Special Issue "Personalized Diagnosis and Therapy for Multiple Sclerosis"

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (10 November 2021) | Viewed by 8655

Special Issue Editor

Dr. Cristina M. Ramo-Tello
E-Mail Website
Guest Editor
Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol Hospital, Badalona 08916, Badalona, Spain
Interests: multiple sclerosis; neuroscience; regenerative medicine; molecular biology

Special Issue Information

Dear Colleagues,

Current management of multiple sclerosis (MS) takes advantage of the many disease-modifying therapeutics of anti-inflammatory and immunomodulatory nature, but people with MS need to be cared for in a new and personalized profound way. We need to evaluate clinical and subclinical changes with greater accuracy through more precise imaging and molecular biomarkers. Advance therapies such as cell therapy, mRNA vaccine technology and regenerative medicine are a way to provide therapeutic solutions. A personalized immunogram would help us to determine whether a treatment will have optimal results and be the best way to predict the response of immunotherapy in the patient. Large datasets and MS registries generated in a real-world setting will allow a joint analysis of very large sets of structured data, improving the life of people with MS.

Background: People with MS need to be cared for in a new and personalized profound way.

Aim and scope: Increase diagnostic sensitivity, augment detection, improve treatment and patient care.

History: Does it make sense to continue growing exponentially and continuously in immunosuppressive therapies?

Cutting-edge research: Novel diagnostic techniques and targeted therapies.

What kind of paper are we looking for? A paper that mobilizes the creation of these new ideas and solutions.

Dr. Cristina M. Ramo-Tello
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multiple sclerosis personalized therapy
  • research in image biomarkers
  • advanced therapies
  • prevention with big data
  • neuroprotective and regenerative treatment strategies
  • mRNA vaccine approach
  • MS multiple sclerosis relapse treatment

Published Papers (9 papers)

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Editorial

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Editorial
Personalized Diagnosis and Therapy for Multiple Sclerosis
J. Pers. Med. 2022, 12(6), 1017; https://doi.org/10.3390/jpm12061017 - 20 Jun 2022
Viewed by 322
Abstract
This Special Issue, entitled “Personalized Diagnosis and Therapy for Multiple Sclerosis” encompasses eight publications that we consider relevant, because their reading will help the clinician working regularly with people who suffer from multiple sclerosis (MS) [...] Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)

