Oral high-dose atorvastatin treatment in relapsing-remitting multiple sclerosis

Background

Recent data from animal models of multiple sclerosis (MS) and from a pilot study indicated a possible beneficial impact of statins on MS.

Methodology/Principal Findings

Safety, tolerability and effects on disease activity of atorvastatin given alone or in combination with interferon-beta (IFN-β) were assessed in a phase II open-label baseline-to-treatment trial in relapsing-remitting MS (RRMS). Patients with at least one gadolinium-enhancing lesion (CEL) at screening by magnetic resonance imaging (MRI) were eligible for the study. After a baseline period of 3 monthly MRI scans (months −2 to 0), patients followed a 9-month treatment period on 80 mg atorvastatin daily. The number of CEL in treatment months 6 to 9 compared to baseline served as the primary endpoint. Other MRI-based parameters as well as changes in clinical scores and immune responses served as secondary endpoints. Of 80 RRMS patients screened, 41 were included, among them 16 with IFN-β comedication. The high dose of 80 mg atorvastatin was well tolerated in the majority of patients, regardless of IFN-β comedication. Atorvastatin treatment led to a substantial reduction in the number and volume of CEL in two-sided multivariate analysis (p = 0.003 and p = 0.008). A trend towards a significant decrease in number and volume of CEL was also detected in patients with IFN-β comedication (p = 0.060 and p = 0.062), in contrast to patients without IFN-β comedication (p = 0.170 and p = 0.140). Immunological investigations showed no suppression in T cell response but a significant increase in IL-10 production.

Conclusions/Significance

Our data suggest that high-dose atorvastatin treatment in RRMS is safe and well tolerated. Moreover, MRI analysis indicates a possible beneficial effect of atorvastatin, alone or in combination with IFN-β, on the development of new CEL. Thus, our findings provide a rationale for phase II/III trials, including combination of atorvastatin with already approved immunomodulatory therapy regimens.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00616187","term_id":"NCT00616187"}}NCT00616187     

Defective structural RNA processing in relapsing-remitting multiple sclerosis

BackgroundSurveillance of integrity of the basic elements of the cell including DNA, RNA, and proteins is a critical element of cellular physiology. Mechanisms of surveillance of DNA and protein integrity are well understood. Surveillance of structural RNAs making up the vast majority of RNA in a cell is less well understood. Here, we sought to explore integrity of processing of structural RNAs in relapsing remitting multiple sclerosis (RRMS) and other inflammatory diseases.ResultsWe employed mononuclear cells obtained from subjects with RRMS and cell lines. We used quantitative-PCR and whole genome RNA sequencing to define defects in structural RNA surveillance and siRNAs to deplete target proteins. We report profound defects in surveillance of structural RNAs in RRMS exemplified by elevated levels of poly(A) + Y1-RNA, poly(A) + 18S rRNA and 28S rRNAs, elevated levels of misprocessed 18S and 28S rRNAs and levels of the U-class of small nuclear RNAs. Multiple sclerosis is also associated with genome-wide defects in mRNA splicing. Ro60 and La proteins, which exist in ribonucleoprotein particles and play different roles in quality control of structural RNAs, are also deficient in RRMS. In cell lines, silencing of the genes encoding Ro60 and La proteins gives rise to these same defects in surveillance of structural RNAs.ConclusionsOur results establish that profound defects in structural RNA surveillance exist in RRMS and establish a causal link between Ro60 and La proteins and integrity of structural RNAs.

Electronic supplementary material

The online version of this article (doi:10.1186/s13059-015-0629-x) contains supplementary material, which is available to authorized users.     

Investigating the role of brain-derived neurotrophic factor in relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) is a common, heterogeneous disorder of the central nervous system with a complex trait composed of both genetic and environmental factors. Recently, scientific interest has increased in defining factors that possibly contribute to brain functional plasticity; the results might be useful to assess the relationship between MS lesion burden and clinical events, as well as explaining the well-known phenotypic heterogeneity of the disease. In this study, we explored the effect of the Val66Met brain-derived neurotrophic factor (BDNF) functional polymorphism on cognitive performances and volumetric measurements obtained by magnetic resonance imaging of the brain in a selected population of relapsing-remitting MS (RRMS) patients, with relatively short disease duration and minimal clinical disability, compared to gender, age and educational-level matched healthy subjects. We found that in the RRMS group, the BDNF Met-allele was significantly associated with the lower volume of cerebral grey matter (GM) (P = 0.005). Furthermore, a significant (P = 0.013) interaction effect between 'MS-status' and the BDNF genotype was found for GM volumes, with the result that patients carrying the BDNF Met-allele showed a higher risk of developing global GM atrophy than the homozygous Val/Val. No BDNF-related impact on global neuropsychological functions resulted in either RRMS patients or controls. Our data seem to be consistent with the reported influence of BDNF in neuronal plasticity, thus suggesting that the Met-allele might have a negative prognostic effect on cortical morphometry in RRMS patients.     

