京都大学 / 新制・課程博士 / 博士(医学) / 甲第24195号 / 医博第4889号 / 新制||医||1060(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 戸井 雅和, 教授 藤田 恭之, 教授 伊藤 貴浩 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

RANKL (ligand du récepteur activateur de NF-KB) est un membre de la famille des TNF dont la signalisation passe par RANK et qui joue un rôle important dans la régulation immunitaire. Chez l'adulte, RANKL est exprimé constitutivement par des cellules réticulaires marginales (MRC) des ganglions lymphatiques. Comme les MRCs sont physiquement proches des lymphocytes B (LB) et ont été proposé d’être des précurseurs de cellules dendritiques folliculaires (FDC), RANKL pourrait jouer un rôle dans la différenciation du stroma associé aux LB et dans la réponse humorale. Afin de mieux comprendre la fonction de RANKL exprimé par les MRC, nous avons généré des souris déficitaires pour RANKL dans les cellules stromales. Nous avons constaté que la formation du follicule B était perturbée ainsi que le réseau FDC. Bien que RANKL ne soit pas requis pour la formation des MRC, il est nécessaire pour l'expression de la chimiokine CXCL13 par ces mêmes cellules. Parmi les TNFRSF dont la signalisation est requise pour l’expression de CXCL13 et la différenciation des FDC, le TNFR1 était significativement réduit dans les cellules stromales des souris dépourvues de RANKL stromal. Ainsi, RANKL pourrait constituer une nouvelle cible thérapeutique contre les immunopathologies des LB en agissant sur son stroma. / RANKL (receptor activator of NF-κB ligand), a member of the TNF family that signals via RANK, plays an important role for immune regulation. In the adult, RANKL is constitutively expressed by marginal reticular cells (MRCs) of the lymph nodes. Because MRCs are positioned in close vicinity to B cells and may be precursors of follicular dendritic cells (FDCs), RANKL could play a role in the differentiation of B cell-associated stroma and the humoral immune response. In order to better understand the role of RANKL expressed by the MRCs, we generated mice with conditional RANKL deficiency in the stromal compartment. We found that the B cell follicle structure was disrupted and FDC network formation was reduced. Although RANKL was not required for MRC formation, it was necessary for the expression of B cell attracting chemokine CXCL13. Among the TNFRSF members known to control CXCL13 expression and FDC formation, we found that TNFR1 was significantly reduced in the RANKL cKO mice. Thus, RANKL may present a novel therapeutic strategy against B cell-mediated immunopathologies by acting on its stroma.

Diagnosticering av neuroborrelios baseras på en kombinerad bedömning av neurologiska symtom, serologiska tester för Borrelia-specifika antikroppar och analys av cerebrospinalvätska för att räkna antalet vita blodkroppar och mäta nivåer av kemokinet CXCL13. Nyligen publicerade studier har visat på att analys av IgM-antikroppar riktade mot Borrelia inte är ett lika starkt laboratoriestöd som analys av IgG-antikroppar. Analys av IgM-antikroppar har bidragit till högre antal falskt positiva svar på grund av ospecifik reaktivitet till andra patogener och persisterande antikroppar från tidigare infektioner. Syftet med denna studie var att utvärdera det diagnostiska värdet av att analysera IgM antikroppar i cerebrospinalvätska och serumprover för patienter med misstänkt neuroborrelios. Dessutom jämfördes prestandan mellan två kemiluminiscens immunanalyser, LIAISON (DiaSorin, Italy) och VirClia (Vircell, Spain). För utvärderingen analyserades 80 patientprover på laboratoriet för Klinisk Mikrobiologi på Länssjukhuset Ryhov i Jönköping, Sverige.  