Ricarda Diem

Comprehensive analysis of microRNA profiles in multiple sclerosis including next-generation sequencing

Background: MicroRNAs (miRNAs) are short, noncoding RNAs with gene regulatory functions whose expression profiles may serve as disease biomarkers. Objective: The objective of this study was to perform a comprehensive analysis of miRNA expression profiles in blood of patients with a clinically isolated syndrome (CIS) or relapsing–remitting multiple sclerosis (RRMS) including next-generation sequencing (NGS). Methods: miRNA expression was analyzed in whole blood samples from treatment-naïve patients with CIS (n = 25) or RRMS (n = 25) and 50 healthy controls by NGS, microarray analysis, and quantitative real-time polymerase chain reaction (qRT-PCR). Results: In patients with CIS/RRMS, NGS and microarray analysis identified 38 and eight significantly deregulated miRNAs, respectively. Three of these miRNAs were found to be significantly up- (hsa-miR-16-2-3p) or downregulated (hsa-miR-20a-5p, hsa-miR-7-1-3p) by both methods. Another five of the miRNAs significantly deregulated in the NGS screen showed the same direction of regulation in the microarray analysis. qRT-PCR confirmed the direction of regulation for all eight and was significant for three miRNAs. Conclusions: This study identifies a set of miRNAs deregulated in CIS/RRMS and reconfirms the previously reported underexpression of hsa-miR-20a-5p in MS. hsa-miR-20a-5p and the other validated miRNAs may represent promising candidates for future evaluation as biomarkers for MS and could be of relevance in the pathophysiology of this disease.

Retinal layer segmentation in multiple sclerosis: a systematic review and meta-analysis

BACKGROUND Structural retinal imaging biomarkers are important for early recognition and monitoring of inflammation and neurodegeneration in multiple sclerosis. With the introduction of spectral domain optical coherence tomography (SD-OCT), supervised automated segmentation of individual retinal layers is possible. We aimed to investigate which retinal layers show atrophy associated with neurodegeneration in multiple sclerosis when measured with SD-OCT. METHODS In this systematic review and meta-analysis, we searched for studies in which SD-OCT was used to look at the retina in people with multiple sclerosis with or without optic neuritis in PubMed, Web of Science, and Google Scholar between Nov 22, 1991, and April 19, 2016. Data were taken from cross-sectional cohorts and from one timepoint from longitudinal studies (at least 3 months after onset in studies of optic neuritis). We classified data on eyes into healthy controls, multiple-sclerosis-associated optic neuritis (MSON), and multiple sclerosis without optic neuritis (MSNON). We assessed thickness of the retinal layers and we rated individual layer segmentation performance by random effects meta-analysis for MSON eyes versus control eyes, MSNON eyes versus control eyes, and MSNON eyes versus MSON eyes. We excluded relevant sources of bias by funnel plots. FINDINGS Of 25 497 records identified, 110 articles were eligible and 40 reported data (in total 5776 eyes from patients with multiple sclerosis [1667 MSON eyes and 4109 MSNON eyes] and 1697 eyes from healthy controls) that met published OCT quality control criteria and were suitable for meta-analysis. Compared with control eyes, the peripapillary retinal nerve fibre layer (RNFL) showed thinning in MSON eyes (mean difference -20·10 μm, 95% CI -22·76 to -17·44; p<0·0001) and in MSNON eyes (-7·41 μm, -8·98 to -5·83; p<0·0001). The macula showed RNFL thinning of -6·18 μm (-8·07 to -4·28; p<0·0001) in MSON eyes and -2·15 μm (-3·15 to -1·15; p<0·0001) in MSNON eyes compared with control eyes. Atrophy of the macular ganglion cell layer and inner plexiform layer (GCIPL) was -16·42 μm (-19·23 to -13·60; p<0·0001) for MSON eyes and -6·31 μm (-7·75 to -4·87; p<0·0001) for MSNON eyes compared with control eyes. A small degree of inner nuclear layer (INL) thickening occurred in MSON eyes compared with control eyes (0·77 μm, 0·25 to 1·28; p=0·003). We found no statistical difference in the thickness of the combined outer nuclear layer and outer plexiform layer when we compared MSNON or MSON eyes with control eyes, but we found a small degree of thickening of the combined layer when we compared MSON eyes with MSNON eyes (1·21 μm, 0·24 to 2·19; p=0·01). INTERPRETATION The largest and most robust differences between the eyes of people with multiple sclerosis and control eyes were found in the peripapillary RNFL and macular GCIPL. Inflammatory disease activity might be captured by the INL. Because of the consistency, robustness, and large effect size, we recommend inclusion of the peripapillary RNFL and macular GCIPL for diagnosis, monitoring, and research. FUNDING None.

Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial—study protocol

Introduction Optic neuritis leads to degeneration of retinal ganglion cells whose axons form the optic nerve. The standard treatment is a methylprednisolone pulse therapy. This treatment slightly shortens the time of recovery but does not prevent neurodegeneration and persistent visual impairment. In a phase II trial performed in preparation of this study, we have shown that erythropoietin protects global retinal nerve fibre layer thickness (RNFLT-G) in acute optic neuritis; however, the preparatory trial was not powered to show effects on visual function. Methods and analysis Treatment of Optic Neuritis with Erythropoietin (TONE) is a national, randomised, double-blind, placebo-controlled, multicentre trial with two parallel arms. The primary objective is to determine the efficacy of erythropoietin compared to placebo given add-on to methylprednisolone as assessed by measurements of RNFLT-G and low-contrast visual acuity in the affected eye 6 months after randomisation. Inclusion criteria are a first episode of optic neuritis with decreased visual acuity to ≤0.5 (decimal system) and an onset of symptoms within 10 days prior to inclusion. The most important exclusion criteria are history of optic neuritis or multiple sclerosis or any ocular disease (affected or non-affected eye), significant hyperopia, myopia or astigmatism, elevated blood pressure, thrombotic events or malignancy. After randomisation, patients either receive 33 000 international units human recombinant erythropoietin intravenously for 3 consecutive days or placebo (0.9% saline) administered intravenously. With an estimated power of 80%, the calculated sample size is 100 patients. The trial started in September 2014 with a planned recruitment period of 30 months. Ethics and dissemination TONE has been approved by the Central Ethics Commission in Freiburg (194/14) and the German Federal Institute for Drugs and Medical Devices (61-3910-4039831). It complies with the Declaration of Helsinki, local laws and ICH-GCP. Trial registration number NCT01962571.

Clinically isolated syndrome

ZusammenfassungAls klinisch isoliertes Syndrom (CIS) wird die erste klinische Manifestation einer potenziellen multiplen Sklerose (MS) bezeichnet. Auch wenn es eher den Charakter eines MS-Stadiums besitzt als dass es eine eigene Krankheitsentität darstellt, ergeben sich doch bezüglich der Diagnosestellung, der Differenzialdiagnostik, der Prognoseabschätzung sowie der immunmodulierenden Therapie Besonderheiten, die in diesem Übersichtsartikel dargestellt und kritisch diskutiert werden. Ergänzend wird das sog. radiologisch isolierte Syndrom (RIS) betrachtet, eine potenzielle Vorstufe der MS, die oftmals als bildgebender Zufallsbefund diagnostiziert wird.SummaryA clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.A clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.

Tryptophan-2,3-Dioxygenase (TDO) deficiency is associated with subclinical neuroprotection in a mouse model of multiple sclerosis.

The catabolism of tryptophan to immunosuppressive and neuroactive kynurenines is a key metabolic pathway regulating immune responses and neurotoxicity. The rate-limiting step is controlled by indoleamine-2,3-dioxygenase (IDO) and tryptophan-2,3-dioxygenase (TDO). IDO is expressed in antigen presenting cells during immune reactions, hepatic TDO regulates blood homeostasis of tryptophan and neuronal TDO influences neurogenesis. While the role of IDO has been described in multiple immunological settings, little is known about TDO’s effects on the immune system. TDO-deficiency is neuroprotective in C. elegans and Drosophila by increasing tryptophan and specific kynurenines. Here we have determined the role of TDO in autoimmunity and neurodegeneration in experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. We created reporter-TDO mice for in vivo imaging to show that hepatic but not CNS TDO expression is activated during EAE. TDO deficiency did not influence myelin-specific T cells, leukocyte infiltration into the CNS, demyelination and disease activity. TDO-deficiency protected from neuronal loss in the spinal cord but not in the optic nerves. While this protection did not translate to an improved overt clinical outcome, our data suggest that spatially distinct neuroprotection is conserved in mammals and support TDO as a potential target for treatment of diseases associated with neurodegeneration.