Cutting edge: mast cells regulate disease severity in a relapsing-remitting model of multiple sclerosis

Mast cells (MCs) exert a significant pathologic influence on disease severity in C57BL/6 (B6) strain-dependent experimental allergic encephalomyelitis (EAE), a model of primary progressive multiple sclerosis (MS). However, relapsing-remitting MS, which is modeled in SJL mice, is the more prevalent form. Given genetically determined heterogeneity in numbers and responsiveness of MCs from various strains of mice, we asked whether these cells also influence this more clinically relevant MS model using SJL-Kit(W/W-v) mice. Similar to the commercially available WBB6F(1)-Kit(W/W-v) mice, SJL-Kit(W/W-v) mice are MC-deficient, anemic, and neutropenic and have normal T cell compartments. They exhibit significantly reduced disease severity, but retain the relapsing-remitting course, a phenotype reversed by selective MC reconstitution. These data confirm that MC influence is not confined to an isolated model of EAE and reveal a new system to study the effects of MC heterogeneity on relapsing-remitting EAE and other SJL strain-specific diseases.     

Detection of human herpesviruses and polyomaviruses DNA in a group of patients with relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system whose pathological features consist of white matter plaques of primary demyelinization and loss of oligodendrocytes. Various risk factors have been associated with MS susceptibility. We have focused this study on different viruses. In particular in the present study we used PCR to search for the genomic DNA of HHV-1, HHV-2, HHV-8, BKV and JCV in urine and peripheral blood mononuclear cells (PBMC) samples from 44 relapsing-remitting MS (RRMS) patients. No viral DNA was found in any urine sample, whereas 29.5% of RRMS PBMC samples were positive. It is suggestive that Human herpesviruses (HHV-1 and HHV-8) were constantly present in all positive samples, indicating that viral agents could contribute to create the demyelination plaques and cause MS.     

Omega-3 fatty acid supplementation decreases matrix metalloproteinase-9 production in relapsing-remitting multiple sclerosis,

ObjectivesThe primary objective was to evaluate the effect of omega-3 fatty acids (omega-3 FA) on matrix metalloproteinase-9 (MMP-9) production by immune cells in multiple sclerosis (MS). Quality of life, fatty acid levels, and safety were also evaluated.Materials and MethodsTen participants with relapsing-remitting MS (RRMS) received omega-3 FA supplementation (9.6 g/day fish oil) in an open-label study. Participants were evaluated at four time points, baseline, after 1 month of omega-3 FA supplementation, after 3 months of omega-3 FA supplementation, and after a 3-month wash out.ResultsImmune cell secretion of MMP-9 decreased by 58% after 3 months of omega-3 FA supplementation when compared with baseline levels (p<0.01). This effect was coupled with a significant increase in omega-3 FA levels in red blood cell membranes.ConclusionsOmega-3 FA significantly decreased MMP-9 levels in RRMS and may act as an immune-modulator that has potential therapeutic benefit in MS patients.     

Association between peripheral IFN-gamma producing CD8+ T-cells and disability score in relapsing-remitting multiple sclerosis

A large body of evidence supports the involvement of the immune system in the pathogenesis of multiple sclerosis (MS). Nevertheless, how the peripheral T-cells phenotypes are associated with factors such as the disability score, the effects of immunomodulatory treatments, or the activation period is poorly understood. In this study, we have centered our attention on the presence of IFN-gamma and IL-4 producing CD4+ and CD8+ T-cells in the peripheral blood of 58 relapsing-remitting MS (RRMS) patients, 48 that were stable and 10 who were in relapse period, and 30 healthy controls (HC). Our results support the existence of an independent association between the percentage of IFN-gamma producing CD8+ lymphocytes and the increased levels of disability score. Furthermore, the number of IFN-gamma producing CD8+ lymphocytes and the disability score were not correlated in patients treated with interferon-beta, evidence of its possible benefits in combating a pro-inflammatory profile. Finally, we compared the T-cell populations in RRMS patients in the stable or active period, and we found a significant decrease of IFN-gamma producing CD4+ lymphocytes in active patients. In conclusion our study supports the hypothesis that different peripheral blood T-cell phenotypes are associated with disability score or active period of the disease.     

