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  1. Article ; Online: Tele-health in neurology: an indispensable tool in the management of the SARS-CoV-2 epidemic.

    Capra, Ruggero / Mattioli, Flavia

    Journal of neurology

    2020  Volume 267, Issue 7, Page(s) 1885–1886

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Disease Management ; Humans ; Nervous System Diseases/epidemiology ; Nervous System Diseases/therapy ; Neurology/methods ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; SARS-CoV-2 ; Telemedicine/methods
    Keywords covid19
    Language English
    Publishing date 2020-05-12
    Publishing country Germany
    Document type Letter ; Review
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-020-09898-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Ocrelizumab for the Treatment of Multiple Sclerosis: Safety, Efficacy, and Pharmacology.

    Mancinelli, Chiara Rosa / Rossi, Nicola De / Capra, Ruggero

    Therapeutics and clinical risk management

    2021  Volume 17, Page(s) 765–776

    Abstract: The success of selective B-cells depleting therapies, as the anti-CD20 antibodies, in patients with multiple sclerosis (MS) has confirmed that B-cells are critical in the immune pathogenesis of the disease. Ocrelizumab, a humanized monoclonal antibody ... ...

    Abstract The success of selective B-cells depleting therapies, as the anti-CD20 antibodies, in patients with multiple sclerosis (MS) has confirmed that B-cells are critical in the immune pathogenesis of the disease. Ocrelizumab, a humanized monoclonal antibody that selectively targets CD20+ B-cells, profoundly suppresses acute inflammatory disease activity, representing a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS). It is also the first proven therapy able to slow disability progression in primary progressive multiple sclerosis (PPMS), particularly in patients with signs of acute radiological activity before being enrolled. Effectiveness has widely been demonstrated in randomized clinical trials (RCTs), and recently confirmed in open-label extension trials. Here, we review the role of B-cells in MS, the mechanism of action of ocrelizumab, its pharmacokinetics and pharmacodynamics, and the clinical data supporting its use, as well as safety data. We focus on issues related to the maintenance of immunocompetence, essential to ensure an immune response to either a primary infection or a vaccination. Lastly, we discuss about the possible role of ocrelizumab as an exit strategy from natalizumab-treated patients at risk of developing multifocal progressive leukoencephalopathy. In view of using ocrelizumab chronically, collecting long-term safety data and finding strategies to minimize adverse events will be extremely relevant.
    Language English
    Publishing date 2021-07-30
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2186560-7
    ISSN 1178-203X ; 1176-6336
    ISSN (online) 1178-203X
    ISSN 1176-6336
    DOI 10.2147/TCRM.S282390
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  4. Article ; Online: Tele-health in neurology

    Capra, Ruggero / Mattioli, Flavia

    Journal of Neurology

    an indispensable tool in the management of the SARS-CoV-2 epidemic

    2020  Volume 267, Issue 7, Page(s) 1885–1886

    Keywords Neurology ; Clinical Neurology ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    ZDB-ID 187050-6
    ISSN 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    ISSN (online) 1432-1459
    ISSN 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X
    DOI 10.1007/s00415-020-09898-x
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Changes in Brain Volumes Are Relevant during Natalizumab-Associated Progressive Multifocal Leukoencephalopathy: Lessons from a Case Report.

    De Masi, Roberto / Orlando, Stefania / Armenise, Silvia / Spagnolo, Pantaleo / Capra, Ruggero / Costa, Maria Carmela

    International journal of molecular sciences

    2022  Volume 23, Issue 21

    Abstract: This is a case report concerning a Natalizumab-associated Progressive Multifocal Leukoencephalopathy (PML) with cerebellar localization and wakefulness disturbances. Awakening and clinical improvement dramatically occurred as soon as the immune ... ...

