Publications by authors named "Mohammad Ali Sahraian"

263 Publications

Pregnancy outcome in patients with neuromyelitis optica spectrum disorder treated with rituximab: A case-series study.

Caspian J Intern Med 2021 ;12(Suppl 2):S491-S494

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory disorder with a tendency to affect the spinal cord and optic nerves. As NMOSDs have a predilection for women of reproductive age and adopt an aggressive course during pregnancy, appropriate treatment strategies before conception and during pregnancy should be well-considered.

Case Presentation: In this report, the pregnancy outcome of eight pregnancies following rituximab treatment was assessed, which led to 50% live births with mean birth weight of 2777.50 (SD: 545.92) grams. Two patients had abortions due to doctor's recommendation. One pregnancy led to intrauterine fetal death (IUFD) due to nuchal cord. No spontaneous abortions were encountered. Two patients received rituximab during pregnancy. No major malformations or serious neonatal infections were encountered.

Conclusion: Rituximab should be administered by caution in NMOSD patients who want to be pregnant and the probable adverse effects of the drug should be discussed by patients.
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http://dx.doi.org/10.22088/cjim.12.0.491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559646PMC
January 2021

Translation and validation of the Persian version of Godin Leisure-Time Exercise Questionnaire in patients with multiple sclerosis.

BMC Neurol 2021 Nov 5;21(1):431. Epub 2021 Nov 5.

Sports and Exercise Medicine, MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Study Design: Psychometric study.

Objective: The purpose of this study is to translate, culturally adapt and evaluate the validity and reliability of the Persian (Farsi) version of GLTEQ in patients with multiple sclerosis.

Methods: This study had three phases, including translation of the questionnaire into Persian and making cultural adaptation, evaluation of pre-final version of questionnaire's comprehensibility in a pilot study, and investigation of reliability and validity of the final version of the translated questionnaire. Content validity, and convergent validity (correlations among the Persian version of GLTEQ and Global physical activity questionnaire (GPAQ), and international physical activity questionnaire (IPAQ)) and after all test-retest reliability were studied.

Results: The subjects were 87 MS patients. The Persian version demonstrated moderate to good convergent validity; the correlation coefficient between the Persian version and GPAQ was r=0.64 (p<0.001), and between the Persian version and IPAQ was r=0.59 (p<0.001). The test-retest reliability was strong (Intra-class Correlation (ICC) value ranged between 0.908 and 0.992). Besides, its face validity and content validity were acceptable.

Conclusions: The Persian version of GLTEQ is a valid and reliable instrument to assess physical activity in patients with MS. This questionnaire can be a step toward standardization of physical activity measurement in patients with MS. Also, in research, it provides the possibilities to carry on a comparative study across cultures using the same outcome measure.
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http://dx.doi.org/10.1186/s12883-021-02465-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569962PMC
November 2021

Anti-LINGO-1 improved remyelination and neurobehavioral deficit in cuprizone-induced demyelination.

Iran J Basic Med Sci 2021 Jul;24(7):900-907

Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Central nervous system demyelination is the main feature of multiple sclerosis (MS). The most important unmet need in MS is use of treatments that delay the progression of the disease. Leucine-rich repeat and Immunoglobulin-like domain containing NOGO receptor-interacting protein 1(LINGO-1) have been known as inhibitors of oligodendrocyte differentiation and myelination.

Materials And Methods: We investigated LINGO-1 antibody effects on remyelination and neurobehavioral deficit using cuprizone-induced demyelination. Animals were randomly divided into three groups (n = 10): (1) Control group; received the regular diet, (2) CPZ group; normal saline was injected intraperitoneally, and (3) Treatment group; LINGO-1 antibody (10 mg/kg) was injected IP once every six days for 3 weeks. We assessed the level of myelin basic protein (MBP), neurofilament heavy chain (NF200), and Brain-derived neuroprotective factor (BDNF) in the corpus callosum (CC) by immunostaining against MBP, NF200, and BDNF.

Results: We found decreased levels of MBP, NF200, and BDNF in demyelinated CC, and anti-LINGO-1 treatment improved demyelinated structures. Furthermore, motor impairment was measured by Open-field (OFT) and Balance beam tests. In the treatment group, motor impairment was significantly improved.

Conclusion: These results provide evidence that LINGO-1 antibody can improve remyelination and neurobehavioral deficit.
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http://dx.doi.org/10.22038/ijbms.2021.53531.12043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8528247PMC
July 2021

Air pollution is a risk factor for multiple sclerosis - Commentary.

Mult Scler 2021 Dec 22;27(14):2140. Epub 2021 Oct 22.

Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hassan Abad Square, Tehran, Iran.

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http://dx.doi.org/10.1177/13524585211046352DOI Listing
December 2021

Burden of multiple sclerosis in Iran from 1990 to 2017.

BMC Neurol 2021 Oct 15;21(1):400. Epub 2021 Oct 15.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Multiple Sclerosis (MS) is a burdensome, chronic and autoimmune disease of the central nervous system. We aimed to report the incidence, prevalence, mortality, and Disability Adjusted Life Years (DALYs) of MS in Iran at a national level for different age and sex groups over a period of 28 years (1990-2017).

Methods: Data were extracted from the Global Burden of Disease study (GBD) from 1990 to 2017, published by the Institute for Health Metrics and Evaluation. The incidence of DALYs and prevalence of MS were estimated to report the burden of MS based on sex and age in Iran from 1990 to 2017.

Results: At the national level, the Age-Standardized Incidence Rate (ASIR), Age-Standardized Prevalence Rate (ASPR), Age-Standardized DALYs Rate (ASDR) and the Age-Standardized Mortality Rate (ASMR) in Iran in 2017 were 2.4 (95% Uncertainty Interval [UI]: 2.1 to 2.7), 69.5 (62.1 to 77.8), 29.1 (23.6 to 34.7), and 0.4 (0.3 to 0.4) per 100,000 population, respectively. During the period of 1990 to 2017, all measures increased, and were higher among females. The incidence rate began upward trend at the age of 20 and attained its highest level at the age of 25.