Linked markers flanking the gene for multiple endocrine neoplasia type 2A

The inherited cancer syndrome multiple endocrine neoplasia type 2A (MEN2A) has recently been mapped to chromosome 10. We have typed 29 families with this disorder with DNA markers from the pericentromeric region of chromosome 10. Two markers, RBP3 and MCK2, were tightly linked to the MEN2A gene at recombination fractions of less than 3%. Multipoint analysis of the linkage data suggests that the gene is located within a 3-cM interval defined by the markers RBP3/MCK2 on one side and TB14.34 on the other. No evidence for locus heterogeneity was detected in any of the 27 families from 14 countries who were informative for the markers tested. The data confirm and refine the original assignment and provide the basis for presymptomatic screening for this disorder.     

Beta-interferon for multiple sclerosis

Interferon beta is widely used as first-line treatment for relapsing remitting multiple sclerosis (RRMS). Several products are marketed world-wide, and biosimilar products are emerging. Interferon beta reduces relapse rates by about 1/3, and reduces the appearance of new MRI lesions by about 2/3, and some studies have shown reduced disability progression, and reduced rates of brain atrophy. The mechanism of action of interferon beta in MS is poorly understood, partly due to the complex nature of the biological response to interferon injections. This mini-review succinctly summarizes clinical effects, possible mechanism of action, physiochemical properties of the different interferon products, issues related to immunogenicity, and biomarkers of the interferon beta response, and proposes important unresolved issues for future research.     

Interleukin 18 gene polymorphism is a risk factor for multiple sclerosis

Proinflammatory cytokines with immunosuppressive properties play an important role in the pathogenesis of multiple sclerosis (MS). Interleukin 18 (IL-18) is one of the most important innate cytokines produced from macrophages in the early stages of the inflammatory immune response. The purpose of this study was to determine whether there was any relationship between IL18 gene polymorphisms and MS. IL18 genotyping were performed in 101 MS patients and 164 control subjects by using the PCR–restriction fragment length polymorphism (PCR–RFLP) method. The frequency of MS patients with the CC genotype of the IL18 gene at position ?137 was significantly higher than with the GG genotype [p = 0.01, odds ratio (OR) 3.17]. In haplotype analysis of two SNPs in the IL18 gene, frequency of the CC haplotype was significantly higher in MS patients (p = 0.002, OR 3.0). However, the genotype distribution of the IL18 ?607 C/A polymorphism in the MS patient group was not significantly different from that of the control group. These data suggest that IL18 gene polymorphisms at position ?137 might be a genetic risk factor for MS in the Turkish population.     

Incorporating gene co-expression network in identification of cancer prognosis markers

Background  

Extensive biomedical studies have shown that clinical and environmental risk factors may not have sufficient predictive power for cancer prognosis. The development of high-throughput profiling technologies makes it possible to survey the whole genome and search for genomic markers with predictive power. Many existing studies assume the interchangeability of gene effects and ignore the coordination among them.     

Polymorphic markers of some genes associated with multiple sclerosis in the population of Kazakhstan

Associations of DR2 specificity of the DRB1 gene and single-nucleotide polymorphisms of the tumor necrosis factor gene TNFα (−308 G/A), interleukin genes IL-1β (−511 C/T), IL-2 (−475 A/T and −631 G/A), IL-6 (−634 C/G), paraoxanase gene PON1 (M55L, Q192R), and the mitochondrial protein transport gene UCP2 (−866 G/A) with the development of multiple sclerosis (MS) were studied in two main ethnic groups of Kazakhstan (Kazakhs and Russians). An association of DR2 specificity of the DRB1 gene with MS was found in the combined group of Kazakhs, Russians, and offsprings from mixed marriages. No correlation between DR2 specificity and MS was found in the separately examined groups of Kazakhs and Russians. Statistically significant (p < 0.05) differences between the MS patients and healthy individuals were observed in the distribution of the genotypes at site −634 G/C of the IL-6 gene in the Kazakh group, in the allelic frequencies at site −308 A/G in the promoter region of the TNFα gene in the Russian group, and in the frequencies of alleles at the polymorphic Q192R locus of the PON1 gene in the Kazakh group.. No significant differences were revealed in the distribution of the genotypes and in the frequencies of alleles at the polymorphic sites of the genes IL-1β (−511 C/T), IL-2 (−475 A/T and −631 G/A), PON1 (M55L), and UCP2 (−866 G/A).