Enfermedades Desmielinizantes.artículos

Collaborative Latin American Imaging Network In Neuroimmunology Research (BRAIMS) : Rationale, Structure, Challenges, and Future Directions

2026-07-03T15:36:30Z

Collaborative Latin American Imaging Network In Neuroimmunology Research (BRAIMS) : Rationale, Structure, Challenges, and Future Directions Carnero Contentti, Edgar; Alonso, Ricardo; Boldrini, Vinícius; Cárcamo, Claudia A.; Casas, Magdalena; Ciampi, Ethel; Damasceno, Alfredo; dos Santos Silva, Jonadab; de Medeiros Rimkus, Carolina; Marrodán, Mariano; Navas, Carlos; Patrucco, Liliana; Pitombeira, Milena; Ramari, Cintia; Sato, Henry Koiti; Soler, Bernardita; Treviño Frenk, Irene; Wagner, Mario; Ontaneda, Daniel; Becker, Jefferson Magnetic resonance imaging (MRI) plays a central role in the diagnosis, differential diagnosis, and monitoring of neuroimmunological disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). However, in Latin America (LATAM), variability in healthcare systems, imaging infrastructure, technical protocols, and subspecialized expertise limits the implementation of standardized MRI-based approaches and contributes to heterogeneity in diagnostic pathways and clinical decision-making. In this context, the Collaborative Latin American Imaging Network in Neuroimmunology Research (BRAIMS) was established as a regional initiative to strengthen MRI research and clinical practice in neuroimmunological diseases. BRAIMS emerged from a collaborative effort among neuroimmunologists, neuroradiologists, and researchers across multiple LATAM countries, with the aim of promoting methodological alignment, facilitating multicenter research, and generating region-specific real-world evidence. The network is structured to integrate core and collaborating centers under a coordinated governance model, enabling the development of shared research agendas and collaborative projects. Initial priorities include mapping MRI availability and practices across the region, standardizing acquisition protocols and reporting frameworks, identifying imaging-related sources of diagnostic variability, and developing consensus-based recommendations adapted to resource-variable settings. Despite sustained growth in neuroimmunology expertise in LATAM, important challenges persist, including unequal access to MRI technology, limited availability of advanced imaging techniques, variability in interpretation, and diagnostic complexity in populations with diverse clinical and epidemiological characteristics. By fostering regional collaboration and strengthening integration with international initiatives, BRAIMS aims to generate context-specific evidence, improve diagnostic accuracy, and enhance research capacity. This initiative represents a shift toward the production of regionally driven data, with the potential to contribute meaningfully to global neuroimmunology research and reduce disparities in access to high-quality neuroimaging.

Expert Opinion on Age-Related Sex Hormone Changes and Hypogonadism in People With Multiple Sclerosis : A Delphi Consensus Program

2026-07-01T16:52:24Z

Expert Opinion on Age-Related Sex Hormone Changes and Hypogonadism in People With Multiple Sclerosis : A Delphi Consensus Program Bove, Riley; Simoni, Manuela; Castelo Branco, Camil; Correale, Jorge; Hellwig, Kerstin; Houtchens, Maria K.; Magyari, Melinda; Merki-Feld, Merki-Feld; Montgomery, Scott; Nappi, Rossella E.; Shen, Wen; Stenager, Egon; Thompson, Heidi; Tulek, Zeliha; Marhardt, Kurt; Hillert, Jan A. Purpose of review: As the life expectancy of people with multiple sclerosis (PwMS) increases, the importance of recognizing and addressing specific needs and challenges faced by those undergoing age-related sex hormone changes and hypogonadism is becoming increasingly evident. We present expert-led, practical recommendations from a consensus program that address gaps in age-related sex hormone changes and hypogonadism in PwMS not sufficiently addressed in current literature and guidelines. A multidisciplinary steering committee (SC) of 15 international experts identified 18 key clinical questions across 6 themes: climacteric symptoms in women with MS; impact of MS on the climacteric stage; impact of menopause on MS disease activity and progression; treatment and management of climacteric symptoms in women with MS; late-onset hypogonadism (LOH) in men with MS; and patient-centered care. After thorough review of the evidence from a systematic literature review, the SC formulated 18 clinical recommendations to address the questions. These recommendations were voted on by the SC and an extended faculty of 23 health care professionals from 16 countries, including 2 nurses and 1 patient association representative. Recent findings: Consensus was reached when ≥75% of respondents expressed agreement, with a score of 7-9 on a 9-point scale. After a single voting round, all 18 recommendations reached consensus (14 reaching consensus at 90%-100% and 4 at 80%-90%). The clinical recommendations addressed the following: the potential overlap and exacerbation of MS symptoms during the climacteric stage; the need for preventive care and screening during the menopausal transition; the potential for, and a paucity of data on, differential efficacy and tolerability of MS medications in menopausal/postmenopausal women; the complex causal interplay between hormonal and/or immunologic changes and natural aging in PwMS switching to a more progressive phase of disease; consideration of behavioral/lifestyle interventions alongside pharmacologic treatments; effects of hormonal treatments on MS symptoms; and management of LOH in men with MS. Summary: These recommendations were based on a robust modified Delphi consensus approach and present a valuable framework for improved patient care. These results emphasize the need to address critical gaps in our understanding and management of PwMS undergoing age-related sex hormone changes and hypogonadism.

