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Abnormal thalamic functional connectivity correlates with cardiorespiratory fitness and physical activity in progressive multiple sclerosis

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Abstract

Background

Altered thalamic volumes and resting state (RS) functional connectivity (FC) might be associated with physical activity (PA) and cardiorespiratory fitness (CRF) in people with progressive multiple sclerosis (PMS).

Objectives

To assess thalamic structural and functional alterations and investigate their correlations with PA/CRF levels in people with PMS.

Methods

Seven-day accelerometry and cardiopulmonary exercise testing were used to assess PA/CRF levels in 91 persons with PMS. They underwent 3.0 T structural and RS fMRI acquisition with 37 age/sex-matched healthy controls (HC). Between-group comparisons of MRI measures and their correlations with PA/CRF variables were assessed.

Results

PMS people had lower volumes compared to HC (all p < 0.001). At corrected threshold, PMS showed decreased intra- and inter-thalamic RS FC, and increased RS FC between the thalamus and the hippocampus, bilaterally. At uncorrected threshold, decreased thalamic RS FC with caudate nucleus, cerebellum and anterior cingulate cortex (ACC), as well as increased thalamic RS FC with occipital regions, were also detected. Lower CRF, measured as peak oxygen consumption (VO2peak), correlated with lower white matter volume (r = 0.31, p = 0.03). Moreover, lower levels of light PA correlated with increased thalamic RS FC with the right hippocampus (r = − 0.3, p = 0.05).

Discussion

People with PMS showed widespread brain atrophy, as well as pronounced intra-thalamic and thalamo-hippocampal RS FC abnormalities. White matter atrophy correlated with CRF, while increased thalamo-hippocampal RS FC was associated to worse PA levels. Thalamic RS FC might be used to monitor physical impairment and efficacy of rehabilitative and disease-modifying treatments in future studies.

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Data availability

The anonymised dataset used and analysed during the current study is available from the corresponding author upon reasonable request.

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Acknowledgments

The authors would like to thank all the centers and their staff members that were involved in the study.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by a grant from the Multiple Sclerosis Society of Canada (grant no. #EGID3185) and the National MS Society.

Author information

Authors and Affiliations

  1. Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Francesco Romanò, Paola Valsasina, Maria A. Rocca & Massimo Filippi

  2. Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA

    Robert W. Motl

  3. Section Neurosciences, Department NEUROFARBA, University of Florence, Florence, Italy

    Maria Pia Amato

  4. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy

    Maria Pia Amato

  5. Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy

    Giampaolo Brichetto

  6. AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Via Operai 30, 16149, Genoa, Italy

    Giampaolo Brichetto

  7. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy

    Nicolò Bruschi & Matilde Inglese

  8. Faculty of Brain Sciences, Queen Square MS Centre, UCL Queen Square Institute of Neurology, UCL, London, UK

    Jeremy Chataway & Rachel Farrell

  9. Biomedical Research Centre, National Institute for Health Research, University College London Hospitals, London, UK

    Jeremy Chataway

  10. Kessler Foundation, West Orange, NJ, USA

    Nancy D. Chiaravalloti, John DeLuca & Brian M. Sandroff

  11. Department of Physical Medicine & Rehabilitation, Rutgers NJ Medical School, Newark, NJ, USA

    Nancy D. Chiaravalloti, John DeLuca & Brian M. Sandroff

  12. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    Gary Cutter

  13. Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark

    Ulrik Dalgas

  14. Faculty of Rehabilitation Sciences, REVAL, Hasselt University, Diepenbeek, Belgium

    Peter Feys

  15. UMSC Hasselt, Pelt, Belgium

    Peter Feys

  16. Faculty of Health, School of Health Professions, University of Plymouth, Devon, UK

    Jennifer Freeman

  17. IRCCS Ospedale Policlinico San Martino, Genoa, Italy

    Matilde Inglese

  18. Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada

    Cecilia Meza & Anthony Feinstein

  19. Section on Statistical Planning and Analysis, Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA

    Amber Salter

  20. Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Maria A. Rocca & Massimo Filippi

  21. Vita-Salute San Raffaele University, Milan, Italy

    Maria A. Rocca & Massimo Filippi

  22. Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

  23. Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Massimo Filippi

Authors
  1. Francesco Romanò
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  2. Robert W. Motl
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  3. Paola Valsasina
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  4. Maria Pia Amato
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  5. Giampaolo Brichetto
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  6. Nicolò Bruschi
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  7. Jeremy Chataway
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  8. Nancy D. Chiaravalloti
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  9. Gary Cutter
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  10. Ulrik Dalgas
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  11. John DeLuca
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  13. Peter Feys
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  14. Jennifer Freeman
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  18. Brian M. Sandroff
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  19. Anthony Feinstein
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  20. Maria A. Rocca
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  21. Massimo Filippi
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Consortia

CogEx Research Team

Corresponding author

Correspondence to Massimo Filippi.