Conclusion: In Iran, all of the age-standardized MS rates have been increasing during the 28 years from 1990 to 2017. Our findings can help policy makers and health planners to design and communicate their plans and to have a better resource allocation, depending on the incidence and prevalence of the growing numbers of MS patients in Iran.
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http://dx.doi.org/10.1186/s12883-021-02431-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518301PMC
October 2021

Treatment With 25-Hydroxyvitamin D (Calcifediol) Is Associated With a Reduction in the Blood Neutrophil-to-Lymphocyte Ratio Marker of Disease Severity in Hospitalized Patients With COVID-19: A Pilot Multicenter, Randomized, Placebo-Controlled, Double-Blinded Clinical Trial.

Endocr Pract 2021 Oct 13. Epub 2021 Oct 13.

Vitamin D, Skin and Bone Research Laboratory, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. Electronic address:

Objective: The goal of this randomized, double-blinded, placebo-controlled clinical trial was to investigate the therapeutic efficacy of oral 25-hydroxyvitamin D (25(OH)D) in improving vitamin D status in vitamin D-deficient/vitamin D-insufficient patients infected with the SARS-CoV-2 (COVID-19) virus.

Methods: This is a multicenter, randomized, double-blinded, placebo-controlled clinical trial. Participants were recruited from 3 hospitals that are affiliated to [Institution Blinded for Review] and [Institution Blinded for Review].

Results: A total 106 hospitalized patients who had a circulating 25(OH)D concentration of <30 ng/mL were enrolled in this study. Within 30 and 60 days, 76.4% (26 of 34) and 100% (24 of 24) of the patients who received 25(OH)D had a sufficient circulating 25(OH)D concentration, whereas ≤12.5% of the patients in the placebo group had a sufficient circulating 25(OH)D concentration during the 2-month follow-up. We observed an overall lower trend for hospitalization, intensive care unit duration, need for ventilator assistance, and mortality in the 25(OH)D group compared with that in the placebo group, but differences were not statistically significant. Treatment with oral 25(OH)D was associated with a significant increase in the lymphocyte percentage and decrease in the neutrophil-to-lymphocyte ratio in the patients. The lower neutrophil-to-lymphocyte ratio was significantly associated with reduced intensive care unit admission days and mortality.

Conclusion: Our analysis indicated that oral 25(OH)D was able to correct vitamin D deficiency/insufficiency in patients with COVID-19 that resulted in improved immune function by increasing blood lymphocyte percentage. Randomized controlled trials with a larger sample size and higher dose of 25(OH)D may be needed to confirm the potential effect of 25(OH)D on reducing clinical outcomes in patients with COVID-19.
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http://dx.doi.org/10.1016/j.eprac.2021.09.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511889PMC
October 2021

The Possible Direct Correlation between Cognitive Impairment and Fear of Catching COVID-19 among Patients with Multiple Sclerosis.

Iran J Psychiatry 2021 Jul;16(3):336-342

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

The prevalence of cognitive impairment in multiple sclerosis (MS) is significant and it is estimated that 40% to 70% of patients with MS suffer from this impairment. COVID-19 is also a new infectious disease. The symptoms of this disease, which include fever, shortness of breath, and cough, can be mild to severe and can even lead to death. Due to the use of immunosuppressive drugs by Patients with MS, they might be at greater risk of catching COVID-19. Thus, patients with MS may be more afraid of catching the virus. One of the important factors is the relationship between cognitive deficit and the increase in patients' fear of COVID-19. The aim of this study was to assess the relationship between fear of catching COVID-19 and cognitive impairment in patients with MS. This cross-sectional study was conducted at the MS Clinic, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran. Our participants in this project were Patients with MS who were over 18 years old and had no history of other neurological and psychiatric diseases. In addition to obtaining demographic and clinical information, we measured the fear of catching the COVID 2019 via Fear of COVID-19 Scale (FCV-19S), which is 7-item questionnaire. We also used Multiple Sclerosis Neuro Psychological Screening Questionnaire (MSNQ) to assess memory and information processing speed in Patients with MS. After adjustment for age, gender, disease duration, highest level of education, MS type, and EDSS in linear regression model, as well as the MSNQ total score and fear score of catching coronavirus, the results demonstrated a significant positive correlation with P value of 0.00 and β: 0.024. The present study showed a direct relationship between cognitive disorder and level of fear regarding COVID-19. Patients with more cognitive disorders were more afraid of COVID-19.
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http://dx.doi.org/10.18502/ijps.v16i3.6260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452838PMC
July 2021

Correlation between the clinical disability and T1 hypointense lesions' volume in cerebral magnetic resonance imaging of multiple sclerosis patients: A systematic review and meta-analysis.

CNS Neurosci Ther 2021 11 3;27(11):1268-1280. Epub 2021 Oct 3.

Tehran University of Medical Sciences, Tehran, Iran.

Background: To evaluate the correlation between T1 hypointense lesions' mean volume on cerebral MRI with disability level of patients with multiple sclerosis.

Methods: We included studies testing the desired outcome in adult patients diagnosed with RRMS or SPMS. In Feb 2021, we searched PubMed, Embase, CENTRAL, and Web of Science to find relevant studies. All included studies were assessed for the risk of bias using a tailored version of the Quality in Prognosis Studies (QUIPS) tool. Extracted correlation coefficients were converted to the Fisher's z scale, and a meta-analysis using a random-effects model was performed on the results.

Results: We included 27 studies (1919 participants). Meta-analysis revealed a correlation coefficient of 0.32 (95% CI 0.26-0.37) between T1 hypointense lesions' mean volume and EDSS score.

Discussion: The correlation between T1 hypointense lesions' mean volume and EDSS was interpreted as low to slightly moderate. The certainty of the evidence was judged to be high.
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http://dx.doi.org/10.1111/cns.13734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504532PMC
November 2021

Adverse events reported by Iranian patients with multiple sclerosis after the first dose of Sinopharm BBIBP-CorV.