Research

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Article
Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder
J. Pers. Med. 2022, 12(5), 743; https://doi.org/10.3390/jpm12050743 - 02 May 2022
Cited by 1 | Viewed by 712
Abstract
Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive [...] Read more.
Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive differences according to their serostatus; furthermore, we aimed to assess the relationship between cognition, demographic and clinical characteristics, and other aspects linked to health-related quality of life (HRQoL). Methods: This cross-sectional study included 41 patients (median age, 44 years; 85% women) from 13 Spanish centres. Demographic and clinical characteristics were collected along with a cognitive z-score (Rao’s Battery) and HRQoL patient-centred measures, and their relationship was explored using linear regression. We used the Akaike information criterion to model which characteristics were associated with cognition. Results: Fourteen patients (34%) had CI, and the most affected cognitive domain was visual memory. Cognition was similar in AQP4-IgG-positive and -negative patients. Gender, mood, fatigue, satisfaction with life, and perception of stigma were associated with cognitive performance (adjusted R2 = 0.396, p < 0.001). Conclusions: The results highlight the presence of CI and its impact on HRQoL in NMOSD patients. Cognitive and psychological assessments may be crucial to achieve a holistic approach in patient care. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Article
Innovating Care in Multiple Sclerosis: Feasibility of Synchronous Internet-Based Teleconsultation for Longitudinal Clinical Monitoring
J. Pers. Med. 2022, 12(3), 433; https://doi.org/10.3390/jpm12030433 - 10 Mar 2022
Cited by 1 | Viewed by 542
Abstract
The ‘coronavirus disease of 2019’ crisis has recently forced an expedited adoption of teleconsultation (TC) in most medical domains. Short-term digital interventions have generally been associated with feasibility, clinical benefits, user satisfaction, and cost-effectiveness in patients with multiple sclerosis (MS) but outcomes after [...] Read more.
The ‘coronavirus disease of 2019’ crisis has recently forced an expedited adoption of teleconsultation (TC) in most medical domains. Short-term digital interventions have generally been associated with feasibility, clinical benefits, user satisfaction, and cost-effectiveness in patients with multiple sclerosis (MS) but outcomes after repeated utilization over extended periods need to be further evaluated. In this feasibility study, 60 subjects with MS were 1:1 randomized to receive standard care augmented by four TCs using an audiovisual Internet platform (intervention) versus standard care alone (controls), over a period of 12 months. Effects on functional status, medical costs, and satisfaction were explored as secondary outcomes. Eighty-nine out of 108 scheduled TCs (82.4%) were completed, and 26 patients could complete at least one TC (86.7%), meeting our prespecified feasibility target of 80%. The intervention did not lead to significant differences in functional status (with the potential exception of fatigue) nor medical costs. Most interventional patients declared themselves to be (very) satisfied about the quality of care and technical aspects associated with the TCs. Our results demonstrate that longitudinal clinical monitoring using real-time audiovisual TC over the Internet is feasible and well-received by patients with MS. Such an approach can be a promising new care strategy. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Article
Recommendations for the Diagnosis and Treatment of Multiple Sclerosis Relapses
J. Pers. Med. 2022, 12(1), 6; https://doi.org/10.3390/jpm12010006 - 22 Dec 2021
Cited by 2 | Viewed by 1232
Abstract
Minimizing the risk of relapse is essential in multiple sclerosis (MS). As none of the treatments currently available are capable of completely preventing relapses, treatment of these episodes remains a cornerstone of MS care. The objective of this manuscript is to reduce uncertainty [...] Read more.
Minimizing the risk of relapse is essential in multiple sclerosis (MS). As none of the treatments currently available are capable of completely preventing relapses, treatment of these episodes remains a cornerstone of MS care. The objective of this manuscript is to reduce uncertainty and improve quality of care of this neurological process. This article addresses definitions of key concepts, recommendations for clinical examination, classification criteria, magnetic resonance imaging, biomarkers, and specific therapeutic counsels including special populations such as pregnant and breastfeeding women, and children. An algorithm for treating MS relapses is also provided. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Article
Assessing Blood-Based Biomarkers to Define a Therapeutic Window for Natalizumab
J. Pers. Med. 2021, 11(12), 1347; https://doi.org/10.3390/jpm11121347 - 10 Dec 2021
Cited by 1 | Viewed by 776
Abstract
Natalizumab is a monoclonal antibody that binds CD49d. Although it is one of the most effective treatments for Relapsing-Remitting Multiple Sclerosis (RRMS), a dosing regimen has not been optimized for safety and efficacy in individual patients. We aimed to identify biomarkers to monitor [...] Read more.
Natalizumab is a monoclonal antibody that binds CD49d. Although it is one of the most effective treatments for Relapsing-Remitting Multiple Sclerosis (RRMS), a dosing regimen has not been optimized for safety and efficacy in individual patients. We aimed to identify biomarkers to monitor Natalizumab treatment and to establish a personalized dose utilizing an ongoing longitudinal study in 29 RRMS patients under Natalizumab with standard interval dose (SD) of 300 mg/4wks or extended interval dose (EID) of 300 mg/6wks. Blood samples were analyzed by flow cytometry to determine CD49d saturation and expression in several T and B lymphocytes subpopulations. Each patient was analyzed at two different timepoints separated by 3 Natalizumab administrations. Natalizumab and sVCAM-1 levels in serum were also analyzed using ELISA. To determine the reproducibility of various markers, two different timepoints were compared and no significant differences were observed for CD49d expression nor for saturation; SD patients had higher saturation levels (~80%) than EID patients (~60%). A positive correlation exists between CD49d saturation and Natalizumab serum levels. CD49d expression and saturation are stable parameters that could be used as biomarkers in the immunomonitoring of Natalizumab treatment. Moreover, Natalizumab and sVCAM-1 serum levels could be used to optimize an individual’s dosing schedule. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Article
Associations between Lifestyle Behaviors and Quality of Life Differ Based on Multiple Sclerosis Phenotype
J. Pers. Med. 2021, 11(11), 1218; https://doi.org/10.3390/jpm11111218 - 17 Nov 2021
Cited by 2 | Viewed by 1149
Abstract
Multiple sclerosis (MS), a neuroinflammatory disorder, occurs as non-progressive or progressive phenotypes; both forms present with diverse symptoms that may reduce quality of life (QoL). Adherence to healthy lifestyle behaviors has been associated with higher QoL in people with MS; whether these associations [...] Read more.
Multiple sclerosis (MS), a neuroinflammatory disorder, occurs as non-progressive or progressive phenotypes; both forms present with diverse symptoms that may reduce quality of life (QoL). Adherence to healthy lifestyle behaviors has been associated with higher QoL in people with MS; whether these associations differ based on MS phenotype is unknown. Cross-sectional self-reported observational data from 1108 iConquerMS participants were analysed. Associations between lifestyle behaviors and QoL were assessed by linear regression, and phenotype differences via moderation analyses. Diet, wellness, and physical activity, but not vitamin D or omega-3 supplement use, were associated with QoL. Specifically, certain diet types were negatively associated with QoL in relapsing-remitting MS (RRMS), and positively associated in progressive MS (ProgMS). Participation in wellness activities had mixed associations with QoL in RRMS but was not associated in ProgMS. Physical activity was positively associated with QoL in RRMS and ProgMS. Phenotype differences were observed in diet and wellness with physical QoL, and physical activity with most QoL subdomains. Our findings show lifestyle behaviors are associated with QoL and appear to differ based on MS phenotype. Future studies assessing timing, duration, and adherence of adopting lifestyle behaviors may better inform their role in MS management. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Article
Dynamics and Predictors of Cognitive Impairment along the Disease Course in Multiple Sclerosis
J. Pers. Med. 2021, 11(11), 1107; https://doi.org/10.3390/jpm11111107 - 28 Oct 2021
Cited by 2 | Viewed by 778
Abstract
(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper [...] Read more.
(1) Background: The evolution and predictors of cognitive impairment (CI) in multiple sclerosis (MS) are poorly understood. We aimed to define the temporal dynamics of cognition throughout the disease course and identify clinical and neuroimaging measures that predict CI. (2) Methods: This paper features a longitudinal study with 212 patients who underwent several cognitive examinations at different time points. Dynamics of cognition were assessed using mixed-effects linear spline models. Machine learning techniques were used to identify which baseline demographic, clinical, and neuroimaging measures best predicted CI. (3) Results: In the first 5 years of MS, we detected an increase in the z-scores of global cognition, verbal memory, and information processing speed, which was followed by a decline in global cognition and memory (p < 0.05) between years 5 and 15. From 15 to 30 years of disease onset, cognitive decline continued, affecting global cognition and verbal memory. The baseline measures that best predicted CI were education, disease severity, lesion burden, and hippocampus and anterior cingulate cortex volume. (4) Conclusions: In MS, cognition deteriorates 5 years after disease onset, declining steadily over the next 25 years and more markedly affecting verbal memory. Education, disease severity, lesion burden, and volume of limbic structures predict future CI and may be helpful when identifying at-risk patients. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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Review

