New imaging research shows increased iron in the brain in earliest stages of MS

While it’s been known for over a century that iron deposits in the brain play a role in the pathology of Multiple Sclerosis (MS), new imaging research from Western University (London, Canada) helps to answer the question of whether these accumulations are a cause or consequence of the disease. The study led by Ravi Menon, PhD, of the Robarts Research Institute found iron deposits in deep gray matter, suggesting the accumulation occurs very early in the disease course. The researchers also found evidence casting further doubt on the controversial liberation therapy for MS. The research is in early publication online in Multiple Sclerosis and Related Disorders.

Menon and PhD candidate Matthew Quinn used 3-Tesla Magnetic Resonance Imaging (MRI) to scan 22 patients with clinically isolated syndrome (CIS). These are patients who’ve had a single clinical attack, at least half of whom will go on to be diagnosed with MS. The others may have a different disease. Sixteen age and sex matched controls were also studied.

"We wanted to know if the iron deposits happen early in the process, or whether it’s something that accumulates with time as the disease progresses," says Menon, who holds a Canada Research Chair in Functional Magnetic Imaging. "We also studied the veins that drain from the brain and looked for a correlation between the diameter of of these veins and iron accumulation. One of the reasons to do this, of course was the hypothesis proposed by Paolo Zamboni that if you had narrow jugular veins, this would give rise to additional iron and in turn cause MS."

The scientists found iron deposits in the CIS group were well above the amounts found in the control group. The MRIs also revealed for the first time, subtle damage to the brain’s white matter even at this early stage. The researchers also found no correlation between the iron deposits and diameter of the veins.

"So while the iron in the brain correlates with the disability of the subjects, the iron in the brain does not correlate with the actual diameter of the jugular veins. So the Zamboni hypothesis is incorrect as far as the iron being related to some kind of obstruction." Menon found narrowed veins in the control group as well as the CIS group, and both groups had narrower veins on one side compared to the other.

Menon hopes this imaging research will lead to the earlier diagnosis of MS. He plans to follow the patients every four months for the next two years, to see retrospectively, what characterizes those patients that go on to be diagnosed with MS compared to those who do not.

"We’re looking at a couple of different approaches to diagnostics using this imaging research. In suspected MS cases –the very first time they appear in clinic, if they have an abnormally high amount of iron in the frontal cortex of the brain –that’s probably a pretty good sign they have MS or some other white matter disease." This research was funded primarily by the Canadian Institutes of Health Research.

MS is the most common neurological disease affecting young adults, with symptoms that include loss of balance, impaired speech, double vision, extreme fatigue and paralysis.

Brain development differs in children who stutter

UAlberta researcher and ISTAR executive director says study results could increase understanding of brain and speech production, improving treatment.

A new study by a University of Alberta researcher shows that children who stutter have less grey matter in key regions of the brain responsible for speech production than children who do not stutter.

The findings not only improve our understanding of how the brain is built for speech production and why people stutter, but also affirm the importance of seeking treatment early, using approaches such as those pioneered by the Institute for Stuttering Treatment and Research in the Faculty of Rehabilitation Medicine at the U of A, said Deryk Beal, ISTAR’s executive director.

Previous research has used MRI scans to look at structural differences between the brains of adults who stutter and those who do not. The problem with that approach is the scans come years after the onset of stuttering, typically between the ages of two and five years, Beal said.

“You can never be quite sure whether the differences in brain structure or function you’re looking at were the result of a lifetime of coping with a speech disorder or whether those brain differences were there from the beginning,” explained Beal, a speech-language pathologist.

For his study, Beal scanned the brains of 28 children ranging from five to 12 years old. Half the children were diagnosed with stuttering; the other half served as a control.

Results showed that the inferior frontal gyrus region of the brain develops abnormally in children who stutter. This is important because that part of the brain is thought to control articulatory coding—taking information our brain understands about language and sounds and coding it into speech movements.