Vaccine 2021 10 23;39(43):6347-6350. Epub 2021 Sep 23.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

MS patients were one of the first populations vaccinated in Iran. To date, the most used vaccine brand on Iranian MS patients is Sinopharm COVID-19 vaccine. Here is the first study on the adverse events after the first dose of Sinopharm vaccine on 583 Iranian MS patients. A Google form link was sent to MS patients through social networks, between May 1, 2021 and May 22, 2021. No serious adverse event was reported. At least one complaint (mostly transient) was reported by 350 (60%) of vaccine recipients. Constitutional symptoms (malaise, fatigue, fever, shivering, & generalized body pain) (51%) and headache (9%) were the most reported complaints. We found a relation between gender and prior infection with COVID-19 and reported symptoms (p value less than 0.05). Only five recipients (0.9%) reported MS relapse after vaccination. MS worsening was a minor incident related to fever.
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http://dx.doi.org/10.1016/j.vaccine.2021.09.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458008PMC
October 2021

Depression, anxiety, and fear of COVID-19 in patients with multiple sclerosis in pandemic era: a cross-sectional study.

Neurol Sci 2021 Sep 23. Epub 2021 Sep 23.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Depression and anxiety are the two important factors determining quality of life of patients with multiple sclerosis (PWMS). In COVID-19 pandemic era, several factors can provoke mental issues of people and patients. In this cross-sectional study, we aim to estimate the new prevalence of anxious and depressive symptoms and their relating factors in PWMS.

Methods: In this cross-sectional study, we include PWMS who are recruited in the MS clinic of Sina Hospital, Tehran, and are joined in our channel of Telegram media. A self-designed online questionnaire consisted of 4 parts handed out between patients: demographic and clinical data, Beck depression inventory, Beck anxiety inventory, and Fear of COVID-19 Scale. Univariate and multiple logistic regression analyses were performed to find the relating factors of expression of depressive and anxious symptoms in PWMS.

Results: Of a total of 282 participants with the mean age of 35.66 (30.75-40) years, had been suffering from multiple sclerosis for 7.36 (3-10) years, 81.7% were women and 69.1% classified as relapsing-remitting MS. Mean score of BDI was 17.13 ± 11.51 which is classified as minimal-moderate depressive symptoms. 48.6% of patients did not express depressive symptoms (BDI-II ≤ 14) and the others reported some degrees of depression. In the univariate analysis employment (p = 0.015), marital status (p = 0.022), level of education (p = 0.004), number of hospitalization due to MS attacks (p = 0.048), and fear of COVID-19 (p ≤ 0.0001) associated significantly with presence of depressive symptoms. After entering these factors in a binary logistic regression model, level of education (p = 0.019), marital status (p = 0.044), number of hospital admissions due to MS relapses (β = 1.10, p = 0.02), and fear of COVID-19 (β = 1.07, p ≤ 0001) remained significant as relating factors. Mean score of the anxiety calculated 14.54 ± 9.75 and just 3.2% of patients had severe anxiety. Employment (p = 0.045), EDSS score (p = 0.004), and fear of COVID-19 (p ≤ 0.0001) reported relating to anxious symptoms significantly in the univariate analysis. After entering in the logistic regression analysis, EDSS (β = 1.30, p = 0.001) and fear of COVID-19 (β = 1.13, p ≤ 0.0001) remained as significant relating factors of anxious symptoms.

Conclusion: The overall prevalence of depressive symptoms in PWMS in our MS clinic is 51.4% which is obviously higher than other world's centers which could be due to fear of COVID-19. In addition to fear of COVID-19, presence of depressive symptoms in PWMS is related significantly with level of education, number of hospital admissions due to MS relapses, and marital status. Other side, the patients classified as suffering from anxious symptoms had more severe problems on fear of COVID-19. But it is recommended for future studies to compare patients score in the COVID-19 era with their score before this pandemic.
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http://dx.doi.org/10.1007/s10072-021-05612-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458786PMC
September 2021

Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report.

Physiother Theory Pract 2021 Sep 21:1-7. Epub 2021 Sep 21.

Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran.

Background: Spasticity is a common cause of disability in multiple sclerosis (MS), which can negatively affect the patient's walking and balance.

Objective: To evaluate the immediate effect of dry needling (DN) on spasticity and mobility in a female with MS.

Case Description: In this case, a 38-year-old female with a 4-year history of MS was treated. The hamstring muscles (biceps femoris and semitendinosus) were needled for 1 minute in a single session. The main outcome measures were the Modified Modified Ashworth Scale (MMAS) to evaluate spasticity, the Timed 25-Foot Walk (T25FW) for the assessment of mobility and leg function performance, and stiffness as a biomechanical index of spasticity measured by a dynamometer. The assessments were done before and immediately after DN.

Outcomes: The MMAS scores decreased in the hamstrings (1 to 0) and quadriceps (2 to 1). The mobility improved as the time for T25FW decreased from 16.30 to 9.29 seconds. The stiffness of hamstring decreased after treatment (0.451 to 0.312).

Conclusion: One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.
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http://dx.doi.org/10.1080/09593985.2021.1978118DOI Listing
September 2021

Neuromyelitis optica spectrum disorder (NMOSD) associated with cancer: A systematic review.

Mult Scler Relat Disord 2021 Aug 27;56:103227. Epub 2021 Aug 27.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

NMOSD: is a disease shown to be highly associated with other diseases such as autoimmune diseases. There are a few reports of this association with cancer. So, this systematic review aimed to obtain a broad understanding on the cancers associated in NMOSD, including the source of common perceptions and assumptions in this regard.

Methods: in this study, we systematically searched the PubMed, EMBASE, SCOPUS, Web of Sciences, Proquest, Ovid, conference proceedings, and reference lists of the retrieved articles. All NMOSD cases who met the last version of criteria for its diagnosis, which reported the patients with a history of cancer before or after the onset of neurological symptoms without time limitations, and those who were referred as paraneoplastic neuromyelitis optica in articles published in English language (both the abstract & full text), were assessed. Finally, each study was critically appraised.

Results: Only 47 studies met the inclusion criteria, so they were assessed for qualitative synthesis. Considering the Euro network criteria, only 62 cases met this issue. The mean age of 52.21 ± 17.14 and 52.16 ± 17.21 was reported for cancer and NMOSD cases with female predominance (79%), respectively. The most reported organ in the cancer population were genitourinary (n = 14, 22.3%), breast (n = 12, 19.4%), lung (n = 12, 19.3%), gastrointestinal (n = 7, 11.3%), and hematology (n = 6, 9.7%), respectively.

