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Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis and neuromyelitis optica spectrum disorder — recommendations from ECTRIMS and the EBMT
Autologous haematopoietic stem cell transplantation (AHSCT) is a treatment option for relapsing forms of multiple sclerosis (MS) that are refractory to disease-modifying therapy (DMT). AHSCT after failure of high-efficacy DMT in aggressive forms of relapsing–remitting MS is a generally accepted indication, yet the optimal placement of this approach in the treatment sequence is not universally agreed upon. Uncertainties also remain with respect to other indications, such as in rapidly evolving, severe, treatment-naive MS, progressive MS, and neuromyelitis optica spectrum disorder (NMOSD). Furthermore, treatment and monitoring protocols, rehabilitation and other supportive care before and after AHSCT need to be optimized. To address these issues, we convened a European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop in partnership with the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party, in which evidence and key questions were presented and discussed by experts in these diseases and in AHSCT. Based on the workshop output and subsequent written interactions, this Consensus Statement provides practical guidance and recommendations on the use of AHSCT in MS and NMOSD. Recommendations are based on the available evidence, or on consensus when evidence was insufficient. We summarize the key evidence, report the final recommendations, and identify areas for further research.
Bayesian p-curve mixture models as a tool to dissociate effect size and effect prevalence
Much research in the behavioral sciences aims to characterize the “typical” person. A statistically significant group-averaged effect size is often interpreted as evidence that the typical person shows an effect, but that is only true under certain distributional assumptions for which explicit evidence is rarely presented. Mean effect size varies with both within-participant effect size and population prevalence (proportion of population showing effect). Few studies consider how prevalence affects mean effect size estimates and existing estimators of prevalence are, conversely, confounded by uncertainty about effect size. We introduce a widely applicable Bayesian method, the p-curve mixture model, that jointly estimates prevalence and effect size by probabilistically clustering participant-level data based on their likelihood under a null distribution. Our approach, for which we provide a software tool, outperforms existing prevalence estimation methods when effect size is uncertain and is sensitive to differences in prevalence or effect size across groups or conditions.
High-resolution spatial prediction of anemia risk among children aged 6 to 59 months in low- and middle-income countries
Anemia, a severe condition among children associated with adverse health effects such as impaired growth, limited physical and cognitive development, and increased mortality risk, remains widespread, particularly in low- and middle-income countries. This study combines Demographic and Health Surveys data with remotely sensed climate, demographic, environmental, and geo-spatial information, creating a data set comprising about 750,000 observations on childhood anemia from 37 countries. It is used to provide high-resolution spatio-temporal estimates of all forms of childhood anemia between 2005 and 2020.
Prevalence of pediatric and adult optic neuritis in the United States from 2016 to 2023
Data on the prevalence of optic neuritis (ON) is limited with reported rates between 5.5 and 115.3 per 100,000. The US data is even more limited with the largest study performed in a single county, finding a prevalence of 115.3. This study aims to fill the gap in US data on ON.
Incomplete elimination of viral genomes is associated with chronic inflammation in nonhuman primate livers after AAV-mediated gene transfer
The liver is a unique organ where immunity can be biased toward ineffective response notably in the context of viral infections. Chronic viral hepatitis depends on the inability of the T-cell immune response to eradicate antigen. In the case of recombinant Adeno-Associated-Virus, used for therapeutic gene transfer, conflicting reports describe tolerance induction to different transgene products while other studies have shown conventional cytotoxic CD8+ T cell responses with a rapid loss of transgene expression. We performed a 1 year follow up of 6 non-human primates after all animals received an rAAV8 vector carrying the GFP transgene at doses of 7×1012 vg/kg. We report that despite anti-GFP peripheral cellular response and loss of hepatic transgene expression, we were still able to detect persisting viral genomes in the liver until 1-year post-injection. These viral genomes were associated with liver inflammation, fibrosis and signs of CD8 T cell exhaustion, including high expression of PD-1. Our study shows that AAV8-mediated gene transfer can results to loss of transgene expression in liver and chronic inflammation several months after gene transfer.
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