Characterizing double seronegative neuromyelitis optica spectrum disorder: A distinct subgroup or part of the continuum?

2026-05-19T18:18:20Z

Characterizing double seronegative neuromyelitis optica spectrum disorder: A distinct subgroup or part of the continuum? Piedrabuena, María Agustina; Marrodán, Mariano; Zárate, María Agustina; Fiol, Marcela; Ysrraelit, María Célica; Correale, Jorge Background: Neuromyelitis optica spectrum disorder (NMOSD) encompasses inflammatory demyelinating CNS conditions. Patients negative for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies are classified as double seronegative (DN). Objective: To characterize and compare the clinical, radiological, and therapeutic profiles of DN, AQP4-IgG+, and MOG-IgG+ patients. Methods: Retrospective analysis of patients meeting 2015 NMOSD criteria, grouped by serostatus (AQP4-IgG+, MOG-IgG+, and DN). Demographic, clinical, and imaging data were compared. Results: We analyzed 111 patients: 64 AQP4-IgG+, 31 DN, and 16 MOG-IgG+. At onset, AQP4-IgG+ patients were older than DN and MOG-IgG+ (49 ± 14 vs 41 ± 12 vs 35 ± 12 years, p < 0.0001). DN had more relapses in the first two years (p = 0.02) and higher EDSS (p < 0.001). Myelitis was common in DN and AQP4-IgG+, while optic neuritis in MOG-IgG+. Relapse rates were highest in AQP4-IgG+ (p < 0.001). Oligoclonal bands were more common in DN (39 %) than in AQP4-IgG+ (27.7 %) and MOG-IgG+ (25 %)(p < 0.0001). Area postrema lesions were more frequent in DN (p = 0.02). Rituximab was mainly used in AQP4-IgG+ and DN (p < 0.001), with lower failure in DN (4.8 % vs 18 %). Conclusion: DN NMOSD shows distinct features but comparable disability to AQP4-IgG+ individuals. Conventional immunosuppressants seem effective, though further research is needed to clarify mechanisms and optimize treatment strategies.

The Neurochemical Landscape of Oligodendrocyte Physiology: From Myelination to Metabolic and Synaptic Modulation

2026-05-19T17:53:18Z

The Neurochemical Landscape of Oligodendrocyte Physiology: From Myelination to Metabolic and Synaptic Modulation Correale, Jorge Oligodendrocytes, traditionally recognized for their role in axonal myelination, are increasingly appreciated as metabolically dynamic and functionally diverse cells integral to central nervous system (CNS) homeostasis. This review delineates the evolving neurochemical landscape of oligodendrocyte physiology, emphasizing their roles beyond myelin production. We explore key processes including lipid metabolism, metabolic coupling with neurons, ion buffering, neurotransmitter signaling, and synaptic modulation. Oligodendrocytes preferentially utilize aerobic glycolysis and support axonal energy metabolism via the export of lactate and phosphocreatine, maintaining ATP levels even in the absence of mitochondria within the myelin sheath. Their capacity for regional and transcriptional heterogeneity allows adaptive responses to local microenvironments and neuronal activity. Lipid biosynthesis and storage mechanisms are intricately regulated through mTORC1, SREBPs, and lipophagy, enabling rapid membrane expansion, and structural integrity during myelination. Furthermore, oligodendrocytes modulate the periaxonal milieu via potassium buffering, pH regulation, and osmotic balance, primarily through Kir channels, carbonic anhydrases, and aquaporins. They also express a wide array of neurotransmitter receptors, enabling bidirectional communication with neurons and activity-dependent modulation of maturation and plasticity. Intracellular signaling pathways such as PI3K/Akt/mTOR, MAPK/ERK, and Wnt/β-catenin orchestrate the integration of metabolic and transcriptional programs. Collectively, these findings redefine oligodendrocytes as active participants in CNS physiology, contributing to neuronal health, circuit plasticity, and responses to injury or disease.