För att konfirmera positiva resultatet från de två kemiluminiscens immunanalyserna användes immunoblot, EUROLINE (EUROIMMUN, Germany). Sammanfattningsvis finns det inte tillräckligt med bevis att analys av IgM har ett tillräckligt diagnostiskt värde för att bekräfta en misstänkt neuroborrelios-diagnos. Jämförelsen mellan två kemiluminiscens immunanalyser visade att VirClia kan vara ett lämpligare alternativ än LIAISON när få prover analyseras. / The diagnosis of neuroborreliosis is based on a combined evaluation of neurological symptoms, serological tests for Borrelia-specific antibodies, cerebrospinal fluid analysis to measure white blood cell count and chemokine CXCL13 levels. Recently published data has shown that analysis of IgM antibodies against Borrelia is not as supportive in establishing a clinical diagnosis as IgG antibodies. IgM analysis has contributed to higher false-positive rates because of unspecific reactivities to other biological agents and persistent antibodies from prior infections.  The purpose of this study was to assess the diagnostic value of analysing IgM antibodies in cerebrospinal fluid and serum samples from patients with suspected neuroborreliosis. The performance of two chemiluminescent immunoassays, LIAISON (DiaSorin, Italy) and VirClia (Vircell, Spain), were compared as well. For this assessment, 80 patient samples were analysed at the Laboratory of Clinical Microbiology in Jönköping County, Sweden. Immunoblotting, EUROLINE (EUROIMMUN, Germany), was utilised to validate positive results from the chemiluminescent immunoassays. In conclusion, there is no convincing evidence to suggest that IgM analysis has sufficient diagnostic value to confirm a suspected diagnosis of neuroborreliosis. The comparison of two immunoassays showed that VirClia could be a valid alternative to LIAISON when analysing fewer samples at a time.

Introduction: les follicules lymphoïdes (FL) sont absents du poumon normal mais ont été décrits dans les poumons de patients atteints de mucoviscidose ou de dilatations de bronches non mucoviscidosiques, suggérant un rôle pour l’infection bronchique dans la néogenèse lymphoïde (NL). Nous avons étudié la dynamique de la néogenèse lymphoïde dans l’infection bactérienne. Méthodes: les souris C57BL/6 ont reçu une instillation intratrachéale de billes d’agarose contenant du PAO1 ou du S. aureus (106 CFU/animal) permettant une infection prolongée et ont été comparées à des souris contrôles (billes stériles ou absence de billes). Les souris ont été sacrifiées à J1, J4, J7 et J14. Résultats: l’instillation unique de billes d’agarose contenant du PAO1 ou du S. aureus induit en 14 jours des FL fonctionnels situés sous l’épithélium en regard des zones d’infection. Le marquage pour CXCL12 et CXCL13 est faible chez contrôles, mais présent dans l’épithélium (CXCL13) dès J1 et présent également dans les FL (CXCL12 et CXCL13) à J14 chez les souris infectées. Le traitement des souris par un anticorps anti CXCL12 ou anti CXCL13 n’inhibe pas la formation des FL induite par l’infection à PAO1. Conclusion: nos données suggèrent un rôle pour l’infection bactérienne prolongée et l’épithélium respiratoire dans la NL des bronchopathies chroniques. Notre modèle permet d’évaluer les mécanismes de la formation et de persistance des FL dans le poumon. / Introduction: lymphoid follicles (LF) are absent in normal lungs, but are described in lungs of subjects with cystic fibrosis (CF) or non-CF bronchiectasis, suggesting a role for bacterial infection in lymphoid neogenesis. We aimed to study the dynamic of pulmonary lymphoid neogenesis (LN) during bacterial infection. Methods: C57BL/6 mice were instilled intratracheally with PAO1- or S. aureus-coated (1.106 CFU/mouse) agarose beads (which produced prolonged airway infection) and compared to controls (sterile beads or no instillation). Mice were sacrificed on day (d)1, d4, d7, and d14 after instillation. Results: chronic pulmonary infection with PAO1 or S. aureus induced organised LF in 14 days