Advances in the Diagnosis and Treatment of Multiple Sclerosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 3288

Special Issue Editor

Dr. Marta Altieri
E-Mail
Guest Editor
Dipartimento di Neuroscienze Umane, Policlin Umberto 1, Sapienza University of Rome, IT-00185 Rome, Italy
Interests: cognitive; multiple sclerosis

Special Issue Information

Dear Colleagues,

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by the inflammation, demyelination, and degeneration of oligodendrocytes and their axons, which are mediated by the activation of cells of the immune system.

MS is the leading cause of progressive neurological disability and the first cause of neurological symptoms in young adults. Because of the high prevalence of MS in the young population, some emerging disease-modifying therapies (DMTs) aiming to control symptoms have been developed; these new drugs have sophisticated capacities for modulating immune function.

Currently, the primary aim of treatment in MS is to reach “no evident disease activity” (NEDA), which is a composite of three related measures of disease activity: (i) no relapses; (ii) no disability progression; and (iii) no MRI activity (such as new or enlarging T2 lesions or Gd-enhancing lesions) (3,4).

DMTs are chosen by evaluating a few factors:

  1. The control of neuro-inflammation to prevent the accumulation of disabilities and prolong wellness;
  2. Avoiding cognitive deterioration, fatigue, and depression, which are caused by MS and at the same time worsen the disease;
  3. The high heterogeneity of prognosis among patients;
  4. Treatment adherence, which is strictly related to patients’ wishes and expectations.

Several elements must be considered about the use of DMTs. Some are objectively standardized factors such as clinical and radiological criteria, and potential treatment efficacy, while others are more related to subjective interpretation such as cognition status, tolerability, and/or poor adherence to treatment, comorbidities that may influence medication management and metabolism, and personal factors that hinder the suspension or continuation of therapy, such as pregnancy. By means of the new drugs with different pharmacokinetic and pharmacodynamic profiles, it is today possible to choose a tailor-made treatment by defining a patient’s precision medicine.

The aim of this Special Issue of JCM entitled "Advances in the Diagnosis and Treatment of Multiple Sclerosis" is to select various author contributions in order to deeply investigate this topic.

Dr. Marta Altieri
Guest Editor

Manuscript Submission Information

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Keywords

  • multiple sclerosis
  • autoimmune disease
  • disease-modifying therapies (DMTs)
  • neuro-inflammation
  • cognitive deterioration
  • treatment

Published Papers (3 papers)

