The longitudinal relationship between fatigue, depression, anxiety, disability, and adherence with cognitive status in patients with early multiple sclerosis treated with interferon beta-1a.

Background: Cognitive dysfunction is common in multiple sclerosis and may worsen with reduced treatment adherence. We examined longitudinal relationships between anxiety, depression, fatigue, disability and adherence with cognitive status in patients with relapsing-remitting multiple sclerosis (MS) treated with interferon beta-1a in four countries. Methods: The Confidence study is a prospective study in 165 people with MS with four visits (baseline/12/24/36 months). Physical and psychological symptoms were assessed using standardized questionnaires. Adherence was calculated as the number of injections divided by number of expected injections. Cognitive status was assessed by the Brief Repeatable Battery of Neuropsychological Tests and converted to a global Z-score. Results: At baseline, mean age was 35.7 ± 11 years and 66% were female (n = 109). Adherence to treatment was very high throughout the study (>99%). A depression score ≥ 8 was significantly associated with a higher risk of low cognitive status compared with a lower score (0-7): relative risk 1.79 (1.14-2.83) adjusted for education and time since diagnosis. The P-value-for-time was not significant (P = 0.304) meaning that associations existed since baseline and remained stable during follow-up. Conclusion: Our findings provide evidence for a longitudinal association between depression and low cognitive status in patients treated with interferon beta-1a in routine medical practice.

Healthcare utilization and costs of multiple sclerosis patients in the Netherlands: a healthcare claims database study.

AIM: To investigate the incidence and prevalence and healthcare costs of multiple sclerosis (MS) in the Netherlands by using healthcare claims data. MATERIALS & METHODS: A claims database was analyzed including 26% of the Dutch population. RESULTS: Average prevalence of MS in the Netherlands was 88 per 100,000 inhabitants (males 48, 127 females) and incidence nine per 100,000. Yearly per patient medication costs were highest in the year after the first MS claim and then decreased. Hospital costs were 30% higher in the first year of MS claims than after 3 years of MS claims. The patients often used co-medication, such as antidepressants and antibiotics. CONCLUSION: Dutch incidence and cost estimates based on claims were consistent with previous estimates. Prevalence estimates were somewhat higher. Drug and hospital costs were highest shortly after the diagnosis. Healthcare consumption related to comorbidities was in-line with the previously reported comorbidity estimates.

Patient adherence to subcutaneous IFN beta-1a injections using the RebiSmart® injection device: a retrospective real-world study among Dutch and German patients with multiple sclerosis.

PURPOSE: Long-term treatment adherence among patients with multiple sclerosis (MS) is a general concern, with an established correlation with clinical efficacy. Closely monitoring patients' treatment behavior may have a beneficial effect on adherence. This study assessed adherence, in daily life, to subcutaneous (sc) IFN beta-1a, self-administered using the RebiSmart® electronic injection device (the IFN beta-Ia autoinjector device), in patients with MS. PATIENTS AND METHODS: This was a retrospective observational study analyzing treatment adherence based on injection data, eg, injection date and dose, extracted from the IFN beta-Ia autoinjector devices collected from patients in Germany and the Netherlands. RESULTS: Data recorded in the period from 2007 to 2012 by the IFN beta-Ia autoinjector devices from 1,682 (79.7% from Germany, 20.3% from the Netherlands) patients were analyzed. A mean of 94.8% of the multi-dose cartridges (containing sc IFN beta-1a for three injections) were used completely, indicating a low incidence of application errors and drug wastage. The mean adherence rate was 90.7% and 82.9% over the entire observation period (mean treatment duration: 150.1 weeks). Median adherence rates were similar between German and Dutch patients (97.9% vs 99.0%). CONCLUSION: In daily clinical practice, patients using the IFN beta-Ia autoinjector device were highly adherent to sc IFN beta-1a. The injection data stored electronically in the device may help patients to adhere to treatment regimens and, if viewed by physicians, promote discussion of adherence issues with patients.

Drosophila Sec16 mediates the biogenesis of tER sites upstream of Sar1 through an arginine-rich motif.

tER sites are specialized cup-shaped ER subdomains characterized by the focused budding of COPII vesicles. Sec16 has been proposed to be involved in the biogenesis of tER sites by binding to COPII coat components and clustering nascent-coated vesicles. Here, we show that Drosophila Sec16 (dSec16) acts instead as a tER scaffold upstream of the COPII machinery, including Sar1. We show that dSec16 is required for Sar1-GTP concentration to the tER sites where it recruits in turn the components of the COPII machinery to initiate coat assembly. Last, we show that the dSec16 domain required for its localization maps to an arginine-rich motif located in a nonconserved region. We propose a model in which dSec16 binds ER cups via its arginine-rich domain, interacts with Sar1-GTP that is generated on ER membrane by Sec12 and concentrates it in the ER cups where it initiates the formation of COPII vesicles, thus acting as a tER scaffold.

Caenorhabditis elegans as a model for lysosomal storage disorders.

The nematode Caenorhabditis elegans is the simplest animal model available to study human disease. In this review, the worm homologues for the 58 human genes involved in lysosomal storage disorders and for 105 human genes associated with lysosomal function have been compiled. Most human genes had at least one worm homologue. In addition, the phenotypes of 147 mutants, in which these genes have been disrupted or knocked down, have been summarized and discussed. The phenotypic spectrum of worm models of lysosomal storage disorders varies from lethality to none obvious, with a large variety of intermediate phenotypes. The genetic power of C. elegans provides a means to identify genes involved in specific processes with relative ease. The overview of potential lysosomal phenotypes presented here might be used as a starting point for the phenotypic characterization of newly developed knock-out models or for the design of genetic screens selecting for loss or gain of suitable knock-out model phenotypes. Screens for genes involved in lysosomal biogenesis and function have been performed successfully resulting in the cup and glo mutants, but screens involving subtle phenotypes are likely to be difficult.

Characterizing pathogenic processes in Batten disease: use of small eukaryotic model systems.

The neuronal ceroid lipofuscinoses (NCLs) are neurodegenerative disorders. Nevertheless, small model organisms, including those lacking a nervous system, have proven invaluable in the study of mechanisms that underlie the disease and in studying the functions of the conserved proteins associated to each disease. From the single-celled yeast, Saccharomyces cerevisiae and Schizosaccharomyces pombe, to the worm, Caenorhabditis elegans and the fruitfly, Drosophila melanogaster, biochemical and, in particular, genetic studies on these organisms have provided insight into the NCLs.