ObjectiveThe Tysabri Observational Programme (TOP), which began >10 years ago, is an open-label, multinational, prospective observational study evaluating the long-term safety and effectiveness of natalizumab in relapsing-remitting multiple sclerosis patients.MethodsThese data provide a 10-year interim analysis of safety and effectiveness in TOP. Annualised relapse rates (ARRs) and disability progression/improvement were analysed using the Poisson model and the Kaplan-Meier method, respectively. Analyses included patients on natalizumab and those who discontinued natalizumab but remained in TOP.ResultsAs of November 2017, TOP included 6148 patients. Overall, 829 patients (13.5%) experienced ≥1 serious adverse event (SAE), with infection the most common (4.1%). Fifty-three patients (0.9%) had confirmed progressive multifocal leukoencephalopathy. SAE data were consistent with natalizumab’s known safety profile; no new safety signals were identified. A total of 3210 patients (52.2%) discontinued natalizumab; 2117 (34.4%) withdrew from TOP. Median time on natalizumab was 3.3 (range 0–11.6) years; median follow-up time was 5.2 (range 0–10.8) years. The on-natalizumab ARR was 0.15, a 92.5% reduction from the year before initiation. Ten-year cumulative probabilities of disability worsening and improvement were 27.8% and 33.1%, respectively. On-natalizumab ARRs were similar between patients who discontinued or remained on natalizumab, suggesting limited attrition bias.ConclusionsSince the TOP 5-year interim analysis (December 2012), cohort size (6148 vs 4821), median exposure (3.3 vs 1.8 years) and median follow-up time (62 vs 26 months) have increased. This 10-year interim analysis further supports the robust real-world effectiveness and well-established safety profile of natalizumab.Trial registration numberNCT00493298.

Over the past several decades, benzodiazepines and the newer non-benzodiazepines have become the anxiolytic/hypnotics of choice over the more readily abused barbiturates. While all drugs from this class act at the GABA(A) receptor, benzodiazepine-type drugs offer the clear advantage of being safer and better tolerated. However, there is still potential for these drugs to be abused, and significant evidence exists to suggest that this is a growing problem. This review examines the behavioral determinants of the abuse and dependence liability of benzodiazepine-type drugs. Moreover, the pharmacological and putative biochemical basis of the abuse-related behavior is discussed.

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A two-dimensional, J-resolved magnetic resonance spectroscopic extraction approach was developed employing GAMMA-simulated, LCModel basis-sets. In this approach, a two-dimensional J-resolved (2D-JPRESS) dataset was resolved into a series of one-dimensional spectra where each spectrum was modeled and fitted with its theoretically customized LCModel template. Metabolite levels were derived from the total integral across the J-series of spectra for each metabolite. Phantoms containing physiologic concentrations of the major brain chemicals were used for validation. Varying concentrations of glutamate and glutamine were evaluated at and around their accepted in vivo concentrations in order to compare the accuracy and precision of our method with 30 ms PRESS. We also assessed 2D-JPRESS and 30 ms PRESS in vivo, in a single voxel within the parieto-occipital cortex by scanning ten healthy volunteers once and a single healthy volunteer over nine repeated measures. Phantom studies demonstrated that serial fitting of 2D-JPRESS spectra with simulated LCModel basis sets provided accurate concentration estimates for common metabolites including glutamate and glutamine. Our in vivo results using 2D-JPRESS suggested superior reproducibility in measuring glutamine and glutamate relative to 30 ms PRESS. These novel methods have clear implications for clinical and research studies seeking to understand neurochemical dysfunction.

Abstract. Low-frequency oscillations (LFOs) in the range of 0.01-0.15 Hz are commonly observed in functional imaging studies, such as blood oxygen level-dependent functional magnetic resonance imaging (BOLD fMRI) and functional near-infrared spectroscopy (fNIRS). Some of these LFOs are nonneuronal and are closely related to autonomic physiological processes. In the current study, we conducted a concurrent resting-state fMRI and NIRS experiment with healthy volunteers. LFO data was collected simultaneously at peripheral sites (middle fingertip and big toes) by NIRS, and centrally in the brain by BOLD fMRI. The cross-correlations of the LFOs collected from the finger, toes, and brain were calculated. Our data show that the LFOs measured in the periphery (NIRS signals) and in the brain (BOLD fMRI) were strongly correlated with varying time delays. This demonstrates that some portion of the LFOs actually reflect systemic physiological circulatory effects. Furthermore, we demonstrated that NIRS is effective for measuring the peripheral LFOs, and that these LFOs and the temporal shifts between them are consistent in healthy participants and may serve as useful biomarkers for detecting and monitoring circulatory dysfunction.