“If you think about the characteristics of stuttering—repetitions of the first sounds or syllables in a word, prolongation of sounds in a word—it’s easy to hypothesize that it’s a speech-motor-control problem,” explained Beal. “The type of stuttering treatment we deliver at ISTAR is delivered with this limitation of the speech system in mind, and we have good success in stuttering treatment.”

Beal initiated the research at the University of Toronto and completed the work upon his arrival at the U of A. He sees the results as a first step toward testing to see how grey matter volumes are influenced by stuttering treatment and understanding motor-sequence learning differences between children who stutter and those who do not.

“The more we know about motor learning in these kids, the more we can adjust our treatment—deliver it in a shorter period of time, deliver it more effectively.”

The study was published in the September issue of the peer-reviewed journal Cortex and received funding from the Canadian Institutes of Health Research Clinical Fellowship and the Hospital for Sick Children’s Clinician Scientist Training Program.

Multiple Sclerosis Appears to Originate in Different Part of Brain Than Long Believed

The search for the cause of multiple sclerosis, a debilitating disease that affects up to a half million people in the United States, has confounded researchers and medical professionals for generations. But Steven Schutzer, a physician and scientist at Rutgers New Jersey Medical School, has now found an important clue why progress has been slow – it appears that most research on the origins of MS has focused on the wrong part of the brain. 

Look more to the gray matter, the new findings published in the journal PLOS ONE suggest, and less to the white. That change of approach could give physicians effective tools to treat MS far earlier than ever before.   

Until recently, most MS research has focused on the brain’s white matter, which contains the nerve fibers. And for good reason: Symptoms of the disease, which include muscle weakness and vision loss, occur when there is deterioration of a fatty substance called myelin, which coats nerves contained in the white matter and acts as insulation for them. When myelin in the brain is degraded, apparently by the body’s own immune system, and the nerve fiber is exposed, transmission of nerve impulses can be slowed or interrupted. So when patients’ symptoms flare up, the white matter is where the action in the brain appears to be.

But Schutzer attacked the problem from a different direction. He is one of the first scientists to analyze patients’ cerebrospinal fluid (CSF) by taking full advantage of a combination of technologies called proteomics and high-resolution mass spectrometry. “Proteins present in the clear liquid that bathes the central nervous system can be a window to physical changes that accompany neurological disease,” says Schutzer, “and the latest mass spectrometry techniques allow us to see them as never before.” In this study, he used that novel approach to compare the cerebrospinal fluid of newly diagnosed MS patients with that of longer term patients, as well as fluid taken from people with no signs of neurological disease.

What Schutzer found startled one of his co-investigators, Patricia K. Coyle of Stony Brook University in New York, one of the leading MS clinicians and researchers in the country. The proteins in the CSF of the new MS patients suggested physiological disruptions not only in the white matter of the brain where the myelin damage eventually shows up. They also pointed to substantial disruptions in the gray matter, a different part of the brain that contains the axons and dendrites and synapses that transfer signals between nerves.   

Several scientists had in fact hypothesized that there might be gray matter involvement in early MS, but the technology needed to test their theories did not yet exist. Schutzer’s analysis, which Coyle calls “exquisitely sensitive,” provides the solid physical evidence for the very first time. It includes a finding that nine specific proteins associated with gray matter were far more abundant in patients who had just suffered their first attack than in longer term MS patients or in the healthy controls. “This evidence indicates gray matter may be the critical initial target in MS rather than white matter,” says Coyle. “We may have been looking in the wrong area.”

According to Coyle, that realization presents exciting possibilities. One, she says, is that patients who suffer attacks that appear related to MS could have their cerebrospinal fluid tested quickly. If proteins that point to early MS are found, helpful therapy could begin at once, before the disease can progress further. 

