PMID- 28928709
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 8
DP  - 2017
TI  - Insight into Metabolic (1)H-MRS Changes in Natalizumab Induced Progressive 
      Multifocal Leukoencephalopathy Brain Lesions.
PG  - 454
LID - 10.3389/fneur.2017.00454 [doi]
LID - 454
AB  - BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a severe 
      complication of immunosuppressive therapies, especially of natalizumab in 
      relapsing-remitting multiple sclerosis (MS). Metabolic changes within PML lesions 
      have not yet been described in natalizumab-associated PML in MS patients. 
      OBJECTIVE: To study metabolic profiles in natalizumab-associated PML lesions of 
      MS patients by (1)H magnetic resonance spectroscopy ((1)H-MRS) at different 
      stages during the PML course. To assess changes associated with the occurrence of 
      the immune reconstitution inflammatory syndrome (IRIS). METHODS: 20 patients 
      received (1)H-MRS and imaging at 3 T either in the pre-IRIS, IRIS, 
      early-post-PML, or late post-PML setting. Five of these patients received 
      individual follow-up examinations, including the pre-IRIS or IRIS phase. Clinical 
      worsening was described by changes in the Karnofsky Performance Scale (KPS) and 
      the expanded disability status scale (EDSS) 1 year before PML and scoring at the 
      time of (1)H-MRS. RESULTS: In PML lesions, increased levels of the Lip/Cr ratio, 
      driven by rising of lipid and reduction of Creatine, were found before the 
      occurrence of IRIS (p = 0.014) with a maximum in the PML-IRIS group (p = 0.004). 
      By contrast, marked rises of Cho/Cr in PML lesions were detected exclusively 
      during the IRIS phase (p = 0.003). The Lip/Cr ratio decreased to above-normal 
      levels in early-post-PML (p = 0.007, compared to normal appearing white matter 
      (NAWM)) and to normal levels in the late-post-PML group. NAA/Cho was reduced 
      compared to NAWM in the pre-IRIS, IRIS, and early-post-PML group. In NAA/Cr, the 
      same effect was seen in the pre-IRIS and early-post-PML group. These 
      cross-sectional results were confirmed by the individual follow-up examinations 
      of four patients. NAA/Cho, Cho/Cr, and the lipid rise relative to NAWM in PML 
      lesions were significantly correlated with the residual clinical worsening (KPS 
      change) in post-PML patients (Spearman correlations rho = 0.481, p = 0.018; 
      rho = -0.505, p = 0.014; and rho = -0.488, p = 0.020). CONCLUSION: (1)H-MRS detected 
      clinically significant dynamic changes of metabolic patterns in PML lesions 
      during the course of natalizumab-associated PML in MS patients. Lip/Cr and Cho/Cr 
      may provide additional information for detecting the onset of the IRIS phase in 
      the course of the PML disease.
FAU - Schneider, Ruth
AU  - Schneider R
AD  - Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, 
      Germany.
FAU - Bellenberg, Barbara
AU  - Bellenberg B
AD  - Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. 
      Josef Hospital, Ruhr University Bochum, Bochum, Germany.
FAU - Hoepner, Robert
AU  - Hoepner R
AD  - Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, 
      Germany.
FAU - Ellrichmann, Gisa
AU  - Ellrichmann G
AD  - Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, 
      Germany.
FAU - Gold, Ralf
AU  - Gold R
AD  - Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, 
      Germany.
FAU - Lukas, Carsten
AU  - Lukas C
AD  - Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. 
      Josef Hospital, Ruhr University Bochum, Bochum, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170905
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC5591840
OTO - NOTNLM
OT  - 1H magnetic resonance spectroscopy
OT  - PML lesions
OT  - immune reconstitution inflammatory syndrome
OT  - multiple sclerosis
OT  - natalizumab
OT  - progressive multifocal leukoencephalopathy
EDAT- 2017/09/21 06:00
MHDA- 2017/09/21 06:01
PMCR- 2017/09/05
CRDT- 2017/09/21 06:00
PHST- 2017/04/20 00:00 [received]
PHST- 2017/08/16 00:00 [accepted]
PHST- 2017/09/21 06:00 [entrez]
PHST- 2017/09/21 06:00 [pubmed]
PHST- 2017/09/21 06:01 [medline]
PHST- 2017/09/05 00:00 [pmc-release]
AID - 10.3389/fneur.2017.00454 [doi]
PST - epublish
SO  - Front Neurol. 2017 Sep 5;8:454. doi: 10.3389/fneur.2017.00454. eCollection 2017.