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Conflicts of interest

Francesco Romanò has nothing to disclose; Robert W. Motl has nothing to disclose; Paola Valsasina received speaker honoraria from Biogen Idec; Maria Pia Amato received compensation for consulting services and/or speaking activities from Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Roche, Pharmaceutical Industries and Fondazione Italiana Sclerosi Multipla; Giampaolo Brichetto has been awarded and receives research support from Roche, Fondazione Italiana Sclerosi Multipla, ARSEP, H2020 EU Call; Nicolò Bruschi has nothing to disclose; Jeremy Chataway has received support from the Efficacy and Evaluation (EME) Programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership and the Health Technology Assessment (HTA) Programme (NIHR), the UK MS Society, the US National MS Society and the Rosetrees Trust, he is supported in part by the National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK, he has been a local principal investigator for commercial trials funded by Actelion, Biogen, Novartis and Roche, has received an investigator grant from Novartis, and has taken part in advisory boards/consultancy for Azadyne, Biogen, Celgene, MedDay, Merck and Roche; Nancy D. Chiaravalloti is on an Advisory Board for Akili Interactive and is a member of the Editorial Boards of Multiple Sclerosis Journal and Frontiers in NeuroTrauma; Gary Cutter is a member of Data and Safety Monitoring Boards for Astra-Zeneca, Avexis Pharmaceuticals, Biolinerx, Brainstorm Cell Therapeutics, Bristol Meyers Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Horizon Pharmaceuticals, Hisun Pharmaceuticals, Mapi Pharmaceuticals LTD, Merck, Merck/Pfizer, Opko Biologics, OncoImmune, Neurim, Novartis, Ophazyme, Sanofi Aventis, Reata Pharmaceuticals, Teva pharmaceuticals, VielaBio Inc, Vivus, NHLBI (Protocol Review Committee), NICHD (OPRU oversight committee), he is on Consulting or Advisory Boards for Biodelivery Sciences International, Biogen, Click Therapeutics, Genzyme, Genentech, GW Pharmaceuticals, Klein-Buendel Incorporated, Medimmune, Medday, Neurogenesis LTD, Novartis, Osmotica Pharmaceuticals, Perception Neurosciences, Recursion/Cerexis Pharmaceuticals, Roche, TG Therapeutics, he is employed by the University of Alabama at Birmingham and President of Pythagoras, Inc, a private consulting company located in Birmingham AL; Ulrik Dalgas has received research support, travel grants, and/or teaching honorary from Biogen Idec, Merck-Serono, Novartis, Bayer Schering, and Sanofi Aventis as well as honoraria from serving on scientific advisory boards of Biogen Idec and Genzyme; John DeLuca is an Associate Editor of the Archives of Physical Medicine, received compensation for consulting services and/or speaking activities from Biogen Idec, Celgene/Bristol Myers Squibb, MedRhythms, Janssen, and Novartis, and receives research support from Biogen Idec, Genzyme, Bristol Myers Squibb, National Multiple Sclerosis Society, Consortium of Multiple Sclerosis Centers, and National Institutes of Health; Rachel Farrell has received honoraria and served on advisory panels for Merck, TEVA, Novartis, Genzyme, GW pharma (Jazz pharmaceuticals), Allergan, Merz, Ipsen and Biogen. She is supported in part by the National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK; Peter Feys is editorial board member of NNR, MSJ and Frontiers in Rehabilitation Sciences (section ‘Strengthening Health Systems’), provides consultancy to NeuroCompass and was board of advisory board meetings for BIOGEN; Jennifer Freeman has been awarded research grants from the NIHR, UK; Matilde Inglese is Co-Editor for Controversies for Multiple Sclerosis Journal, received compensation for consulting services and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, and received research support from NIH, NMSS, the MS Society of Canada, the Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, H2020 EU Call; Cecilia Meza has nothing to disclose; Amber Salter receives research funding from Multiple Sclerosis Society of Canada, National Multiple Sclerosis Society, CMSC and the US Department of Defense and is a member of editorial board for Neurology; Brian Sandroff has nothing to disclose; Anthony Feinstein is on Advisory Boards for Akili Interactive and Roche, and reports grants from the MS Society of Canada, book royalties from Johns Hopkins University Press, Cambridge University Press, Amadeus Press and Glitterati Editions, and speaker’s honoraria from Novartis, Biogen, Roche and Sanofi Genzyme; Maria Assunta Rocca received consulting fees from Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche; and speaker honoraria from Bayer, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Merck Healthcare Germany, Merck Serono SpA, Novartis, Roche, and Teva. She receives research support from the MS Society of Canada and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders; Massimo Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Associate Editor of Radiology, and Associate Editor of Neurological Sciences; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi; speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda; scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

Ethical approval

The study was approved by local research ethics committees or institutional review boards at enrolling sites. All participants provided written informed consent prior to study participation according to the Declaration of Helsinki.

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Romanò, F., Motl, R.W., Valsasina, P. et al. Abnormal thalamic functional connectivity correlates with cardiorespiratory fitness and physical activity in progressive multiple sclerosis. J Neurol 270, 3213–3224 (2023). https://doi.org/10.1007/s00415-023-11664-8

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