Coyle says Schutzer’s findings may also lead one day to more effective treatments for MS with far fewer side effects. Without specific knowledge of what causes multiple sclerosis, patients now need to take medications that can broadly weaken their immune systems. These drugs slow the body’s destruction of myelin in the brain, but also degrade the immune system’s ability to keep the body healthy in other ways. By suggesting an exciting new direction for MS research, Schutzer and his team may have set the stage for more targeted treatments that attack MS while preserving other important immune functions.     

Schutzer sees an even broader future for the work he is now doing. He also has used advanced analysis of cerebrospinal fluid to identify physical markers for neurological ailments that include Lyme disease, in which he has been a world leader in research for many years, as well as chronic fatigue syndrome. He says, “When techniques are refined, more medical conditions are examined, and costs per patient come down, one day there could be a broad panel of tests through which patients and their doctors can get early evidence of a variety of disorders, and use that knowledge to treat them both more quickly and far more effectively than is possible now. “

Centers throughout the brain work together to make reading possible

A combination of brain scans and reading tests has revealed that several regions in the brain are responsible for allowing humans to read.

The findings open up the possibility that individuals who have difficulty reading may only need additional training for specific parts of the brain — targeted therapies that could more directly address their individual weaknesses.

“Reading is a complex task. No single part of the brain can do all the work,” said Qinghua He, postdoctoral research associate at the USC Brain and Creativity Institute, based at the USC Dornsife College of Letters, Arts and Sciences, and first author of a study on this research that was published in The Journal of Neuroscience on July 31.

The study looked at the correlation between reading ability and brain structure revealed by high-resolution magnetic resonance imaging (MRI) scans of more than 200 participants.

To control for external factors, the participants were about the same age and education level (college students); right-handed (lefties use the opposite hemisphere of their brain for reading); and all had about the same language skills (Chinese-speaking, with English as a second language for more than nine years). Their IQ, response speed and memory were also tested.

The study first collected data for seven different reading tests of a sample of more than 400 participants. These tests were intended to explore three aspects of their reading ability: phonological decoding ability (the ability to sound out printed words); form-sound association (how well participants could make connections between a new word and sound); and naming speed (how quickly participants were able to read out loud).

Each of these aspects, it turned out, was related to the gray matter volume — the amount of neurons — in different parts of the brain.

The MRI analysis showed that phonological decoding ability was strongly connected with gray matter volume in the left superior parietal lobe (around the top/rear of the brain); form-sound association was strongly connected with the hippocampus and cerebellum; and naming speed lit up a variety of locations around the brain.

“Our results strongly suggest that reading consists of unique capacities and is supported by distinct neural systems that are relatively independent of general cognitive abilities,” said Gui Xue, corresponding author of the study. Xue was formerly a research assistant professor at USC and now is a professor and director of the Center for Brain and Learning Sciences at Beijing Normal University.

“Although there is no doubt that reading has to build up existing neural systems due to the short history of written language in human evolution, years of reading experiences might have finely tuned the system to accommodate the specific requirement of a given written system,” Xue said.

He and Xue collaborated with Chunhui Chen and Qi Dong of Beijing Normal University; Chuansheng Chen of the University of California, Irvine; and Zhong-Lin Lu of Ohio State University.

One of the top features of this study was its unusually wide sample size, according to researchers. Typically, MRI studies test a relatively small sample of individuals — perhaps around 20 to 30 — because of the high cost of using the MRI machine. Testing a single individual can cost about $500, depending on the nature of the research.

The team had the good fortune of receiving access to Beijing Normal University’s new MRI center — the BNU Imaging Center for Brain Research — just before it opened to the public. With support from several grants, the researchers were able to conduct MRI tests on 233 individuals.

Next, the group will explore how to combine data from other factors, such as white matter, resting and task functional MRI, as well as more powerful machine-learning techniques, to improve the accuracy of individuals’ reading abilities.

“Research along this line will enable the early diagnosis of reading difficulties and the development of more targeted therapies,” Xue said.

