Contributions
Abstract: P828
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Natalizumab (NTZ) not only reduces relapses, but may also improve disability in certain multiple sclerosis (MS) patients. The mechanism of action for such improvement is not well-understood. One hypothesis would be a possible effect of NTZ on remyelination, however the verification has been hindered by the non-specific nature of conventional T2-weighted images (T2WI). We have recently developed a clinically-feasible myelin-specific MRI modality named q-space Myelin Map (qMM; Fujiyoshi et al, J Neurosci (2016)) and have shown a possible involvement of remyelination as confirmed by qMM in disability improvement under fingolimod treatment (Tanikawa et al, J Neurol Sci (2017)).
Objective: To analyze possible involvement of remyelination in disability improvement under NTZ treatment by utilizing qMM imaging.
Methods: Seven consecutive MS patients treated with NTZ were included in the study. A longitudinal analysis of qMM was performed with 3-month intervals. Expanded disability status scale (EDSS) and qMM analysis was performed by different board-certified neurologists in an independent manner. This study was approved in advance by ethics committee at Keio University School of Medicine (#20110364).
Results: During the treatment course (average of 15.7 months), two patients (28.6%) exhibited improvement and the rest maintained their EDSS. No new or enlarging T2-lesions nor contrast-enhancing lesions were noted in the study population. However, their qMM revealed presence of remyelination during NTZ treatment in three patients (42.9%), including the two who exhibited improvement in their EDSS. Baseline age (33.3±8.3 vs. 37.5±9.9) and EDSS (4.5±2.6 vs. 3.8±2.5) did not differ between patient groups with or without remyelination under NTZ treatment.
Conclusions: qMM-supported remyelination was confirmed in a subset of NTZ-treated MS patients, and therefore remyelination may be at least partially involved in the observed EDSS improvement under NTZ treatment. A larger clinical study is required to draw a final conclusion.
Disclosure: Disclosures: J.N. received honoraria from Biogen, Mitsubishi Tanabe, Novartis, and Takeda, served as a paid scientific advisor to Biogen, Novartis, and Takeda. H.O. served as a paid member of scientific advisory board of SanBio Co. Ltd. Other authors have nothing to disclose. This study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan and by a research grant from The Takeda Science Foundation to J.N., and by Brain Mapping by Integrated Neurotechnologies for Disease Studies (Brain/MINDS) from MEXT and the Japan Agency for Medical Research and Development (AMED) to H.O.
Abstract: P828
Type: Poster Sessions
Abstract Category: Pathology and pathogenesis of MS - MRI and PET
Background: Natalizumab (NTZ) not only reduces relapses, but may also improve disability in certain multiple sclerosis (MS) patients. The mechanism of action for such improvement is not well-understood. One hypothesis would be a possible effect of NTZ on remyelination, however the verification has been hindered by the non-specific nature of conventional T2-weighted images (T2WI). We have recently developed a clinically-feasible myelin-specific MRI modality named q-space Myelin Map (qMM; Fujiyoshi et al, J Neurosci (2016)) and have shown a possible involvement of remyelination as confirmed by qMM in disability improvement under fingolimod treatment (Tanikawa et al, J Neurol Sci (2017)).
Objective: To analyze possible involvement of remyelination in disability improvement under NTZ treatment by utilizing qMM imaging.
Methods: Seven consecutive MS patients treated with NTZ were included in the study. A longitudinal analysis of qMM was performed with 3-month intervals. Expanded disability status scale (EDSS) and qMM analysis was performed by different board-certified neurologists in an independent manner. This study was approved in advance by ethics committee at Keio University School of Medicine (#20110364).
Results: During the treatment course (average of 15.7 months), two patients (28.6%) exhibited improvement and the rest maintained their EDSS. No new or enlarging T2-lesions nor contrast-enhancing lesions were noted in the study population. However, their qMM revealed presence of remyelination during NTZ treatment in three patients (42.9%), including the two who exhibited improvement in their EDSS. Baseline age (33.3±8.3 vs. 37.5±9.9) and EDSS (4.5±2.6 vs. 3.8±2.5) did not differ between patient groups with or without remyelination under NTZ treatment.
Conclusions: qMM-supported remyelination was confirmed in a subset of NTZ-treated MS patients, and therefore remyelination may be at least partially involved in the observed EDSS improvement under NTZ treatment. A larger clinical study is required to draw a final conclusion.
Disclosure: Disclosures: J.N. received honoraria from Biogen, Mitsubishi Tanabe, Novartis, and Takeda, served as a paid scientific advisor to Biogen, Novartis, and Takeda. H.O. served as a paid member of scientific advisory board of SanBio Co. Ltd. Other authors have nothing to disclose. This study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan and by a research grant from The Takeda Science Foundation to J.N., and by Brain Mapping by Integrated Neurotechnologies for Disease Studies (Brain/MINDS) from MEXT and the Japan Agency for Medical Research and Development (AMED) to H.O.