ABSTRACT
Helminth parasites are highly prevalent in many low- and middle-income countries, in which inflammatory bowel disease and other immunopathologies are less frequent than in the developed world. Many of the most common helminths establish themselves in the gastrointestinal tract and can exert counter-inflammatory influences on the host immune system. For these reasons, interest has arisen as to how parasites may ameliorate intestinal inflammation and whether these organisms, or products they release, could offer future therapies for immune disorders. In this review, we discuss interactions between helminth parasites and the mucosal immune system, as well as the progress being made toward identifying mechanisms and molecular mediators through which it may be possible to attenuate pathology in the intestinal tract.
Subject(s)
Gastrointestinal Tract/parasitology , Helminthiasis/parasitology , Helminths/physiology , Immunity, Mucosal , Intestinal Diseases, Parasitic/parasitology , Animals , Gastrointestinal Tract/immunology , Gastrointestinal Tract/metabolism , Gastrointestinal Tract/pathology , Helminthiasis/immunology , Helminthiasis/metabolism , Helminthiasis/pathology , Helminths/immunology , Helminths/metabolism , Host-Parasite Interactions , Humans , Hygiene Hypothesis , Immunotherapy/methods , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/metabolism , Inflammatory Bowel Diseases/parasitology , Inflammatory Bowel Diseases/therapy , Intestinal Diseases, Parasitic/immunology , Intestinal Diseases, Parasitic/metabolism , Intestinal Diseases, Parasitic/pathology , Symbiosis , Therapy with HelminthsABSTRACT
A possibly causal relationship between multiple sclerosis and chronic cerebrospinal venous insufficiency has recently been hypothesized. Studies investigating chronic cerebrospinal venous insufficiency have reported conflicting results and few have employed multiple diagnostic imaging modalities across a large patient and control population. In this study, three complementary imaging modalities were used to investigate the chronic cerebrospinal venous insufficiency hypothesis in patients with multiple sclerosis and two age- and sex-matched control groups: healthy volunteers and patients with other neurological diseases. Strictly blinded Doppler ultrasound according to the original chronic cerebrospinal venous insufficiency hypothesis; four-dimensional flow magnetic resonance imaging of venous flow in the head, neck, and chest; and contrast-enhanced magnetic resonance venography for neck and chest venous luminography were acquired. An internal jugular vein stenosis evaluation was also performed across modalities. Percentage of subjects meeting ultrasound-based chronic cerebrospinal venous insufficiency criteria was small and similar between groups. In group-wise and pairwise testing, no four-dimensional flow magnetic resonance imaging variables were statistically significantly different, for any measurement location. In contrast-enhanced magnetic resonance venography of the internal jugular and azygos veins, no statistically significant differences were observed in stenosis scores between groups. These results represent compelling evidence against the chronic cerebrospinal venous insufficiency hypothesis in multiple sclerosis.
Subject(s)
Cerebrovascular Circulation/physiology , Magnetic Resonance Angiography/methods , Multiple Sclerosis/diagnostic imaging , Ultrasonography, Doppler/methods , Venous Insufficiency/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Humans , Middle Aged , Multiple Sclerosis/physiopathology , Venous Insufficiency/physiopathologyABSTRACT
The ensemble average propagator (EAP) describes the 3D average diffusion process of water molecules, capturing both its radial and angular contents, and hence providing rich information about complex tissue microstructure properties. Bessel Fourier orientation reconstruction (BFOR) is one of several analytical, non-Cartesian EAP reconstruction schemes employing multiple shell acquisitions that have recently been proposed. Such modeling bases have not yet been fully exploited in the extraction of rotationally invariant q-space indices that describe the degree of diffusion anisotropy/restrictivity. Such quantitative measures include the zero-displacement probability (P(o)), mean squared displacement (MSD), q-space inverse variance (QIV), and generalized fractional anisotropy (GFA), and all are simply scalar features of the EAP. In this study, a general relationship between MSD and q-space diffusion signal is derived and an EAP-based definition of GFA is introduced. A significant part of the paper is dedicated to utilizing BFOR in a clinical dataset, comprised of 5 multiple sclerosis (MS) patients and 4 healthy controls, to estimate P(o), MSD, QIV, and GFA of corpus callosum, and specifically, to see if such indices can detect changes between normal appearing white matter (NAWM) and healthy white matter (WM). Although the sample size is small, this study is a proof of concept that can be extended to larger sample sizes in the future.