Role of early activated microglia during onset of autoimmune optic neuritis

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system (CNS) that leads to disability already in young adults. For research purposes the experimental autoimmune encephalomyelitis (EAE) serves as a model mimicking parts of the human pathology. In order to investigate gray matter pathology on functional microcircuit level distant to inflammatory lesions,we applied functional 2 photon laser scanning microscopy (TPLSM) in vivo in the visual cortex upon preparation of a cranial window. The Injection of the synthetic fluorescent Ca indicator Oregon Green Bapta-1 (OGB-1) combined with TPLSM allowed us tomeasure suprathreshold neuronal microcircuit activity in EAE induced in SJL mice in vivo. In remission, when no clinical symptoms were detectable (disease score 0), we found an increased frequency of spontaneous neuronal Ca transients associated with action potential firing in layer 2/3 neurons of the visual cortex. Besides spontaneous activity, the percentage of neurons responding to visual stimulation increased as well, compared to control SJL animals. The observed changes in spontaneous activity of layer 2/3 neurons indicate an increased network activation status as sign for residual pathology despite ostensible homeostasis in clinical remission (e.g. disease score 0). We conclude that in the remission phase of clinically healthy EAE induced SJL mice, changes in the network activity of layer 2/3 neurons of the visual cortex can be detected suggesting alterations of the excitatory cortical circuitry after only one relapse.

Anti-TNFR1 targeting in humanized mice ameliorates disease in a model of multiple sclerosis

Amsterdam, Amsterdam, Netherlands; Department of Geriatrics, Medical Center Alkmaar, Alkmaar, Netherlands; Department of Respiratory Medicine, UniversityMedical Center Utrecht, University of Utrecht, Utrecht, Netherlands; Department of Intensive Care Medicine, Leiden University Medical Center, University of Leiden, Leiden, Netherlands; Neuroinfection Amsterdam, AcademicMedical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Neurology, AcademicMedical Center, University of Amsterdam, Amsterdam, Netherlands

Erythropoietin als ein neuroprotektiver Therapieansatz

Auch bei frühzeitiger Methylprednisolontherapie einer Optikusneuritis (ON) kommt es zu irreversibler Schädigung von retinalen Ganglienzellen und deren Axonen. Eine zusätzliche neuroprotektive Therapie im Akutstadium könnte daher von Nutzen sein.

Klinisch isoliertes Syndrom@@@Clinically isolated syndrome

ZusammenfassungAls klinisch isoliertes Syndrom (CIS) wird die erste klinische Manifestation einer potenziellen multiplen Sklerose (MS) bezeichnet. Auch wenn es eher den Charakter eines MS-Stadiums besitzt als dass es eine eigene Krankheitsentität darstellt, ergeben sich doch bezüglich der Diagnosestellung, der Differenzialdiagnostik, der Prognoseabschätzung sowie der immunmodulierenden Therapie Besonderheiten, die in diesem Übersichtsartikel dargestellt und kritisch diskutiert werden. Ergänzend wird das sog. radiologisch isolierte Syndrom (RIS) betrachtet, eine potenzielle Vorstufe der MS, die oftmals als bildgebender Zufallsbefund diagnostiziert wird.SummaryA clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.A clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.

Klinisch isoliertes Syndrom

ZusammenfassungAls klinisch isoliertes Syndrom (CIS) wird die erste klinische Manifestation einer potenziellen multiplen Sklerose (MS) bezeichnet. Auch wenn es eher den Charakter eines MS-Stadiums besitzt als dass es eine eigene Krankheitsentität darstellt, ergeben sich doch bezüglich der Diagnosestellung, der Differenzialdiagnostik, der Prognoseabschätzung sowie der immunmodulierenden Therapie Besonderheiten, die in diesem Übersichtsartikel dargestellt und kritisch diskutiert werden. Ergänzend wird das sog. radiologisch isolierte Syndrom (RIS) betrachtet, eine potenzielle Vorstufe der MS, die oftmals als bildgebender Zufallsbefund diagnostiziert wird.SummaryA clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.A clinically isolated syndrome (CIS) is a term which describes the first clinical onset of a potential multiple sclerosis (MS). It ought to be defined as an MS stage rather than a separate disease entity; however, with respect to the diagnostic work-up, differential diagnoses to be considered, prognostic factors for the development of a clinically confirmed MS and initiation of an immunomodulatory therapy, there are some important considerations supported by recent studies. These considerations as well as the current guidelines are critically discussed in this review article. Additionally, recommendations are given regarding the management of radiologically isolated syndrome (RIS) an imaging-based diagnosis of a potential preclinical stage of MS.