed for all subjects included in the study. The retinal, choroidal vascular structures and choroidal thickness (CT) of all subjects were analysed in a detailed way with a commercial spectral domain OCTA. Moreover, all participants underwent detailed neurological examination including Mini Mental State Examination (MMSE) test to evaluate cognitive function. Results In the group of patients with ATD, the MMSE score was significantly lower than that of the control group (p<0.001). The retinal vascular density was significantly lower than that of the control group in all zones (p<0.05). Foveal avascular zone (FAZ) was significantly enlarged compared with the control group (p=0.001). CT was significantly lower in the group of patients with ATD (p<0.001). Outer retinal and choroidal flow rates were lower in the group of patients with ATD, while the difference was not significant (p>0.05). Furthermore, significant correlation was found between the MMSE and all vascular density parameters, CT parameter and FAZ tested with OCTA imaging (p<0.05). Conclusions In patients with ATD, retinal and choroidal vascular pathologies detected through OCTA imaging can be used as a new biomarker in the early diagnosis of the disease, follow-up of its progression and in investigating the efficacy of the drugs.

Serum iron metabolism markers including hepcidin in multiple sclerosis patients

The impact and pathogenesis of iron accumulation in multiple sclerosis (MS) is not yet clear. In this study, we investigated serum markers of iron metabolism, namely iron, ferritin, transferrin, total iron binding capacity (TIBC), and hepcidin in patients with MS, and compared to a healthy control group. Thirty-five stable relapse remitting MS patients (15 males and 20 females; mean age 38 ± 11 years) and thirty-five age-sex matched healthy controls (13 males and 22 females; mean age 38 ± 10 years) were included in this study. All patients were diagnosed with MS, according to the criteria of McDonald. Serum transferrin and TIBC levels were significantly lower (p = 0.02 and p = 0.03, respectively), whereas hepcidin, iron and ferritin values did not show any significant difference (p = 0.8, p = 0.2 and p = 0.8, respectively) in patients with MS compared to controls. There was no statistically significant correlation between iron metabolism markers and disease duration, Expanded Disability Status Scale and progression index. Our results were as expected from a chronic disease; thus were in favor of local, rather than a systemic impairment in iron metabolism in these patients. Our study, contributes to the establishment of further hypotheses on the role of hepcidin and iron metabolism in MS.

The Three Sisters of Fate in Multiple Sclerosis: Klotho (Clotho), Fibroblast Growth Factor-23 (Lachesis), and Vitamin D (Atropos).

Background: The klotho (Klt)-fibroblast growth factor-23 (FGF-23)-vitamin D axis is the main component of calcium (Ca) and phosphorus (P) metabolisms; on the contrary, it is also secreted from the choroid plexus (CP). Purpose: This study is aimed at evaluating serum soluble Klt (sKlt), FGF-23, and 25-(OH)-vitamin D levels in multiple sclerosis (MS) patients. Methods: Thirty-two relapsing-remitting MS patients (11 males and 21 females; mean age 38.3 years) and 31 age-sex matched healthy controls (12 males and 19 females; median age 38.5 years) were included in this study. All patients were diagnosed with MS according to the criteria of McDonald. Results: Serum sKlt, FGF-23, and P levels were significantly higher in MS patients compared to the control group (p < 0.01, p < 0.01, and p = 0.02, respectively). Serum 25-(OH)-vitamin D and Ca levels were significantly lower in MS patients (p < 0.01 and p = 0.04, respectively). Conclusion: Klt, which is secreted from CP, could be a response to the inflammatory condition in MS. Elevated FGF-23 levels suppress 1α-hydroxylase and upregulates 24α-hydroxylase, which results in a decrease in 1,25-(OH)2D3 levels. Thus, the neuroprotective and immunomodulatory effects of vitamin D might not be seen in MS patients.

NEUROMYELITIS OPTICA AND NEUROMYELITIS OPTICA SPECTRUM DISORDERS : REPORT OF NINE CASES

Objective: We aimed to report our nine Neuromyelitis Optica (NMO) and NMO Spectrum Disorders (NMOSD) cases which have different presentations. Patients and Methods: In this observational retrospective study, conducted between September 2011 and September 2015 in Antalya Education and Research Hospital Neurology Department, we enrolled 9 patients who were diagnosed as NMO/NMOSD. Results: We had 9 patients (8 female, 1 male). The mean age at onset was 49 years (36-67). While 7 patients were diagnosed with NMO, 2 patients’ diagnoses were NMOSD. The Case 6 was admitted to our clinic with an LETM (longitudinally extensive transverse myelitis) attack after 4 months of chemotherapy and radiotherapy treatment for gallbladder adenocancer. The Case 8 experienced LETM after the diagnosis of pulmonary tuberculosis and under anti-tuberculosis treatment, and the Case 9 was presented with LETM after post-vaccination. Optic nerve and spinal cord involvement occurred simultaneously in three patients. In three cases, optic neuritis developed 4 months, 15 months and 5 years after the myelitis attack. The Case 7 was referred to the hospital owing to cranial involvement, following a history of optic neuritis attacks six months earlier. The Case 1 had three recurrent optic neuritis attacks before the last attack of admission which included brain stem involvement and LETM. The Case 4 was receiving low dose interferone beta-1a with diagnosis of MS. NMO-IgG seropositivity was detected in 6 patients. Conclusion: Most of our patients were female and have relapsing course. Patients who experienced relapses, mostly were seropositive for NMO- IgG.

Balanced oxidative stress index in spite of decreased uric acid levels in multiple sclerosis patients

As anti-oxidative therapies come into consideration, finding feasible markers of oxidative stress becomes mandatory. We here in this study investigated the levels of major internal antioxidant uric acid (UA), oxidative stress parameters total antioxidant status (TAS), total oxidative status (TOS) in multiple sclerosis (MS) patients compared to controls. Thirty-five stable relapse remitting MS patients (15 males and 20 females; mean age 38 ± 11 years) and thirty-five age-sex matched healthy controls (13 males and 22 females; mean age 38 ± 10 years) were included in this study. All patients were diagnosed with MS according to the criteria of McDonald. Serum UA levels were significantly lower in the MS group (p = 0.03). When MS patients were sub-classified according to gender, female patients showed lower UA levels compared to male patients (p = 0.01). We did not find statistically significant differences in TAS and TOS between patients and controls. Serum UA correlated well with serum TAS as expected. However the correlation was more powerful in MS group (p < 0.0001 in MS group versus p = 0.02 in controls). Interpreting sole measurements of oxidative stress parameters may be deceptive as their values depend on many factors including serum levels of each other. We believe in the superiority of using TAS and TOS as markers of oxidative stress in MS patients as they inform about totals, independent of levels of individual parameters.