Conclusion: In older NMOSD patients without suspicious symptoms, we recommend paying more attention to lung, breast and genitourinary (especially ovary) cancer screening. Also, cancer resection had positive effect on the attack numbers after receiving treatment and NMOSD recovery.
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http://dx.doi.org/10.1016/j.msard.2021.103227DOI Listing
August 2021

Dietary risk factors of primary progressive multiple sclerosis: A population-based case-control study.

Mult Scler Relat Disord 2021 Aug 31;56:103233. Epub 2021 Aug 31.

Multiple Sclerosis Research Center, Neuroscience Institute, University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: There are growing evidences on the role of nutritional factors in multiple sclerosis (MS) occurrence. But dietary data are limited in primary progressive type of MS (PPMS). We assessed the role of dietary factors during adolescence in PPMS risk.

Methods: An incident case-control study on 143 PPMS cases with definite diagnosis and 400 controls were conducted in Sina hospital, Tehran, Iran. Demographic data were collected. Data on nutritional habits during adolescence were obtained using questionnaire designed for multinational case-control studies of environmental risk factors for multiple sclerosis (EnvIMS-Q). Logistic regression models were run to evaluate the role of diet in PPMS risk.

Results: A significant association was founded between higher intake of dairy, seafood, red meat, poultry, vegetable, fruit and nut and lower risk of PPMS (P< 00.5). This association was dose dependent for all mentioned food groups except fruit. In the fully adjusted model, more intake of dairy (OR: 0.27; 95%CI: 0.14-0.53), seafood (OR: 0.21; 95%CI: 0.10-0.44), red meat (OR:0.44; 95%CI: 0.22-0.90), vegetable (OR: 0.19; 95%CI: 0.09-0.39), fruit (OR: 0.47; 95%CI: 0.22-0.99) and nut (OR: 0.29; 95%CI: 0.15-0.56) in the third tertiles resulted in significant reduction in PPMS risk. In case of poultry consumption, the association was meaningful just in the third tertile of crude model (OR: 0.54; 95%CI: 0.30-0.95). Nutrient supplementation with calcium, iron, folic acid, vitamin B12 and C were also related with more than 84% lower risk of PPMS.

Conclusion: Our data proposed that adequate intake of food groups and nutrient supplementation during adolescence may be effective in reducing adult-onset PPMS risk.
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http://dx.doi.org/10.1016/j.msard.2021.103233DOI Listing
August 2021

Widespread Disruptions of White Matter in Familial Multiple Sclerosis: DTI and NODDI Study.

Front Neurol 2021 16;12:678245. Epub 2021 Aug 16.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Diffusion tensor imaging (DTI) is a noninvasive, quantitative MRI technique that measures white matter (WM) integrity. Many brain dimensions are heritable, including white matter integrity measured with DTI. Family studies are valuable to provide insights into the interactive effects of non-environmental factors on multiple sclerosis (MS). To examine the contribution of familial factors to the diffusion signals across WM microstructure, we performed DTI and calculated neurite orientation dispersion plus density imaging (NODDI) diffusion parameters in two patient groups comprising familial and sporadic forms of multiple sclerosis and their unaffected relatives. We divided 111 subjects (49 men and 62 women: age range 19-60) into three groups conforming to their MS history. The familial MS group included 30 participants (patients; = 16, healthy relatives; = 14). The sporadic group included 41 participants (patients; = 10, healthy relatives; = 31). Forty age-matched subjects with no history of MS in their families were defined as the control group. To study white matter integrity, two methods were employed: one for calculating the mean of DTI, FA, and MD parameters on 18 tracts using Tracts Constrained by Underlying Anatomy (TRACULA) and the other for whole brain voxel-based analysis using tract-based spatial statistics (TBSS) on NDI and ODI parameters derived from NODDI and DTI parameters. Voxel-based analysis showed considerable changes in FA, MD, NDI, and ODI in the familial group when compared with the control group, reflecting widespread impairment of white matter in this group. The analysis of 18 tracts with TRACULA revealed increased MD and FA reduction in more tracts (left and right ILF, UNC, and SLFT, forceps major and minor) in familial MS patients vs. the control group. There were no significant differences between the patient groups. We found no consequential changes in healthy relatives of both patient groups in voxel-based and tract analyses. Considering the multifactorial etiology of MS, familial studies are of great importance to clarify the effects of certain predisposing factors on demyelinating brain pathology.
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http://dx.doi.org/10.3389/fneur.2021.678245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415561PMC
August 2021

The association between dietary total antioxidant capacity and NMO-IgG seropositivity in patients with neuromyelitis optica spectrum disorder.

Clin Neurol Neurosurg 2021 10 21;209:106903. Epub 2021 Aug 21.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: There is growing evidence highlighting the role of environmental risk factors of NMO-IgG seropositivity in patients with neuromyelitis optica spectrum disorder (NMOSD). The present study investigated the possible association between dietary total antioxidant capacity (TAC) and NMO-IgG seropositivity in NMOSD patients.

Methods: Fifty-six patients with a definite diagnosis of NMOSD were included in the study. Data on patients' age, gender, height, weight, cigarette smoking status, and alcohol consumption were collected and recorded. Body mass index (BMI) was also calculated. In addition, dietary habits of patients were evaluated using an adjusted semi-quantitative food frequency questionnaire (FFQ) that consists of 168 food items. Dietary TAC was calculated using the oxygen radical absorption capacity (ORAC) method. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the NMO-IgG serum status. The association between dietary TAC and odds of NMO-IgG seropositivity was measured using the logistic regression analysis.