    Abstract This is a case report concerning a Natalizumab-associated Progressive Multifocal Leukoencephalopathy (PML) with cerebellar localization and wakefulness disturbances. Awakening and clinical improvement dramatically occurred as soon as the immune reconstitution inflammatory syndrome (IRIS) took place, being it mild in nature and colocalizing with the PML lesion. In these ideal experimental conditions, we applied brain magnetic resonance imaging post-analysis in order to know changes in brain volumes underlying the pathological process over the infection period. White matter volume increased with a decrease in grey matter during IRIS. Conversely, we found a constant increase in cerebrospinal fluid volume throughout the duration of PML, suggesting a widespread abiotrophic effect, far from the lesion. Furthermore, brain parenchymal fraction significantly decreased as expected while the total brain volume remained stable at all times. Neurodegeneration is the main contributor to the steady disability in Natalizumab-associated PML. This process is thought to be widespread and inflammatory in nature as well as sustained by IRIS and humoral factors derived from the PML lesion.
    MeSH term(s) Humans ; Natalizumab/adverse effects ; Leukoencephalopathy, Progressive Multifocal/diagnostic imaging ; Leukoencephalopathy, Progressive Multifocal/etiology ; Leukoencephalopathy, Progressive Multifocal/pathology ; Immune Reconstitution Inflammatory Syndrome/etiology ; Immune Reconstitution Inflammatory Syndrome/complications ; Magnetic Resonance Imaging ; Brain/diagnostic imaging ; Brain/pathology ; Multiple Sclerosis/pathology
    Chemical Substances Natalizumab
    Language English
    Publishing date 2022-11-07
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms232113642
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  6. Article ; Online: Multiple Sclerosis Progressive Courses: A Clinical Cohort Long-Term Disability Progression Study.

    Cortesi, Paolo A / Fornari, Carla / Capra, Ruggero / Cozzolino, Paolo / Patti, Francesco / Mantovani, Lorenzo G

    Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

    2022  Volume 25, Issue 9, Page(s) 1489–1498

    Abstract: Objectives: Improving the understanding of multiple sclerosis (MS) mechanism and disability progression over time is essential to assess the value of healthcare interventions. Poor or no data on disability progression are available for progressive ... ...

    Abstract Objectives: Improving the understanding of multiple sclerosis (MS) mechanism and disability progression over time is essential to assess the value of healthcare interventions. Poor or no data on disability progression are available for progressive courses. This study aims to fill this gap.
    Methods: An observational cohort study of patients with primary MS (PPMS) and secondary progressive MS (SPMS) was conducted on 2 Italian MS centers disease registries over an observational time of 34 years. Annual transition probabilities among Expanded Disability Status Scale (EDSS) states were estimated using continuous Markov models. A sensitivity analysis was performed in relation to clinical characteristic associated to disability progression.
    Results: The study cohort included 758 patients (274 PPMS and 434 SPMS) with a median follow-up of 8.2 years. Annual transition probability matrices of SPMS and PPMS reported different annual probabilities to move within EDSS levels. Excluding EDSS associated to relapse events or patient with relapses, the annual probability of staying stable in an EDSS level increased in both disease courses even not significantly.
    Conclusions: This study provides estimates of annual disability progression as EDSS changes for PPMS and SPMS. These estimates could be a useful tool for healthcare decision makers and clinicians to properly assess impact of clinical interventions.
    MeSH term(s) Cohort Studies ; Disability Evaluation ; Disease Progression ; Humans ; Longitudinal Studies ; Multiple Sclerosis/epidemiology ; Multiple Sclerosis, Chronic Progressive/epidemiology ; Recurrence
    Language English
    Publishing date 2022-04-26
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1471745-1
    ISSN 1524-4733 ; 1098-3015
    ISSN (online) 1524-4733
    ISSN 1098-3015
    DOI 10.1016/j.jval.2022.03.010
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    Zs.A 5904: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  7. Article ; Online: Changes in Brain Volumes Are Relevant during Natalizumab-Associated Progressive Multifocal Leukoencephalopathy

    Roberto De Masi / Stefania Orlando / Silvia Armenise / Pantaleo Spagnolo / Ruggero Capra / Maria Carmela Costa

    International Journal of Molecular Sciences, Vol 23, Iss 13642, p

    Lessons from a Case Report

    2022  Volume 13642

    Abstract: This is a case report concerning a Natalizumab-associated Progressive Multifocal Leukoencephalopathy (PML) with cerebellar localization and wakefulness disturbances. Awakening and clinical improvement dramatically occurred as soon as the immune ... ...