Researchers discover a gene’s key role in building the developing brain’s scaffolding

The gene, Arl13b, is necessary for the proper construction of the cerebral cortex. The finding offers new insights on normal brain development and illuminates some of the factors behind Joubert’s syndrome, a rare neurological disorder.

Researchers have pinpointed the role of a gene known as Arl13b in guiding the formation and proper placement of neurons in the early stages of brain development. Mutations in the gene could help explain brain malformations often seen in neurodevelopmental disorders.

The research, led by a team at the University of North Carolina School of Medicine, was published June 30 in the journal Nature Neuroscience.

“We wanted to get a better sense of how the cerebral cortex is constructed,” said senior study author Eva Anton, PhD, a professor in the Department of Cell Biology and Physiology and a member of the UNC Neuroscience Center. “The cells we studied — radial glial cells — provide a scaffolding for the formation of the brain by making neurons and guiding them to where they have to go. This is the first step in the formation of functional neuronal circuitry in the brain. This study gives us new information about the mechanisms involved in that process.”

The researchers became interested in the Arl13b gene because of its expression in a part of the cell called primary cilium and its association with a rare neurological disorder known as Joubert syndrome. The syndrome is characterized by brain malformations and autism like features.

“In addition to helping us understand an important cellular mechanism involved in normal brain development, this study may offer an explanation for some of the malformations seen in Joubert syndrome patients,” said Anton. Although there is no immediate clinical application for these patients, the study does help illuminate the factors behind the disease. “It shows what may have gone wrong in some of those patients that led to the malformations,” said Anton.

The cerebral cortex, the brain’s “gray matter,” is responsible for higher-order functions such as memory and consciousness. Like the scaffolding builders use to move people and materials during construction, radial glial cells provide an instructive matrix to create the basic structural features of the cerebral cortex. Mistakes in the formation and development of radial glial cells can translate into structural problems in the brain as it develops, said Anton.

Both mice and humans have the Arl13b gene. The researchers generated a series of mice with mutations on the Arl13b gene at different developmental stages to track the mutations’ effects on brain development. They discovered that the gene is crucial to the radial glial cells’ ability to sense signals through an appendage called the primary cilium. Without this signaling capability, the radial glia were unable to organize into an instructive scaffold capable of orchestrating the orderly formation of cerebral cortex. “The cilia in these cells play an important role in the initial setup of this scaffolding,” said Anton. “Without a functioning Arl13b gene, the cells were not able to determine polarity and formed haphazardly. As a result, they formed a malformed cerebral cortex with ectopic clusters of neurons, instead of the orderly layers of neurons with appropriate connectivity that would be expected, in the developing brain.

B vitamins could delay dementia

Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer’s Disease (AD). Now, A. David Smith at the University of Oxford and his colleagues have discovered that, in some patients experiencing mild cognitive impairment (MCI), a cocktail of high-dose B vitamins could prevent gray matter loss associated with progression to AD. The study appears in the Proceedings of the National Academy of Sciences.

The World Health Organization predicts that between 2010 and 2050 the number of dementia cases will increase from 26 million to 115 million worldwide. Although there is an urgent demand for treatment, pharmaceutical companies have been unable to develop drugs that will delay or cure dementia. So far, approved drugs merely ease symptoms.

Smith and his team wanted to see if B vitamins reduced the risk of AD by lowering total homocysteine (tHcy) levels. There is a positive correlation between high tHcy levels and risk of cognitive impairment and AD.

The researchers studied 156 subjects over 70 in Oxford, England who suffered from MCI. The subjects received either a placebo or a high-dose B vitamin cocktail consisting of 20 milligrams of vitamin B6, 0.5 milligrams of vitamin B12 and 0.8 milligrams of folic acid.

Over a two-year period, subjects in both the experimental and control groups lost gray matter in the medial temporal, lateral temporoparietal and occipital regions and in the anterior and posterior cingulate cortex.