Results: The mean of dietary TAC was 8362.8 (μmolTE/1000 kcal) in seronegative patients and 6609.9 (μmolTE/1000 kcal) in seropositive patients and had a significant difference between the mentioned groups of patients (P: 0.02). An inverse association was found between dietary TAC and odds of NMO-IgG seropositivity in all three regression models. The higher dietary intake of antioxidant resulted in significant findings as follows: 92% (95% CI: 0.01-0.53), 97% (95% CI: 0.00-0.34), and 97% (95% CI: 0.00-0.32) lower odds of NMO-IgG seropositivity in the fourth quartiles of the first, the second, and the third regression model, respectively. Moreover, the inverse association between fruit intake and odds of NMO-IgG seropositivity was significant in the third quartile (OR:0.10; 95%CI: 0.01-0.97).

Conclusion: The present study indicated a significant inverse association between dietary TAC and NMO-IgG seropositivity of NMOSD patients. As no definite treatment can be offered for NMOSD and nutrition is a modifiable factor in this regard, specification of dietary factors affecting the risk of NMOSD is of great value.
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http://dx.doi.org/10.1016/j.clineuro.2021.106903DOI Listing
October 2021

Home-based exercise training influences gut bacterial levels in multiple sclerosis.

Complement Ther Clin Pract 2021 Nov 30;45:101463. Epub 2021 Jul 30.

Department of Physical Education and Sport Sciences, Tarbiat Modares University, Tehran, Iran.

Background: Multiple sclerosis is associated with gut microbiome alterations. The current study aimed to investigate the effect of home-based exercise on gut bacteria in people with multiple sclerosis (MS). We also examined the association of exercise-induced gut bacterial modulation with circulating levels of inflammatory and anti-inflammatory cytokines.

Materials And Methods: Forty-two people with MS (female/male: 31/11, expanded disability scale status <5) participated in this study and were divided into two groups: 6 months of home-based exercise (5 sessions per week) and controls. Before and after the intervention, the following parameters were assessed: gut microbiota, including faecalibacterium prausnitzii, akkermansia muciniphila, prevotella and bacteroides counts; cytokine levels including interleukin (IL)-10 and tumor necrosis factor-alpha (TNF-α); and psychosocial factors including anxiety, depression, and fatigue.

Results: Home-based exercise significantly increased prevotella counts, and decreased akkermansia muciniphila counts (p < 0.05); however, there were no significant effects on faecalibacterium prausnitzii and bacteroides counts (p > 0.05). There were no significant effects of home-based exercise on circulating cytokine levels (p > 0.05). Moreover, home-based exercise was associated with significant improvements in anxiety and depression (p < 0.05); however, fatigue revealed no significant change (p > 0.05). Akkermansia muciniphila, prevotella and bacteroides count changes in response to the intervention were correlated with changes in IL-10 (r = -0.052, r = 0.67, and r = -0.55, respectively).

Conclusion: In general, our data revealed the effect of exercise on gut bacteria, especially prevotella, and akkermansia muciniphila counts, which can probably have a beneficial effect on MS disease pathology and course; however, the lack of changes in cytokines following exercise suggests the possible role of mechanisms other than modulation of circulating IL-10 and TNF- α levels.
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http://dx.doi.org/10.1016/j.ctcp.2021.101463DOI Listing
November 2021

RNA Sequencing of CD4 T Cells in Relapsing-Remitting Multiple Sclerosis Patients at Relapse: Deciphering the Involvement of Novel genes and Pathways.

J Mol Neurosci 2021 Dec 21;71(12):2628-2645. Epub 2021 Jul 21.

Immunology Department, School of Medicine, Tehran University of Medical Sciences, Poorsina St, 16 Azar St., Enghelab Ave, Tehran, Iran.

CD4 T cells are known as a noteworthy potential modulator of inflammation in multiple sclerosis (MS). In the current study, we investigated the transcriptome profile of CD4 T cells in patients with relapsing-remitting MS (RRMS) at the relapse phase. We performed RNA sequencing of CD4 T cells isolated from four relapsing-remitting MS (RRMS) patients at the relapse phase and four age- and sex-matched healthy controls. The edgeR statistical method was employed to determine differentially expressed genes (DEGs). Gene set enrichment analysis was subsequently performed. Applying a physical interaction network, genes with higher degrees were selected as hub genes. A total of 1278 and 1034 genes were defined at significantly higher or lower levels, respectively, in CD4 T cells of RRMS patients at the relapse phase as compared with healthy controls. The top up- and downregulated genes were JAML and KDM3A. The detected DEGs were remarkable on chromosomes 1 and 2, respectively. The DEGs were mainly enriched in the pathways "regulation of transcription, DNA-templated," "regulation of B cell receptor signaling pathway," "protein phosphorylation," "epidermal growth factor receptor signaling pathway," and "positive regulation of neurogenesis." Moreover, 16 KEGG pathways mostly associated with the immune system and viral infections were enriched. In the constructed physical interaction networks, UBA52 and TP53 were shown to be the most highly ranked hub genes among upregulated and downregulated genes, respectively. By applying global transcriptome profiling of CD4 T cells, we deciphered the involvement of several novel genes and pathways in MS pathogenesis. The present results must be confirmed by in vivo and in vitro studies.
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http://dx.doi.org/10.1007/s12031-021-01878-8DOI Listing
December 2021

A focus on allogeneic mesenchymal stromal cells as a versatile therapeutic tool for treating multiple sclerosis.

Stem Cell Res Ther 2021 07 13;12(1):400. Epub 2021 Jul 13.

Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Multiple sclerosis (MS) is a central nervous system (CNS) chronic illness with autoimmune, inflammatory, and neurodegenerative effects characterized by neurological disorder and axonal loss signs due to myelin sheath autoimmune T cell attacks. Existing drugs, including disease-modifying drugs (DMD), help decrease the intensity and frequency of MS attacks, inflammatory conditions, and CNS protection from axonal damage. As they cannot improve axonal repair and show side effects, new therapeutic options are required. In this regard, due to their neuroprotection properties, immunomodulatory effects, and the ability to differentiate into neurons, the transplantation of mesenchymal stromal cells (MSCs) can be used for MS therapy. The use of adipose-derived MSCs (AdMSCs) or autologous bone marrow MSCs (BMSCs) has demonstrated unexpected effects including the invasive and painful isolation method, inadequate amounts of bone marrow (BM) stem cells, the anti-inflammatory impact reduction of AdMSCs that are isolated from fat patients, and the cell number and differentiation potential decrease with an increase in the age of BMSCs donor. Researchers have been trying to search for alternate tissue sources for MSCs, especially fetal annexes, which could offer a novel therapeutic choice for MS therapy due to the limitation of low cell yield and invasive collection methods of autologous MSCs. The transplantation of MSCs for MS treatment is discussed in this review. Finally, it is suggested that allogeneic sources of MSCs are an appealing alternative to autologous MSCs and could hence be a potential novel solution to MS therapy.
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http://dx.doi.org/10.1186/s13287-021-02477-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278627PMC
July 2021

Safety and efficacy of fingolimod in Iranian patients with relapsing-remitting multiple sclerosis: An open-label study.