    Abstract This is a case report concerning a Natalizumab-associated Progressive Multifocal Leukoencephalopathy (PML) with cerebellar localization and wakefulness disturbances. Awakening and clinical improvement dramatically occurred as soon as the immune reconstitution inflammatory syndrome (IRIS) took place, being it mild in nature and colocalizing with the PML lesion. In these ideal experimental conditions, we applied brain magnetic resonance imaging post-analysis in order to know changes in brain volumes underlying the pathological process over the infection period. White matter volume increased with a decrease in grey matter during IRIS. Conversely, we found a constant increase in cerebrospinal fluid volume throughout the duration of PML, suggesting a widespread abiotrophic effect, far from the lesion. Furthermore, brain parenchymal fraction significantly decreased as expected while the total brain volume remained stable at all times. Neurodegeneration is the main contributor to the steady disability in Natalizumab-associated PML. This process is thought to be widespread and inflammatory in nature as well as sustained by IRIS and humoral factors derived from the PML lesion.
    Keywords JC virus ; multiple sclerosis ; progressive multifocal leukoencephalopathy ; brain segmentation ; MRI post-processing ; Biology (General) ; QH301-705.5 ; Chemistry ; QD1-999
    Subject code 616
    Language English
    Publishing date 2022-11-01T00:00:00Z
    Publisher MDPI AG
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Bilateral visual loss recovering after tadalafil withdrawal.

    Cordioli, Cinzia / Capra, Ruggero

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

    2016  Volume 37, Issue 5, Page(s) 809–810

    MeSH term(s) Aged ; Blindness/chemically induced ; Erectile Dysfunction/drug therapy ; Humans ; Male ; Phosphodiesterase 5 Inhibitors/adverse effects ; Substance Withdrawal Syndrome/etiology ; Tadalafil/adverse effects
    Chemical Substances Phosphodiesterase 5 Inhibitors ; Tadalafil (742SXX0ICT)
    Language English
    Publishing date 2016-05
    Publishing country Italy
    Document type Case Reports ; Letter
    ZDB-ID 2016546-8
    ISSN 1590-3478 ; 1590-1874
    ISSN (online) 1590-3478
    ISSN 1590-1874
    DOI 10.1007/s10072-015-2447-z
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    Zs.A 1877: Show issues Location:
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  9. Article ; Online: Age-Related Lymphocyte Output During Disease-Modifying Therapies for Multiple Sclerosis.

    Paghera, Simone / Sottini, Alessandra / Previcini, Vanessa / Capra, Ruggero / Imberti, Luisa

    Drugs & aging

    2020  Volume 37, Issue 10, Page(s) 739–746

    Abstract: Background: Patients with multiple sclerosis exhibit the same qualitative and quantitative changes in immune system cells observed in aging. In the last 20 years, multiple sclerosis patients have shown an increase in life expectancy and average age, but ...