after a single challenge with PAO1- or S. aureus-coated beads. Bacteria- induced LF were exclusively localized in the subepithelium of infected airways. Staining for CXCL12 and CXCL13 was weak in airway epithelium of controls, but was positive in airway epithelium (CXCL13) at 1 day and in LF (both) of infected mice at 14 days. Treatment with anti CXCL12 or anti CXCL13 Ab did not reduce LN induced by PAO1 infection. Conclusions: chronic bacterial infection and respiratory epithelium could contribute to LN in chronic airway diseases. Our unique model allows to study mechanisms for the formation and maintenance of lung LF.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-04-03T13:38:30Z No. of bitstreams: 1 Joselli Silva. Desestruturação da polpa... 2014.pdf: 6952851 bytes, checksum: 512840eb0cc488e4f61742ce875c4837 (MD5) / Made available in DSpace on 2014-04-03T13:38:30Z (GMT). No. of bitstreams: 1 Joselli Silva. Desestruturação da polpa... 2014.pdf: 6952851 bytes, checksum: 512840eb0cc488e4f61742ce875c4837 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Universidade Federal da Bahia. Faculdade de Medicina da Bahia. Salvador, BA, Brasil / A leishmaniose visceral está associada às alterações arquiteturais esplênicas e redistribuição de populações celulares envolvidas na resposta imunológica. Os objetivos desta tese foram estudar a desestruturação da polpa branca do baço na leishmaniose visceral canina e quais as células e citocinas envolvidas nesse processo. Para isso, amostras de baços de cães de uma área endêmica para LV foram agrupadas em três categorias: TIPO1-CONT ou TIPO1-SIA (cães não infectados ou sem infecção ativa e com polpa branca organizada), TIPO1-INF (cães infectados com polpa branca organizada) e TIPO3-INF (cães infectados com polpa branca desorganizada). No capítulo 2 e 3, as secções de baço foram marcadas através de imunoistoquímica com anticorpos anti-CD3 (linfócitos T), anti-CD79-α (linfócitos B), anti-S100 (célula dendrítica folicular), anti-Ki-67 (células em proliferação), anti-IgG e anti-IgM (plasmócitos secretores de IgA, IgG e IgM). Foram estimadas as densidades de todas as populações celulares através de morfometria. As expressões de citocinas e quimiocinas foram avaliadas através de RT-PCR em tempo real. A ativação policlonal de células B e hipergamaglobulinemia foram avaliadas por ELISA e eletroforese de proteínas séricas. No capítulo 2, foi visto que a densidade de linfócitos B foi maior nos folículos e na zona marginal dos animais com baço TIPO1 do que nos dos animais com baço TIPO3 (teste de Mann-Whitney P < 0,02). Os números de células proliferantes, células B e células dendríticas foliculares foram menores em animais de baço TIPO3. A expressão da quimiocina CXCL13 foi maior nos animais com baço TIPO 1 (teste de Mann-Whitney, P < 0,02). No capítulo 3, foi visto que a plasmocitose foi maior em animais de baço TIPO3 do que nos animais com baço TIPO1 (Teste qui-quadrado, P < 0,04). A densidade de plasmócitos secretores de imunoglobulina do isotipo IgG foi maior na polpa vermelha de animais com baço TIPO3 (Teste Man-Whitney, P <0,05). Em geral, observou-se uma tendência de maior densidade de plasmócitos secretores de imunoglobulinas dos isotipos IgM e IgG nos animais de baço TIPO3 em comparação com animais do baço TIPO1. Animais de baço TIPO3 apresentam maiores níveis séricos de proteína gamaglobulina e também uma maior expressão das citocinas BAFF e APRIL e da quimiocina CXCL12, que estão envolvidas no processo de ativação e homing de plasmócitos. No capítulo 4 foi visto que uma região de aproximadamente 1.28Mb do cromossomo 8 canino foi encontrada com os segmentos gênicos VH, DH e JH. As principais conclusões obtidas nesse estudo foram que a redistribuição de populações celulares do baço, especialmente de linfócitos B, células dendríticas