A multidisciplinary assessment through OCT and correlations to brain pathology and endothelial factors in multiple sclerosis
ECTRIMS Online Library. Lanzillo R. 10/26/17; 200253; P598
Roberta Lanzillo
Roberta Lanzillo
Contributions
Abstract

Abstract: P598

Type: Poster

Abstract Category: Pathology and pathogenesis of MS - 22 OCT

Background: Degeneration of optic nerve in Multiple Sclerosis (MS) can be measured through optical coherence tomography (OCT) . A vascular density reduction is also present in MS. High homocystein (Hcy) levels and low Vascular Endhotelial Growth Factor-A (VEGF-A) levels, well-known factors influencing the vascular flow, have been related to MS.
Objective: To analyse the correlations between retinal pathology, assessed by Angio- and spectral domain (SD)-OCT, homocystein/VEGF-A serum levels and brain pathology by MRI in MS patients.
Methods: Patients with and without history of Optic Neuritis (ON) were included and underwent angio- and (SD)-OCT. We assessed supratentorial white matter lesion (WML) load on 3D-FLAIR images, using a semiquantitative score raging from 0 (no lesions) to 6 (large and confluent WMLs), and performed quantitative flow-rate measurements of the extracranial internal carotid (ICA) and vertebral arteries (VA) using a 2D axial phase-contrast, ECG-triggered sequence placed just below the skull base. Intracranial volume (ICV) was also automatically measured. Hcy was dosed in 46 patients and VEGF-A in 18 patients..
Results: Fifty patients (31 females, mean age 40.64 ± 12.45 years) with 100 consecutives eyes were included. Twenty-three eyes of MS patients had optic neuritis (ON). EDSS disability mean score was 3.50 ± 1.28, and mean disease duration was 11.06 ± 7.19 years. Mean Hcy level was 13.5 ± 4.2 (µmol/L), while mean VEGF-A level was 121 ± 48.2 (U/mL).
Vascular density (VD) was inversely correlated to ARR, EDSS and Total Arterial Flow (TAF, ie.sum of ICA+VA flowrates), while it was positively correlated to MRI-measured ICV. Retinal nerve fiber layer (RNFL) and combined ganglion cell complex layers (GCC) measured through SD-OCT were correlated to ICV, while they were inversely correlated to homocystein. Moreover, TAF was inversely correlated to homocystein and directly to VEGF-A levels.
Discussion: We confirmed a relation of VD with disease severity in MS. Its increase in patients with decreased extracranial arterial flow might be a compensatory phenomenon (ie the lower the neck flow, the higher the retinal vascular density). Angiogenetic VEGF-A induction may explain TAF increase. We confirm that Homocystein levels are related to retinal atrophy, probably due its negative effect on endothelial functions and vascularisation. These results, taken together, corroborate the use of OCT in understanding endothelial vascular pathology in MS.
Disclosure:
R Lanzillo and V Brescia Morra received personal compensations for speaking or consultancy from Biogen, Teva, Genzyme, Merck, Novartis, Almirall
S Cocozza reports personal fees from Sanofi Genzyme
M Moccia has received salary from Federico II University of Naples, grant from the ECTRIMS-MAGMNISM fellowship program, honoraria and travel support form Almirall, Coloplast, Genzyme, and Merck-Serono.
D Paolicelli has received honoraria for consultancy and/or speaking
from Biogen Idec, Merck-Serono, Almirall, Sanofi-Aventis, TEVA,
Novartis and Genzyme.
G Lus has received personal compensation for activities with Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis Pharmaceuticals, Teva neuroscience as a consultant and speaker; has received research support from Biogen Idec, Merck Serono, and Novartis.
E has received personal compensation for activities with Biogen Idec, Roche, Merck Serono, Novartis as a consultant; has received support for travelling from Biogen Idec, Merck Serono, Novartis, Teva, Roche, Genzyme
G Cennamo, E Tedeschi, C Criscuolo, A Carotenuto, F Sparnelli, A Cianflone1, G Palma, N Frattaruolo, N Velotti,have nothing to disclose.