    Abstract Background: Patients with multiple sclerosis exhibit the same qualitative and quantitative changes in immune system cells observed in aging. In the last 20 years, multiple sclerosis patients have shown an increase in life expectancy and average age, but clinical trial inclusion criteria typically exclude patients over the age of 55 years. Therefore, disease-modifying therapies are likely administered to patients older than those enrolled in clinical trials.
    Objective: In order to investigate whether disease-modifying therapies for multiple sclerosis induce modifications to the immune system that may have (super)additive effects resulting in an acceleration of immunosenescence, we quantified the number of T-cell receptor excision circles (TRECs) and K-deleting recombination excision circles (KRECs). These molecules are contained in new T and B lymphocytes released by the thymus and bone marrow and are considered molecular age-related markers.
    Methods: The markers of aging were measured by a multiplex quantitative real-time PCR assay in 122 patients who had started therapy with interferon-beta (IFN-β), fingolimod, alemtuzumab, or natalizumab. Samples were obtained before the therapy and at 6 and 12 months of treatment. Comparisons between the variables were performed by a non-parametric statistical analysis.
    Results: In therapy-naive patients, a significant and direct correlation was found between a lower number of newly produced T and B cells and older age. Although disease-modifying therapies induced different changes (both increases and decreases) in the production of new T and B lymphocytes, 12 months of therapy with IFN-β or natalizumab did not affect the correlations found at baseline between the release of lymphocytes containing TRECs or KRECs and age. On the contrary, in patients treated with alemtuzumab, both correlations were lost, while in fingolimod-treated patients, only the correlation between TRECs and age disappeared.
    Conclusions: This observational study indicated that different age-related changes of the new T and B lymphocyte production could be one of the reasons for the emergence, in the real-world setting, of adverse events not otherwise observed in clinical trials; thus, caution is advised when choosing disease-modifying therapies for multiple sclerosis patients.
    MeSH term(s) Age Factors ; Aged ; B-Lymphocytes/cytology ; B-Lymphocytes/drug effects ; B-Lymphocytes/immunology ; Bone Marrow/drug effects ; Bone Marrow/immunology ; Female ; Humans ; Immunosenescence/drug effects ; Immunosenescence/genetics ; Immunosuppressive Agents/therapeutic use ; Male ; Multiple Sclerosis/drug therapy ; Multiple Sclerosis/immunology ; Receptors, Antigen, T-Cell/genetics ; Receptors, Antigen, T-Cell/immunology ; Recombination, Genetic ; T-Lymphocytes/cytology ; T-Lymphocytes/drug effects ; T-Lymphocytes/immunology ; Thymus Gland/drug effects ; Thymus Gland/immunology
    Chemical Substances Immunosuppressive Agents ; Receptors, Antigen, T-Cell
    Language English
    Publishing date 2020-08-05
    Publishing country New Zealand
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1075770-3
    ISSN 1179-1969 ; 1170-229X
    ISSN (online) 1179-1969
    ISSN 1170-229X
    DOI 10.1007/s40266-020-00789-4
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    Zs.A 3481: Show issues Location:
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  10. Article ; Online: Immune profiling of a patient with alemtuzumab-associated progressive multifocal leukoencephalopathy.

    Gerevini, Simonetta / Capra, Ruggero / Bertoli, Diego / Sottini, Alessandra / Imberti, Luisa

    Multiple sclerosis (Houndmills, Basingstoke, England)

    2019  Volume 25, Issue 8, Page(s) 1196–1201

    Abstract: A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic-clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal fluid (CSF) and lesion iconography at magnetic resonance ... ...

    Abstract A 31-year-old woman affected by multiple sclerosis (MS) experienced generalized tonic-clonic seizures 2 months after the second alemtuzumab cycle. Positive JC virus (JCV)-DNA in cerebrospinal fluid (CSF) and lesion iconography at magnetic resonance imaging (MRI) were suggestive of progressive multifocal leukoencephalopathy (PML). After 1 month, during full-blown immune reconstitution inflammatory syndrome, JCV-DNA became negative and symptoms gradually improved. New T- and B-cell output and T- and B-cell diversity were low and lymphocytes poorly responded to stimulation. This is the first case of an alemtuzumab-treated patient with clinical symptoms and radiological features compatible with PML. The lack of large T- and B-cell diversity, necessary for JCV recognition, is likely to have concurred to PML insurgence.
    MeSH term(s) Adult ; Alemtuzumab/adverse effects ; Female ; Humans ; Immunologic Factors/adverse effects ; Leukoencephalopathy, Progressive Multifocal/chemically induced ; Multiple Sclerosis/drug therapy
    Chemical Substances Immunologic Factors ; Alemtuzumab (3A189DH42V)
    Language English
    Publishing date 2019-04-09
    Publishing country England
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1290669-4
    ISSN 1477-0970 ; 1352-4585
    ISSN (online) 1477-0970
    ISSN 1352-4585
    DOI 10.1177/1352458519832259
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