foliculares e plasmócitos estão relacionada com a desorganização do tecido esplênico e com a expressão anômala de CXCL13, CXCL12, BAFF e APRIL, que são citocinas e quimiocinas envolvida com a organização do tecido esplênico, ativação e homing de plasmócitos. A ativação policlonal, a hipergamaglobulinemia e a diglobulinemia são também relacionadas com a desorganização do baço. As regiões variáveis (VH), diversidade (DH) e de junção (JH) da cadeia pesada de imunoglobulina são compostos de noventa e dois, dez e nove genes obtidos na linha germinativa canina, respectivamente. / Visceral leishmaniasis is associated with splenic architectural changes and redistribution of cell populations involved in the immune response. The objectives of this thesis was to study the disruption of the white pulp of the spleen in canine visceral leishmaniasis and which cells and cytokines are involved in this process. For this, samples of spleens of dogs from an endemic area for VL were grouped into three categories: TYPE1-CONT or TYPE1-NIF (non-infected dogs or without active infection with organized white pulp), TYPE1-INF (infected dogs with pulp organized white) and TYPE3-INF (infected animals with disorganized white pulp). In Chapter 2 and 3 the spleens sections were stained by immunohistochemistry with anti-CD3 (T lymphocytes), anti-CD79 (B lymphocytes), anti-S100 (follicular dendritic cells), anti-Ki-67 (cells proliferation), anti-IgG and anti-IgM (plasma cells). The number and distribution of all cell populations were estimated by morphometry. The expressions of cytokines and chemokines were assessed by real time RT-PCR. The polyclonal B cell activation and hypergammaglobulinemia were evaluated by ELISA and serum protein electrophoresis. In chapter 2, it was seen that the density of B lymphocytes was higher in the marginal zone and follicles of animals with spleen TYPE1-INF than animals with the spleen TYPE3-INF (Mann -Whitney test P < 0.02). The numbers of proliferating cells, B cells and follicular dendritic cells was lower in animals of TYPE3-INF. The expression of the chemokine CXCL13 was higher in the spleen of animal with the spleen TYPE 1 (Mann-Whitney, P < 0.02). No difference was observed in the expression of other cytokines compared between the two groups of animals. In chapter 3, it was seen that the plasma cells was higher in animals with spleen TYPE 3 than in animals with spleen TYPE1 (Chi-square test, P < 0.04). The density of plasma cells secreting the isotype IgG was higher in the red pulp of spleen of animals TYPE3 (Man-Whitney test, P < 0.05). In general, there was a trend toward higher density of plasma cells secreting the immunoglobulin of isotype IgM and IgG in the spleen of animals with spleen TYPE3-INF in comparison to animal’s spleen TYPE1. Animals with spleen TYPE3 have higher levels of serum gamma globulin protein as well as increased expression of citokines, BAFF and APRIL and the chemokine CXCL12 that are involved in the activation and homing plasma cells. The main conclusions of this study were that the redistribution of cell populations of the spleen, especially B lymphocytes, follicular dendritic cells and plasma cells (characterized by intense plasmacytosis) are related to the disorganization of the splenic tissue and aberrant expression of CXCL13, CXCL12, BAFF and APRIL, which are cytokines and chemokines involved in the organization of the splenic tissue, activation of B cells and plasma cell homing. The polyclonal activation, hypergammaglobulinemia and diglobulinemia are also related to the structural disorganization of the splenic lymphoid tissue. In addition, it was concluded that the variable regions (VH), the diversity (DH) and junction (JH) immunoglobulin heavy chain are composed of ninety-two, ten and nine genes that have been obtained in canine germline.