Abstract: P598

Type: Poster

Abstract Category: Pathology and pathogenesis of MS - 22 OCT

Background: Degeneration of optic nerve in Multiple Sclerosis (MS) can be measured through optical coherence tomography (OCT) . A vascular density reduction is also present in MS. High homocystein (Hcy) levels and low Vascular Endhotelial Growth Factor-A (VEGF-A) levels, well-known factors influencing the vascular flow, have been related to MS.
Objective: To analyse the correlations between retinal pathology, assessed by Angio- and spectral domain (SD)-OCT, homocystein/VEGF-A serum levels and brain pathology by MRI in MS patients.
Methods: Patients with and without history of Optic Neuritis (ON) were included and underwent angio- and (SD)-OCT. We assessed supratentorial white matter lesion (WML) load on 3D-FLAIR images, using a semiquantitative score raging from 0 (no lesions) to 6 (large and confluent WMLs), and performed quantitative flow-rate measurements of the extracranial internal carotid (ICA) and vertebral arteries (VA) using a 2D axial phase-contrast, ECG-triggered sequence placed just below the skull base. Intracranial volume (ICV) was also automatically measured. Hcy was dosed in 46 patients and VEGF-A in 18 patients..
Results: Fifty patients (31 females, mean age 40.64 ± 12.45 years) with 100 consecutives eyes were included. Twenty-three eyes of MS patients had optic neuritis (ON). EDSS disability mean score was 3.50 ± 1.28, and mean disease duration was 11.06 ± 7.19 years. Mean Hcy level was 13.5 ± 4.2 (µmol/L), while mean VEGF-A level was 121 ± 48.2 (U/mL).
Vascular density (VD) was inversely correlated to ARR, EDSS and Total Arterial Flow (TAF, ie.sum of ICA+VA flowrates), while it was positively correlated to MRI-measured ICV. Retinal nerve fiber layer (RNFL) and combined ganglion cell complex layers (GCC) measured through SD-OCT were correlated to ICV, while they were inversely correlated to homocystein. Moreover, TAF was inversely correlated to homocystein and directly to VEGF-A levels.
Discussion: We confirmed a relation of VD with disease severity in MS. Its increase in patients with decreased extracranial arterial flow might be a compensatory phenomenon (ie the lower the neck flow, the higher the retinal vascular density). Angiogenetic VEGF-A induction may explain TAF increase. We confirm that Homocystein levels are related to retinal atrophy, probably due its negative effect on endothelial functions and vascularisation. These results, taken together, corroborate the use of OCT in understanding endothelial vascular pathology in MS.
Disclosure:
R Lanzillo and V Brescia Morra received personal compensations for speaking or consultancy from Biogen, Teva, Genzyme, Merck, Novartis, Almirall
S Cocozza reports personal fees from Sanofi Genzyme
M Moccia has received salary from Federico II University of Naples, grant from the ECTRIMS-MAGMNISM fellowship program, honoraria and travel support form Almirall, Coloplast, Genzyme, and Merck-Serono.
D Paolicelli has received honoraria for consultancy and/or speaking
from Biogen Idec, Merck-Serono, Almirall, Sanofi-Aventis, TEVA,
Novartis and Genzyme.
G Lus has received personal compensation for activities with Biogen Idec, Merck Serono, Novartis, Sanofi-Aventis Pharmaceuticals, Teva neuroscience as a consultant and speaker; has received research support from Biogen Idec, Merck Serono, and Novartis.
E has received personal compensation for activities with Biogen Idec, Roche, Merck Serono, Novartis as a consultant; has received support for travelling from Biogen Idec, Merck Serono, Novartis, Teva, Roche, Genzyme
G Cennamo, E Tedeschi, C Criscuolo, A Carotenuto, F Sparnelli, A Cianflone1, G Palma, N Frattaruolo, N Velotti,have nothing to disclose.

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