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Evolution of MS lesions to black holes under DNA vaccine treatment

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Abstract

Persistent black holes (PBH) are associated with axonal loss and disability progression in multiple sclerosis (MS). The objective of this work was to determine if BHT-3009, a DNA plasmid-encoding myelin basic protein (MBP), reduces the risk of new lesions becoming PBH, compared to placebo, and to test if pre-treatment serum anti-MBP antibody levels impact on the effect of BHT-3009 treatment. In this retrospective, blinded MRI study, we reviewed MRI scans of 155 MS patients from a double-blind, randomized, phase II trial with three treatment arms (placebo, 0.5 and 1.5 mg BHT-3009). New lesions at weeks 8 and 16 were tracked at week 48 and those appearing as T1-hypointense were classified as PBH. A subset of 46 patients with available pre-treatment serum anti-MBP IgM levels were analyzed separately. Overall, there was no impact of treatment on the risk for PBH. However, there was a significant interaction between anti-MBP antibodies and treatment effect: patients receiving 0.5 mg BHT-3009 showed a reduced risk of PBH with higher antibody levels compared to placebo (p < 0.01). Although we found no overall reduction of the risk for PBH in treated patients, there may be an effect of low-dose BHT-3009, depending on the patients’ pre-treatment immune responses.

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Abbreviations

ABH:

Acute black holes

CL:

Candidate lesions

CSF:

Cerebrospinal fluid

EDSS:

Expanded Disability Status Scale

Gd:

Gadolinium

MBP:

Myelin basic protein

MS:

Multiple sclerosis

MSSS:

MS Severity Score

MTR:

Magnetization transfer ratio

NAA:

N-Acetyl aspartate

NAGM:

Normal appearing grey matter

NAWM:

Normal appearing white matter

NUM:

Number of human MBP peptide epitopes recognized by serum antibodies

PBH:

Persistent black holes

PD-w SE:

Proton density-weighted sequence

RRMS:

Relapsing remitting multiple Sclerosis

T1-w SE:

T1-weighted sequence

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Acknowledgments

The original study was supported by Bayhill Therapeutics. A. Papadopoulou takes full responsibility for the data, the analyses and interpretation, and the conduct of the research, has full access to all of the data, and has the right to publish any and all data separate and apart from any sponsor. We acknowledge the support of Pascal Kuster (MIAC, Basel, Switzerland) and Marcus Weber (Neurology Clinic, Basel, Switzerland) in technical issues as well as the advice and guidance through this study of Danilo Marzetti, Dr. Nicole Müller-Lenke, Dr. Kerstin Bendfeldt (MIAC, Basel, Switzerland) and Thomas Fabbro, PhD (Clinical Trial Unit, University Hospital Basel, Switzerland).

Conflicts of interest

The original study was supported by Bayhill Therapeutics. Athina Papadopoulou, Stefanie von Felten and Stefan Traud have no conflict of interest. Amena Rahman is paid as a consultant from Bayhill Therapeutics. Joanne Quan and Hideki Garren are employees of Bayhill Therapeutics and hold Bayhill stock options. Robert King is employed full-time by Bayhill Therapeutics and receives stock and financial compensation. Lawrence Steinman consults for Bayhill Therapeutics and serves on their Board of Directors. Gary Cutter has received Consulting, Speaking, & Advisory Boards fees from Bayhill Therapeutics. Ludwig Kappos’ institution has received payments for his participation as principal investigator, member or chair of planning and steering committees or advisory boards in corporate-sponsored clinical trials in multiple sclerosis and other neurological diseases. Sponsoring pharmaceutical companies for these trials include Bayhill Therapeutics. Ernst Wilhelm Radue has received research support (mainly for MS projects) from Bayhill Therapeutics.

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Correspondence to Ludwig Kappos.

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415_2011_6361_MOESM1_ESM.jpg

Supplementary Fig. 1. Two examples of patients with ABH at week 8 and outcome at week 48 (isointense or PBH). Left panel: Patient with two enhancing CL at baseline (week 8: first row), one with ring enhancement and one with nodular enhancement, both mildly hypointense on the T1-w pre-contrast sequence (ABH). At end-point MRI (week 48: second row), both ABH have become T1-isointense. Right panel: Patient with a CL at baseline (week 8: first row), with ring Gd-enhancement, appearing as mildly hypointense on the T1-w pre-contrast SE (ABH). At week 48 (second row), the CL remained T1-hypointense (PBH). The MRI sequences in both examples are (from left to right): T1-weighted Sequence pre-contrast, T1-weighted Sequence post-contrast and Proton Density-weighted Sequence. (JPEG 38 kb)

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Papadopoulou, A., von Felten, S., Traud, S. et al. Evolution of MS lesions to black holes under DNA vaccine treatment. J Neurol 259, 1375–1382 (2012). https://doi.org/10.1007/s00415-011-6361-x

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