<p>In the demyelinating autoimmune disease multiple sclerosis (MS) there is a great need for validated prognostic biomarkers that can give information about both prognosis and disease course. So far only clinical parameters have been shown to predict future outcome. CXCL13 is a potent B cell chemoattractant that has been suggested to be a potential biomarker candidate. The aim of this study was to investigate the usefulness of CXCL13 as a prognostic biomarker for MS.</p><p>Clinical, paraclinical, laboratory and MRI data about a large group of MS patients and controls were collected. CXCL13 levels in cerebrospinal fluid (CSF) samples from these patients were determined by standard enzymelinked immunosorbent assay (ELISA).</p><p>In general CXCL13 were increased in CSF in MS, especially in relapsing-remitting MS during relapses, i.e. with ongoing inflammations in the central nervous system. CXCL13 is a good candidate prognostic marker for MS, since newly diagnosed MS with high CXCL13 levels showed worsened disease course within five years. Most importantly, MS conversion occurred in higher rate in possible MS patients with high concentrations of CXCL13 in CSF, and in a shorter time point. This observation may support an early treatment decision in these patients.</p><p>In conclusion, this study provides support for an association between CXCL13 levels in the CSF and later development of disease severity in MS.</p>

Submitted by Carla Santos (biblioteca.cp2.carla@bahiana.edu.br) on 2018-11-20T14:06:17Z No. of bitstreams: 1 DANIEL LIMA DE S?? RIBEIRO.pdf: 15828554 bytes, checksum: f475ae99a02f0773348b7abdcc5abcd8 (MD5) / Approved for entry into archive by JOELMA MAIA (ebmsp-bibliotecacp2@bahiana.edu.br) on 2018-11-20T18:40:35Z (GMT) No. of bitstreams: 1 DANIEL LIMA DE S?? RIBEIRO.pdf: 15828554 bytes, checksum: f475ae99a02f0773348b7abdcc5abcd8 (MD5) / Made available in DSpace on 2018-11-20T18:40:35Z (GMT). No. of bitstreams: 1 DANIEL LIMA DE S?? RIBEIRO.pdf: 15828554 bytes, checksum: f475ae99a02f0773348b7abdcc5abcd8 (MD5) Previous issue date: 2018-10-17 / O envolvimento articular ?? a manifesta????o cl??nica mais freq??ente do l??pus eritematoso sist??mico (LES). A artropatia de Jaccoud (AJ), embora menos frequente, ?? uma artrite deformante, "revers??vel", que pode ocorrer em at?? 5% desses pacientes. Objetivo: O objetivo prim??rio ?? estudar e avaliar a correla????o entre o grau de sinovite, tenossinovite e eros??es pela USG nos casos de LES com e sem AJ e os n??veis s??ricos de CXCL13. Os objetivos secund??rios s??o descrever os achados USG de m??os em pacientes com AJ secund??ria a LES, comparar os achados USG dos pacientes com AJ com aqueles vistos em pacientes l??picos com artrite mas sem AJ e avaliar a correla????o entre os n??veis s??ricos de CXCL13 e a atividade de doen??a. Material e M??todos: Sessenta e quatro pacientes com l??pus eritematoso sist??mico foram selecionados, 32 com e 32 sem AJ. Cada paciente foi submetido a exame f??sico, exames laboratoriais (incluindo dosagem s??rica de CXCL13 por ELISA) e estudo ultrassonogr??fico de m??os e punhos. Hipertrofia sinovial, tenossinovite e eros??es foram avaliados de acordo com um sistema de classifica????o semi-quantitativo de 0-3. Os achados ultrassonogr??ficos foram correlacionados com os n??veis s??ricos de CXCL13, outros par??metros sorol??gicos e ??ndice de atividade da doen??a. Resultados: Sinovite foi encontrado em 25/64 pacientes (39%) e tenossinovite em 14/64 (22%). Estes achados foram mais freq??entes nos pacientes com AJ, particularmente tenossinovite (p = 0,002). O n??vel s??rico m??dio de CXCL13 foi de 20,16 pg / ml em toda a popula????o (23,2 pg / ml no grupo com AJ e 11,5 pg / ml no grupo sem AJ). Houve associa????o entre atividade de doen??a e n??veis elevados de CXCL13 ( p = 0,004). No entanto, nenhuma associa????o foi encontrada entre os n??veis s??ricos de CXCL13 e o item "artrite" do SLEDAI ou mesmo de edema articular ao exame f??sico e sinovite no estudo ultrassonogr??fico.Conclus??o: Os achados ultrassonogr??ficos articulares de pacientes com LES e AJ confirmam que sinovite e tenossinovite s??o mais comuns nesses pacientes. Al??m disso, n??veis s??ricos de CXCL13 est??o associados ?? atividade da doen??a no LES, mas n??o parece ser um biomarcador de artrite nesses pacientes.