Caspian J Intern Med 2021 Apr;12(3):263-274

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Fingolimod was the first oral therapy approved for treating relapsing-remitting multiple sclerosis (RRMS) in 2010. This open-label study evaluated the safety and efficacy of fingolide, 0.5 mg in Iranian MS patients during one-year follow-up.

Methods: A multicenter, open-label, longitudinal was designed to evaluate the safety and efficacy of fingolide, 0.5 mg over a one-year follow-up period across 11 centers. The patients were visited by their neurologists every two months to evaluate possible adverse events and clinical disease activity considered by recording Kurtzke's Expanded Disability Status Scale (EDSS).

Results: A total of 252 patients with the mean treatment duration of 343±45.70 days were. 20 patients experienced adverse events (AEs) and serious adverse events (SAEs) such as resistant urinary tract infection (UTI), premature atrial contraction (PAC), skin allergic reaction, macular edema, chicken pox, zona, panic attacks, and exacerbations associated with steroids treatment, all of which led to Fingolide discontinuation. The mean EDSS decreased from (2.15±1.29, 95%CI: 1.99to2.32) at baseline to (1.85±1.22, 95%CI: 1.68to2.02) at 12th month (final visit) while a p-value revealed significant differences comparing baseline and final EDSS (p<0.001). Mean annualized relapse rate (ARR) of the patients in one year prior to the study was (0.006±0.016, 95%CI: 0.004to0.008) which changed to (0.005±0.016, 95%CI: 0.003to0.007) at the end of the study period. Patients with a 12-month period of fingolide treatment experienced sustained ARR and disease progression (p<0.001).

Conclusion: The obtained findings suggest that the administration of Fingolide, 0.5 mg (Fingolimod, Osvahpharma, Tehran, Iran) is safe and efficient for Iranian MS patients.
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http://dx.doi.org/10.22088/cjim.12.3.263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223042PMC
April 2021

Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis.

Int J Prev Med 2021 15;12:42. Epub 2021 May 15.

Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Multiple sclerosis (MS) is an inflammatory disease while there are controversies regarding the role of vitamin D supplements in controlling relapse and disability improvement during treatment.

Objective: The goal of this systematic review and meta-analysis was to evaluate the effect of vitamin D supplements on MS-related relapse and the Expanded Disability Status Scale (EDSS).

Methods: We searched databases to include randomized clinical trials (RCTs) which were published up to October 2018. We included RCTs, being single-blinded or double-blinded or open-label trials in which one of the main outcomes was EDSS and/or relapse after vitamin D supplementation. All statistical analyses were performed using RevMan 5.3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for relapse between treatment arms. The mean difference was calculated for EDSS comparisons.

Results: Nine articles were included for analysis. Of these nine studies, five compared vitamin D supplement groups with placebo (group 1 studies), and four compared high- and low-dose vitamin D groups. A total of 561 patients were analyzed. Being treated with vitamin D instead of placebo showed no effect on relapse rate (OR = 0.66, 95% CI = 0.28-1.54) as well as EDSS (mean difference = 0.06, 95%CI [-0.31, 0.42]). The results of studies comparing high- vs. low-dose vitamin D interventions showed no significant effect on relapse rate (OR = 1.08, 95%CI [0.29-4.08] as well as final EDSS (mean difference = 0.17, 95% CI = -0.73, 1.07).

Conclusions: Our findings show that vitamin D supplements (high or low dose) have no significant effect on relapse rate and disability during treatment in MS patients.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_208_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223916PMC
May 2021

Multiple sclerosis projection in Tehran, Iran using Bayesian structural time series.

BMC Neurol 2021 Jun 24;21(1):235. Epub 2021 Jun 24.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The prevalence of Multiple Sclerosis (MS) has been increasing worldwide and the highest prevalence ratio among Asian countries was reported in Iran. This study aims to estimate the increase in MS occurrence during more than three decades in Tehran and forecast the future condition of the disease using time series approaches for the next ten years.

Methods: The cross-sectional study was conducted from 1999 to 2019 based on records of MS cases from Iranian MS Society (IMSS) registry system. The prevalence was estimated using population data presented by the Statistical Centre of Iran. Through Bayesian Structural Time Series (BSTS) model, we want to predict the prevalence of familial and sporadic MS in the next ten years. .

Results: Among 22,421 cases with MS, 16,831 (75.1 %) were female and 5589 (24.9 %) were male. Female to male ratio was 3.0:1 and the number of familial MS cases were 2982 (13.3 %) of subjects. Female gender was less responsible for higher rate of MS in familial definition (beta = 0.020) in comparison to sporadic cases (beta = 0.034). Forecasting by BSTS revealed an increase in MS prevalence for the next ten years so that the prevalence rate for total, familial and sporadic MS respectively begins with 189.50 (183.94-195.14), 25.69 (24.97-26.45) and 163.74(159.06-168.57) in 2020 and ends with 220.84 (171.48-266.92), 30.79 (24.16-37.15), and 189.33(146.97-230.19) in 2029.

Conclusions: According to the findings, MS prevalence increased during three decades and it will increase over the next ten years. Tehran province is one of the regions with highest MS prevalence in Asia. The results of present study indicated that females are at higher risk for MS than males in both sporadic and familial MS.
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http://dx.doi.org/10.1186/s12883-021-02281-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223333PMC
June 2021

Anti-N-methyl-D-aspartate receptor encephalitis in a patient with multiple sclerosis on dimethyl fumarate: a case report.