However, those receiving B vitamin treatment experienced significantly less atrophy in regions of the brain most affected in people with AD and people with MCI who go on to develop AD. These include the bilateral hippocampus, the parahippocampal gyrus, the retrosplenial precuneus, the lingual gyrus, the fusiform gyrus and the cerebellum. The placebo group experienced a 3.7 percent loss of gray matter in these regions, compared with a 0.5 percent loss among the experimental group.

When they looked at baseline tHcy levels, Smith and his colleagues found that B-vitamin treatment did not significantly reduce gray matter atrophy among subjects with tHcy levels below the median. The B-vitamin cocktail did have a significant effect on high-tHcy participants: those receiving the cocktail experienced only a 0.6 percent loss of gray matter, while high-tHcy participants in the placebo group experienced a 5.2 percent loss.

The team found a correlation between gray matter loss and worsening of scores on tests that measure cognitive function.

A causal Bayesian network analysis showed that B vitamins lower tHcy levels. This decreases gray matter atrophy, which delays cognitive decline.

Multiple Sclerosis research: the thalamus moves into the spotlight

A growing body of research by multiple sclerosis (MS) investigators at the University at Buffalo and international partners is providing powerful new evidence that the brain’s gray matter reflects important changes in the disease that could allow clinicians to diagnose earlier and to better monitor and predict how the disease will progress.

Over the past three years, the UB researchers and their partners around the world, supported by an active fellowship program at UB’s Buffalo Neuroimaging Analysis Center (BNAC), have published journal papers and given presentations demonstrating that the thalamus region, in particular, is key to a host of issues involving MS.

“The thalamus is providing us with a new window on MS,” says Robert Zivadinov, MD, PhD, UB professor of neurology, BNAC director and leader of the research team. “In our recent studies, we have used large datasets to investigate the evolution of atrophy of the thalamus and its association with clinical impairment in MS, starting with the earliest stages of the disease. The location of the thalamus in the brain, its unique function and its vulnerability to changes wrought by the disease make the thalamus a critical barometer of the damage that MS causes to the brain.”

Zivadinov and UB professor of neurology Ralph Benedict discuss the new research in a video.

At the annual meeting of the American Academy of Neurology today, Zivadinov will discuss a study he performed in collaboration with colleagues from Charles University in Prague. The study found that atrophy of the thalamus, determined with MRI, can help identify which patients with clinically isolated syndrome (CIS), a patient’s first episode of MS, are at risk for developing clinically definite MS. Such a tool would be immensely helpful to clinicians, Zivadinov notes.

“This study, which included more than 200 patients, shows that thalamic atrophy is one of the most important predictors of clinically definite MS,” says Dana Horakova, MD, PhD, the principal investigator at Charles University.

“Therefore, based on these findings, we think MRI should be used to determine which patients are at highest risk for a second attack,” explains Zivadinov.

Genome-wide Atlas of Gene Enhancers in the Brain On-line

Future research into the underlying causes of neurological disorders such as autism, epilepsy and schizophrenia, should greatly benefit from a first-of-its-kind atlas of gene-enhancers in the cerebrum (telencephalon). This new atlas, developed by a team led by researchers with the U.S. Department of Energy (DOE)’s Lawrence Berkeley National Laboratory (Berkeley Lab) is a publicly accessible Web-based collection of data that identifies and locates thousands of gene-regulating elements in a region of the brain that is of critical importance for cognition, motor functions and emotion.

“Understanding how the brain develops and functions, and how it malfunctions in neurological disorders, remains one of the most daunting challenges in contemporary science,” says Axel Visel, a geneticist with Berkeley Lab’s Genomics Division. “We’ve created a genome-wide digital atlas of gene enhancers in the human brain – the switches that tell genes when and where they need to be switched on or off. This enhancer atlas will enable other scientists to study in more detail how individual genes are regulated during development of the brain, and how genetic mutations may impact human neurological disorders.”

Visel is the corresponding author of a paper in the journal Cell that describes this work. The paper is titled “A High-Resolution Enhancer Atlas of the Developing Telencephalon.”