Subject(s)
Algorithms , Brain/pathology , Diffusion Magnetic Resonance Imaging/methods , Image Interpretation, Computer-Assisted/methods , Multiple Sclerosis/pathology , Pattern Recognition, Automated/methods , Humans , Image Enhancement/methods , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
There is a long history of research into body fluid biomarkers in neurodegenerative and neuroinflammatory diseases. However, only a few biomarkers in cerebrospinal fluid (CSF) are being used in clinical practice. Anti-aquaporin-4 antibodies in serum are currently useful for the diagnosis of neuromyelitis optica (NMO), but we could expect novel CSF biomarkers that help define prognosis and response to treatment for this disease. One of the most critical factors in biomarker research is the inadequate powering of studies performed by single centers. Collaboration between investigators is needed to establish large biobanks of well-defined samples. A key issue in collaboration is to establish standardized protocols for biobanking to ensure that the statistical power gained by increasing the numbers of CSF samples is not compromised by pre-analytical factors. Here, consensus guidelines for CSF collection and biobanking are presented, based on the guidelines that have been published by the BioMS-eu network for CSF biomarker research. We focussed on CSF collection procedures, pre-analytical factors and high quality clinical and paraclinical information. Importantly, the biobanking protocols are applicable for CSF biobanks for research targeting any neurological disease.
Subject(s)
Helminthiasis/immunology , Helminthiasis/therapy , Host-Parasite Interactions/immunology , Multiple Sclerosis/immunology , Multiple Sclerosis/therapy , Nematode Infections/immunology , Nematode Infections/therapy , Animals , Developing Countries , Helminthiasis/parasitology , Humans , Hygiene/standards , Multiple Sclerosis/parasitology , Nematode Infections/parasitologySubject(s)
Astrocytoma/diagnosis , Brain Neoplasms/diagnosis , Brain/pathology , Myelin Sheath/pathology , Neoplasms, Neuroepithelial/diagnosis , Paresis/etiology , Astrocytoma/complications , Astrocytoma/pathology , Biopsy , Brain Neoplasms/complications , Brain Neoplasms/pathology , Brain Stem/pathology , Cerebral Cortex/pathology , Demyelinating Diseases/diagnosis , Diagnosis, Differential , Disease Progression , Dysarthria/etiology , Fatal Outcome , Gait Disorders, Neurologic/etiology , Humans , Lymphoma, Non-Hodgkin/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Sclerosis/diagnosis , Neoplasms, Neuroepithelial/complications , Neoplasms, Neuroepithelial/pathology , Personality , Vision Disorders/etiologyABSTRACT
OBJECTIVE: This article will discuss the diagnosis of multiple sclerosis (MS), with particular attention to differentiating it from other diseases that can mimic it. METHODS: We reviewed our own data, as well as the published experience on the differential diagnosis of MS and the most common errors leading to misdiagnosis. RESULTS: Psychiatric diseases are mistaken for multiple sclerosis more often than any other conditions. Other multifocal illnesses or white-matter diseases are seldom confused with multiple sclerosis. CONCLUSION: Neurologists are most likely to misdiagnose multiple sclerosis in patients who have psychiatric problems or who have uncommon presentations of common diseases such as migraine, stroke, or neuropathies.
Subject(s)
Central Nervous System/physiopathology , Diagnostic Errors/prevention & control , Mental Disorders/diagnosis , Multiple Sclerosis/diagnosis , Central Nervous System/pathology , Diagnosis, Differential , Encephalitis/diagnosis , Encephalitis/immunology , Encephalitis/physiopathology , False Positive Reactions , Humans , Mental Disorders/physiopathology , Mental Disorders/psychology , Multiple Sclerosis/physiopathology , Multiple Sclerosis/psychology , Physician-Patient Relations , Predictive Value of TestsSubject(s)
Hygiene , Multiple Sclerosis/epidemiology , Animals , Humans , Multiple Sclerosis/parasitology , Trichuriasis/epidemiology , TrichurisABSTRACT
The noninvasive discrimination of myelin disease from axonal loss and other pathologic confounds remains an unsolved problem in multiple sclerosis but may be possible through magnetic resonance quantitation of the intramyelinic water compartment. Technical challenges have limited the study of this approach in the spinal cord, a common site of involvement in multiple sclerosis. This technical note reports the test-retest reproducibility of a short T2-based estimate of myelin content in human spinal cord in vivo.
Subject(s)
Body Water , Magnetic Resonance Imaging/methods , Multiple Sclerosis/pathology , Myelin Sheath/pathology , Spinal Cord/pathology , Algorithms , Cervical Vertebrae , Humans , Reproducibility of ResultsABSTRACT
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition affecting the peripheral nervous system; however, it has been associated with central nervous system (CNS) involvement. The natural history and response to treatment of these CNS lesions are unknown. We report the case of a patient with CIDP which met research criteria for definite CIDP and associated symptomatic CNS lesions. She had resolution of her CNS-based clinical and radiographic findings with intravenous immunoglobulin (IVIG) therapy. IVIG is a reasonable treatment option when symptomatic, CIDP-associated CNS lesions are present.