Neurol Sci 2021 Sep 22;42(9):3929-3931. Epub 2021 Jun 22.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1007/s10072-021-05385-xDOI Listing
September 2021

Exome sequencing reveals novel rare variants in Iranian familial multiple sclerosis: The importance of POLD2 in the disease pathogenesis.

Genomics 2021 Jul 8;113(4):2645-2655. Epub 2021 Jun 8.

Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

The prevalence of familial multiple sclerosis (FMS) is increasing worldwide which endorses the heritability of the disease. Given that many genome variations are ethnicity-specific and consanguineous marriage could affect genetic diseases, hereditary disease gene analysis among FMS patients from Iran, a country with high rates of parental consanguinity, could be highly effective in finding mutations underlying disease pathogenesis. To examine rare genetic mutations, we selected three Iranian FMS cases with ≥3 MS patients in more than one generation and performed whole exome sequencing. We identified a homozygous rare missense variant in POLD2 (p. Arg141Cys; rs372336011). Molecular dynamics analysis showed reduced polar dehydration energy and conformational changes in POLD2 mutant. Further, we found a heterozygote rare missense variant in NBFP1 (p. Gly487Asp; rs778806175). Our study revealed the possible role of novel rare variants in FMS. Molecular dynamic simulation provided the initial evidence of the structural changes behind POLD2 mutant.
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http://dx.doi.org/10.1016/j.ygeno.2021.06.008DOI Listing
July 2021

Attitudes toward vaccination in patients with multiple sclerosis: A report from Iran.

Mult Scler Relat Disord 2021 08 26;53:103045. Epub 2021 May 26.

Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran. Electronic address:

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http://dx.doi.org/10.1016/j.msard.2021.103045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152211PMC
August 2021

The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysis.

Neurol Sci 2021 Aug 7;42(8):3093-3099. Epub 2021 Jun 7.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The prevalence of COVID-19 is different in studies conducted in different countries. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of COVID-19 in patients with MS.

Methods: Two independent researchers independently searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (((coronavirus OR Wuhan coronavirus OR novel coronavirus OR coronavirus disease OR COVID-19 OR 2019 novel coronavirus infection OR 2019-nCOV OR severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2) AND (Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).

Results: We found 1466 articles by literature search, and after deleting duplicates, 1029 remained. Twelve articles remained for meta-analysis. Totally, 101,462 patients were evaluated and the total number of possible/confirmed cases was 1394. Mean age ranged from 35 to 54 years. Totally, 49 patients died. The pooled prevalence of suspected COVID-19 in MS patients was 4% (95% CI: 3-4%) (I = 98.5%, P < 0.001). The pooled prevalence of hospitalization in infected cases was 10% (95% CI: 7-12%) (I = 95.6%, P < 0.001). The pooled prevalence of death in hospitalized cases was 4% (95% CI: 1-6%) (I = 82.4%, P < 0.001).

Conclusion: Hospitalization rate is higher among MS patients based on COVID-19 infection while the pooled infection rate is estimated as 4%.
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http://dx.doi.org/10.1007/s10072-021-05373-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184129PMC
August 2021

The Factors Associated With Olfactory Dysfunction in Patients with Multiple Sclerosis.

Basic Clin Neurosci 2021 Jan-Feb;12(1):89-94. Epub 2021 Jan 1.

Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: An impaired sense of smell has a remarkable impact on the quality of life. It is seen in a variety of neurodegenerative diseases such as Parkinson disease. In this study, we assessed the olfactory function in patients with Multiple Sclerosis (MS) by Sniff Magnitude Test (SMT).

Methods: A cross-sectional study was conducted on 48 patients with MS. A questionnaire, including demographic and clinical variables, was completed for each patient. The SMT was used for the evaluation of olfactory function.

Results: Olfactory dysfunction was found in 14.6% of patients (8.3% hyposmia and 6.3% anosmia). Older age, longer disease duration, higher hospital admission rate, lower minimental status examination score, and secondary progressive course of MS were significantly related to olfactory dysfunction.

Conclusion: Secondary progressive MS and markers of advanced disease toward neurodegenerative phase (including older age, longer disease duration, and lower cognitive function) can be associated with olfactory dysfunction in MS patients.
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http://dx.doi.org/10.32598/bcn.12.1.1368.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114867PMC
January 2021

Physical activity may contribute to brain health in multiple sclerosis: An MR volumetric and spectroscopy study.

J Neuroimaging 2021 07 6;31(4):714-723. Epub 2021 May 6.

Division for Performance and Health (Sports Medicine), Department of Sport and Sport Science, TU Dortmund University, Dortmund, Germany.

Background And Purpose: Physical activity may represent a disease-modifying therapy in persons with multiple sclerosis (pwMS). To date, there is limited research regarding mechanisms based on brain imaging for understanding the beneficial effects of physical activity in pwMS. This study examined the relationship between physical activity levels and thalamic and hippocampal volumes and brain metabolism in pwMS.

Methods: The sample of 52 pwMS (37.3 ± 9.6 years of age; 35 females, 17 males) underwent a combination of volumetric magnetic resonance imaging and magnetic resonance spectroscopy. Current and lifetime physical activity were assessed using actigraphy and the adapted version of the Historical Activity Questionnaire, respectively.

Results: Positive associations were observed between both actigraphy and self-reported levels of moderate-to-vigorous physical activity (MVPA) and thalamic and hippocampal volumes. Regarding brain metabolism, actigraphy and self-reported levels of MVPA were positively associated with higher hippocampal and thalamic levels of N-acetylaspartate/creatine ratio (NAA/Cr: marker of neural integrity and cell energy state).

Conclusions: This study provides novel evidence for a positive association between physical activity and thalamic and hippocampal volume and metabolism in pwMS. These findings support the hypothesis that physical activity, particularly MVPA, may serve as a disease-modifying treatment by improving brain health in pwMS.
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http://dx.doi.org/10.1111/jon.12869DOI Listing
July 2021

The possible role of Interleukin-6 as a regulator of insulin sensitivity in patients with neuromyelitis optica spectrum disorder.