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Review
Escalation vs. Early Intense Therapy in Multiple Sclerosis
J. Pers. Med. 2022, 12(1), 119; https://doi.org/10.3390/jpm12010119 - 17 Jan 2022
Cited by 1 | Viewed by 802
Abstract
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure [...] Read more.
The treatment strategy of multiple sclerosis (MS) is a highly controversial debate. Currently, there are up to 19 drugs approved. However, there is no clear evidence to guide fundamental decisions such as what treatment should be chosen in first place, when treatment failure or suboptimal response should be considered, or what treatment should be considered in these cases. The “escalation strategy” consists of starting treatment with drugs of low side-effect profile and low efficacy, and “escalating” to drugs of higher efficacy—with more potential side-effects—if necessary. This strategy has prevailed over the years. However, the evidence supporting this strategy is based on short-term studies, in hope that the benefits will stand in the long term. These studies usually do not consider the heterogeneity of the disease and the limited effect that relapses have on the long-term. On the other hand, “early intense therapy” strategy refers to starting treatment with drugs of higher efficacy from the beginning, despite having a less favorable side-effect profile. This approach takes advantage of the so-called “window of opportunity” in hope to maximize the clinical benefits in the long-term. At present, the debate remains open. In this review, we will critically review both strategies. We provide a summary of the current evidence for each strategy without aiming to reach a definite conclusion. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
Review
Towards Multimodal Machine Learning Prediction of Individual Cognitive Evolution in Multiple Sclerosis
J. Pers. Med. 2021, 11(12), 1349; https://doi.org/10.3390/jpm11121349 - 11 Dec 2021
Cited by 2 | Viewed by 1398
Abstract
Multiple sclerosis (MS) manifests heterogeneously among persons suffering from it, making its disease course highly challenging to predict. At present, prognosis mostly relies on biomarkers that are unable to predict disease course on an individual level. Machine learning is a promising technique, both [...] Read more.
Multiple sclerosis (MS) manifests heterogeneously among persons suffering from it, making its disease course highly challenging to predict. At present, prognosis mostly relies on biomarkers that are unable to predict disease course on an individual level. Machine learning is a promising technique, both in terms of its ability to combine multimodal data and through the capability of making personalized predictions. However, most investigations on machine learning for prognosis in MS were geared towards predicting physical deterioration, while cognitive deterioration, although prevalent and burdensome, remained largely overlooked. This review aims to boost the field of machine learning for cognitive prognosis in MS by means of an introduction to machine learning and its pitfalls, an overview of important elements for study design, and an overview of the current literature on cognitive prognosis in MS using machine learning. Furthermore, the review discusses new trends in the field of machine learning that might be adopted for future studies in the field. Full article
(This article belongs to the Special Issue Personalized Diagnosis and Therapy for Multiple Sclerosis)
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