Mariko Tanikawa1, Jin Nakahara2, Junichi Hata3, Shigeaki Suzuki1, Kanehiro Fujiyoshi4, Hirokazu Fujiwara5, Suketaka Momoshima5, Masahiro Jinzaki5, Masaya Nakamura6, Hideyuki Okano3, Shinichi Takahashi1, Norihiro Suzuki7. 1. Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. 2. Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: nakahara@a6.keio.jp. 3. Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; Laboratory for Marmoset Neural Architecture, RIKEN Brain Science Institute, 2-1 Hirosawa, Wako, Saitama 351-0106, Japan. 4. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan; National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan. 5. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, 160-8582, Japan. 6. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. 7. Department of Neurology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Electronic address: nrsuzuki@a2.keio.jp.
Abstract
BACKGROUND: Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models. OBJECTIVE: To analyze feasibility of a novel q-space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MS patients. METHODS: Treatment outcomes of 24 consecutive MS patients treated with FTY were analyzed. A longitudinal analysis of q-space Myelin Map imaging was performed in a subset of these patients. RESULTS: During the treatment course (average of 16.1months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state ("optimal responders"). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q-space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions. CONCLUSION: FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q-Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MS patients.
BACKGROUND:Fingolimod (FTY) is an oral sphingosine-1-phosphate receptor modulator that reduces relapse and slows brain atrophy in multiple sclerosis (MS) patients. In addition, FTY has been shown to enhance remyelination in certain animal models. OBJECTIVE: To analyze feasibility of a novel q-space Myelin Map imaging to monitor demyelination and remyelination under FTY treatment in MSpatients. METHODS: Treatment outcomes of 24 consecutive MSpatients treated with FTY were analyzed. A longitudinal analysis of q-space Myelin Map imaging was performed in a subset of these patients. RESULTS: During the treatment course (average of 16.1months), 10 patients (42%) exhibited improvement on the Expanded Disability Status Scale (EDSS) or maintained disability-free state ("optimal responders"). The average baseline age and EDSS score were significantly younger and milder in optimal responders compared to the rest of patients. A pilot longitudinal q-space Myelin Map study in 8 patients (including 4 optimal responders) showed that optimal responders tended to show signs of remyelination while exhibiting no newly evolved demyelinated lesions. CONCLUSION:FTY may improve disability in younger patients with milder MS, and absence of demyelination activity and presence of remyelination activity may in part be associated with such improvement. q-Space Myelin Map imaging is a clinically feasible modality to monitor demyelination and remyelination in MSpatients.
Authors: Qiyuan Tian; Grant Yang; Christoph Leuze; Ariel Rokem; Brian L Edlow; Jennifer A McNab Journal: Neuroimage Date: 2019-01-23 Impact factor: 6.556