BMC Neurol 2021 Apr 20;21(1):167. Epub 2021 Apr 20.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is associated with inflammatory mediators that may also trigger downstream signaling pathways leading to reduce insulin sensitivity.

Methods: We aimed to determine the risk association of hyperinsulinemia in NMOSD patients with seropositive AQP4-IgG and the serum levels of interleukin (IL)-6 and IL-17A compared with the control group. Serum levels of metabolic (Insulin, Fasting Blood Sugar (FBS), lipid profile) and inflammatory (IL-6 and IL-17) markers were assessed in 56 NMOSD patients and 100 controls.

Results: Hyperinsulinemia was more prevalent in NMOSD patients independent of age, sex and body mass index (BMI) (48.2% vs. 26%, p = 0.005) compared to control group. After adjusting age, sex and BMI, there was significant association between lower insulin sensitivity (IS) and NMOSD risk (95% CI: Beta = 0.73, 0.62 to 0.86, p = 0.0001). Circulating levels of IL-6 and IL-17 were higher in NMOSD patients, and only IL-6 had an effect modifier for the association between lower insulin sensitivity and NMOSD risk.

Conclusions: Our data suggests that inflammatory pathogenesis of NMOSD leads to hyperinsulinemia and increases the risk of insulin resistance.
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http://dx.doi.org/10.1186/s12883-021-02198-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056566PMC
April 2021

Reduction in circulating vitamin D binding protein in patients with multiple sclerosis.

BMC Neurol 2021 Apr 20;21(1):168. Epub 2021 Apr 20.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: In this study, we aimed to determine the risk association between vitamin D binding protein (VDBP) polymorphism in patients with multiple sclerosis (MS) in a MS biobank and the difference in VDBP serum levels in MS patients who were recently diagnosed.

Method: The current case-control study was performed on 296 MS patients and 313 controls. Thereafter, two common missense VDBP polymorphisms, named rs7041and rs4588, were evaluated in all the participants. Serum levels of vitamin D and vitamin D binding protein were assessed in 77 MS patients who were diagnosed since one year ago and in 67 healthy people who were matched in terms of age and sex.

Result: The frequency distributions of VDBP genotypes and alleles of SNP rs7041 and rs4588 were observed to be similar in both the MS and control groups (p > 0.05). The VDBP haplotypes, as Gc2/Gc2, Gc1/Gc1, and Gc1/Gc2, were found to be similar in the MS and control groups (p > 0.05). In subgroup analysis, circulating VDBP was lower in MS patients (Ln-VDBP (μgr/ml): 3.64 ± 0.91 vs. 5.31 ± 0.77, p = 0.0001) even after adjusting for vitamin D levels, body mass index, and taking vitamin D supplement. There was no significant association between VDBP haplotypes and vitamin D levels in the two groups.

Conclusion: The present study suggested an association between lower levels of circulating VDBP and multiple sclerosis in newly diagnosed patients. However, the VDBP causative role in the development of MS is still unclear, so it needs more studies.
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http://dx.doi.org/10.1186/s12883-021-02200-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056586PMC
April 2021

Stressful life events and the risk of primary progressive multiple sclerosis: A population-based case-control study.

Mult Scler Relat Disord 2021 Jun 7;51:102937. Epub 2021 Apr 7.

Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: The onset and presentation of primary progressive multiple sclerosis (PPMS) like any other autoimmune diseases can be triggered by unexpected lifetime stressful events, which require to be assessed in order to minimize our exposure to such events as much as possible.

Objective: The aim of the present study was to determine the possible role of socioeconomic status (SES) and stressful events in PPMS development METHODS: The present population-based case-control study recruited PPMS cases and healthy controls from the general population during 2019-2020 in Tehran, Iran. Clinical diagnosis of cases was based on the 2017 McDonald criteria and confirmed by a neurologist. The selection of sex-matched controls from the same source population of cases was performed using the standard method of Random Digit Dialing (RDD). The study questionnaire was filled out over telephone interviews. Matched logistic regression was administered to estimate the adjusted and unadjusted odds ratio (OR) at 95% confidence intervals (CIs) adjusted for sex, age, and marital status using SPSS 23.

Results: This study examined 146 PPMS cases and 294 controls. Mean ages (SD) for cases and controls were 46.97 (9.4) and 37.67 (6.12), respectively (P < 0.001). No stressful events over five years prior to the disease onset were associated with an increased risk of PPMS. Marriage (OR: 0.04; 95% CI (0.01- 0.37), P = 0.004), close family members' serious disease (OR: 0.10; 95% CI (0.02-0.60), P = 0.01), and being in debt (OR: 0.03; 95% CI (0-0.37), P = 0.006) were found to have a negative association with the risk of disease occurrence. Death of a loved one, family disruption, jail term, homelessness period, Conquer(national university entrance exam), death of spouse, getting fired from a job, joblessness, divorce, migration, close family members' suicide, and retirement were not associated with the risk of PPMS (P > 0.05). History of depression before the PPMS presentation was considerably associated with the incidence of PPMS (P < 0.001). Self-rated health status was scored noticeably lower by cases as compared with controls (P < 0.001). Participants with the paternal educational degree of guidance school showed a higher risk of PPMS by 2.83 time (OR: 2.83; 95% CI (1.02 - 7.80), P = 0.04) than participants with university educated fathers. In total, SES during adolescence did not indicate any association with the risk of PPMS (with the exception of levels 2 (P = 0.02) and 7 (P = 0.05)).

Conclusion: No stressful life events were identified as possible increasing risk factors for PPMS. Marriage, close family members' serious disease, and being in debt had a negative association with the disease risk. The history of depression may elevate the risk of PPMS. While the highest and lowest SES levels in adolescence were not remarkable determiners for PPMS, levels 2 and 7 had a positive association with the risk of PPMS. The maternal educational level was not an important factor; however, the paternal educational degree of guidance school as compared to university degree made individuals more susceptible to PPMS. Self-rated health status score was higher in controls.
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http://dx.doi.org/10.1016/j.msard.2021.102937DOI Listing
June 2021
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