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17 pages, 299 KiB  
Article
The Influence of TEP1 and TERC Genetic Variants on the Susceptibility to Multiple Sclerosis
J. Clin. Med. 2023, 12(18), 5863; https://doi.org/10.3390/jcm12185863 - 09 Sep 2023
Viewed by 658
Abstract
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. According to recent studies, cellular senescence caused by telomere shortening may contribute to the development of MS. Aim of the study: Our aim was to determine the associations of [...] Read more.
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. According to recent studies, cellular senescence caused by telomere shortening may contribute to the development of MS. Aim of the study: Our aim was to determine the associations of TEP1 rs1760904, rs1713418, TERC rs12696304, rs35073794 gene polymorphisms with the occurrence of MS. Methods: The study included 200 patients with MS and 230 healthy controls. Genotyping of TEP1 rs1760904, rs1713418 and TERC rs12696304, rs35073794 was performed using RT-PCR. The obtained data were analysed using the program “IBM SPSS Statistics 29.0”. Haplotype analysis was performed using the online program “SNPStats”. Results: The TERC rs12696304 G allele of this SNP is associated with 1.4-fold lower odds of developing MS (p = 0.035). TERC rs35073794 is associated with approximately 2.4-fold reduced odds of MS occurrence in the codominant, dominant, overdominant, and additive models (p < 0.001; p < 0.001; p < 0.001; p < 0.001, respectively). Haplotype analysis shows that the rs1760904-G—rs1713418-A haplotype is statistically significantly associated with 1.75-fold increased odds of developing MS (p = 0.006). The rs12696304-C–rs35073794-A haplotype is statistically significantly associated with twofold decreased odds of developing MS (p = 0.008). In addition, the rs12696304-G—rs35073794-A haplotype was found to be statistically significantly associated with 5.3-fold decreased odds of developing MS (p < 0.001). Conclusion: The current evidence may suggest a protective role of TERC SNP in the occurrence of MS, while TEP1 has the opposite effect. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Multiple Sclerosis)
16 pages, 1660 KiB  
Article
Depression and Anxiety in Association with Polypharmacy in Patients with Multiple Sclerosis
J. Clin. Med. 2023, 12(16), 5379; https://doi.org/10.3390/jcm12165379 - 18 Aug 2023
Cited by 1 | Viewed by 684
Abstract
Polypharmacy (intake of ≥5 drugs) is an important issue for patients with chronic diseases such as multiple sclerosis (MS). We aimed to assess the prevalence of polypharmacy with regard to the severity of anxiety/depression and to comorbidities. Therefore, 374 MS patients from two [...] Read more.
Polypharmacy (intake of ≥5 drugs) is an important issue for patients with chronic diseases such as multiple sclerosis (MS). We aimed to assess the prevalence of polypharmacy with regard to the severity of anxiety/depression and to comorbidities. Therefore, 374 MS patients from two German neurological sites were examined for drug burden, comorbidities, disability level and psychopathological measures capturing depression and anxiety using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D). We found that patients with a higher HADS-D score take more medication (r = 0.217, p < 0.001). Furthermore, patients with higher depression severity were more likely to show polypharmacy (p < 0.001). These differences were not significant for anxiety. (p = 0.413). Regarding the frequency of ≥1 comorbidities, there were no significant differences between patients with different HADS-A (p = 0.375) or HADS-D (p = 0.860) severity levels, whereas the concrete number of comorbidities showed a significant positive linear correlation with HADS-A (r = 0.10, p = 0.045) and HADS-D scores (r = 0.19, p < 0.001). In conclusion, symptoms of depression pose a relevant issue for MS patients and are correlated with polypharmacy and comorbidities. Anxiety is not correlated with polypharmacy but with the frequency of several comorbidity groups in MS patients. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Multiple Sclerosis)
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24 pages, 1927 KiB  
Systematic Review
Mesenchymal Stem Cell Therapy in Multiple Sclerosis: A Systematic Review and Meta-Analysis
J. Clin. Med. 2023, 12(19), 6311; https://doi.org/10.3390/jcm12196311 - 30 Sep 2023
Cited by 1 | Viewed by 1524
Abstract
The assurance of safety and effectiveness is a significant focal point in all therapeutic approaches. Although mesenchymal stem cells (MSCs) have been identified as a potential novel therapeutic strategy for multiple sclerosis (MS), existing evidence regarding the effectiveness and safety of this strategy [...] Read more.
The assurance of safety and effectiveness is a significant focal point in all therapeutic approaches. Although mesenchymal stem cells (MSCs) have been identified as a potential novel therapeutic strategy for multiple sclerosis (MS), existing evidence regarding the effectiveness and safety of this strategy remains inconclusive. Thus, the primary aim of this systematic review and meta-analysis (SRMA) was to comprehensively assess the effectiveness and safety of MSC therapy in individuals diagnosed with MS. A comprehensive search was conducted using appropriate keywords in the PubMed, Scopus, Cochrane, ScienceDirect, and Google Scholar databases to determine the eligible studies. The change in the expanded disability status scale (EDSS) score from baseline to follow-up was used to assess MSC efficacy. The effectiveness of the therapy was assessed using a random-effects model, which calculated the combined prevalence and 95% confidence intervals (CIs) for MS patients who experienced improvement, stability, or worsening of their condition. The protocol was registered in PROSPERO (CRD42020209671). The findings indicate that 40.4% (95% CI: 30.6–50.2) of MS patients exhibited improvements following MSC therapy, 32.8% (95% CI: 25.5–40.1) remained stable, and 18.1% (95% CI: 12.0–24.2) experienced a worsening of their condition. Although no major complications were observed, headaches 57.6 [37.9–77.3] and fever 53.1 [20.7–85.4] were commonly reported as minor adverse events. All of the results reported in this meta-analysis are consistent and credible according to the sensitivity analyses. Regardless of different individual studies, our meta-analysis provides a comprehensive overview showing the potential of MSC therapy as a possible effective treatment strategy for patients with MS. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Multiple Sclerosis)
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