SUMMARYConflict procedures can be used to study the receptor mechanisms underlying the anxiolytic effects of benzodiazepines and other GABA A receptor modulators. In the present study, we first determined the efficacy and binding affinity of the benzodiazepine diazepam and recently synthesized GABA A receptor modulators JY-XHe-053, XHe-II-053, HZ-166, SH-053-2'F-S-CH 3 and SH-053-2'F-R-CH 3 at GABA A receptors containing α1, α2, α3 and α5 subunits. Results from these studies suggest that each compound displayed lower efficacy at GABA A receptors containing α1 subunits and varying degrees of efficacy and affinity at GABA A receptors containing α2, α3 and α5 subunits. Next, we assessed their anxiolytic effects using a rhesus monkey conflict procedure in which behavior was maintained under a fixed-ratio schedule of food delivery in the absence (nonsuppressed responding) and presence (suppressed responding) of response-contingent electric shock. Relatively non-selective compounds, such as diazepam and JY-XHe-053 produced characteristic increases in rates of suppressed responding at low to intermediate doses and decreased the average rates of non-suppressed responding at higher doses. XHe-II-053 and HZ-166 also produced increases in suppressed responding at low to intermediate doses, but were ineffective at decreasing rates of non-suppressed responding, consistent with their relatively low efficacy at GABA A receptors containing α1 and α5 subunits. In contrast, SH-053-2'F-S-CH 3 and SH-053-2'F-R-CH 3 produced only partial increases in suppressed responding and were ineffective on non-suppressed responding, consistent with their profiles as partial agonists at GABA A receptors containing α2, α3 and α5 subunits. These behavioral effects suggest that the anxiolytic and rate-reducing effects of GABA A receptor positive modulators are dependent on their relative efficacy and affinity at different GABA A receptor subtypes.

Independent component analysis (ICA) is widely used in resting state functional connectivity studies. ICA is a data-driven method, which uses no a priori anatomical or functional assumptions. However, as a result, it still relies on the user to distinguish the independent components (ICs) corresponding to neuronal activation, peripherally originating signals (without directly attributable neuronal origin, such as respiration, cardiac pulsation and Mayer wave), and acquisition artifacts. In this concurrent near infrared spectroscopy (NIRS)/functional MRI (fMRI) resting state study, we developed a method to systematically and quantitatively identify the ICs that show strong contributions from signals originating in the periphery. We applied group ICA (MELODIC from FSL) to the resting state data of 10 healthy participants. The systemic low frequency oscillation (LFO) detected simultaneously at each participant’s fingertip by NIRS was used as a regressor to correlate with every subject-specific IC timecourse. The ICs that had high correlation with the systemic LFO were those closely associated with previously described sensorimotor, visual, and auditory networks. The ICs associated with the default mode and frontoparietal networks were less affected by the peripheral signals. The consistency and reproducibility of the results were evaluated using bootstrapping. This result demonstrates that systemic, low frequency oscillations in hemodynamic properties overlay the timecourses of many spatial patterns identified in ICA analyses, which complicates the detection and interpretation of connectivity in these regions of the brain

In the present experiments we administered an alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist (CNQX), N-methyl-D-aspartate (NMDA) receptor antagonist (AP-5), or l-type calcium channel blocker (diltiazem) directly into the ventral tegmental area (VTA) before each of four daily systemic cocaine injections in order to assess their influence on the initiation phase of behavioural sensitization. Results indicated that pretreatment with CNQX or AP-5 impaired the initiation of cocaine-induced behavioural sensitization. Intra-VTA administration of diltiazem significantly increased the behavioural activation induced by an acute cocaine injection, but impaired the development of cocaine-induced behavioural sensitization. Because AMPA and NMDA receptors, as well as l-type calcium channels are calcium permeable, we also investigated the role of the calcium-activated second messenger calcium/calmodulin-dependent protein kinase II (CaM-KII). Similar to the results obtained with diltiazem, administration of the CaM-KII inhibitor KN-93 into the VTA enhanced the acute behavioural response to cocaine but prevented the augmentation of cocaine-induced behavioural hyperactivity following repeated injections. Consistent with this finding, the behavioural hyperactivity produced by cocaine was markedly enhanced among homozygous alpha-CaM-KII knockout mice but the initiation of behavioural sensitization to cocaine was attenuated relative to wild-type mice. Separate experiments performed in rats demonstrated an increase in total protein levels of CaM-KII in the VTA 24 h after the last of seven daily injections of cocaine. Taken together, these results indicate that blocking l-type calcium channels or impairing CaM-KII activity in the VTA augments the acute behavioural hyperactivity induced by cocaine. The present findings also suggest that increased calcium influx through AMPA receptors, NMDA receptors and l-type calcium channels on dopaminergic neurons in the VTA contributes significantly to the initiation of behavioural sensitization by amplifying calcium signalling through CaM-KII.