Breast cancer (BC) is the most common cancer in women. It is a highly heterogeneous disease in terms of histology, therapeutic response and patient outcomes. Early and accurate detection of breast cancer is crucial as the patient prognosis varies greatly depending on the diagnosis of the disease. Patient outcomes have been linked to the presence of tumor infiltrating lymphocytes (TIL) in solid tumors. In human BC, higher TIL infiltration is associated with a better prognosis and also predicts relevant responses to pre-operative chemotherapy. TIL are primarily composed of T cells, albeit around 20% of BC patients (pts) show significant B cell infiltration, and can organize in tertiary lymphoid structures (TLS) located in the peritumoral stroma, which are associated with survival in HER2+ and triple negative BC patients. Further, these studies revealed that CD4+ follicular helper T (Tfh) cells producing CXCL13 were specifically associated with peritumoral TLS. CXCL13 is an important B cell chemoattractant whose function is to recruit B cells to the germinal center (GC) in secondary lymphoid organs and TLS, where they can mature and differentiate into memory or antibody-producing B cells. The principal objective of this thesis project was to investigate the role of CXCL13 and Tfh cells play in the development and/or maintenance of GC-like structures in BC-associated TLS.Further understanding of the factors that promote TLS formation in vivo could provide important insight for treatment decisions in BC. CXCL13 expression was originally identified as an important signal associated with TLS that was predictive for patient outcomes. We investigated factors capable of inducing CXCL13 expression in CD4+ T cells isolated from peripheral blood, using flow cytometry analysis. Treatment with TGFβ1 alone, or together with several cytokines (IL12, IL21, and in particular IL2 blockade), increased CXCL13 expression in activated CD4+ T cells. Similar to our characterization of Tfh TIL in fresh tumor tissues, these CXCL13-producing CD4+ T cells were CXCR5 negative and expressed the Tfh markers PD-1 and ICOS. The positive correlation, in treated cells and fresh TIL, between CXCL13-producing CD4+ T cells and FoxP3-expressing regulatory CD4+ T cells, and the diminished chemokine production upon depletion of the latter population, suggest a possible positive relationship between regulatory CD4+ T cells and CXCL13-producing CD4+ T cells.We then derived a GC-associated B cell gene signature for integration in our previously published Tfh cell gene signature, including CXCL13 gene. The combined GC gene signature was tested for its ability to sensitively detect BC-associated TLS using a qRT-PCR-based assay on two different cohorts, a primary BC set (n=83) and a retrospective series (n=52) of formalin-fixed paraffin-embedded (FFPE) BC tissues. These data revealed a correlation between gene signature expression and the extent of TLS scored by trained pathologists on dual-immunohistochemistry stained (CD3+CD20 for T and B cells, respectively) FFPE tissue sections. In addition, the high GC signature expression predicted better overall and disease-free survival of BC pts in our retrospective BC cohort, as well as in public microarray data.This thesis research has demonstrated that CXCL13-producing CD4+ T cells lacking CXCR5 differentiate and exert their function in IL-2-limited but TGF-β1-rich conditions. Furthermore, we developed a GC-associated gene signature able to detect TLS in BC and predict BC pts better survival. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Final publication is available at http://onlinelibrary.wiley.com/doi/10.1002/art.38173/abstract;jsessionid=DA29F0C067C89EC1147E79EE7380D21A.f01t04?systemMessage=Wiley+Online+Library+will+be+disrupted+on+24th+October+2015+at+10%3A00-10%3A30+BST+%2F+05%3A00-05%3A30+EDT+%2F+17%3A00-17%3A30++SGT++for+essential+maintenance.++Apologies+for+the+inconvenience / 京都大学 / 0048 / 新制・論文博士 / 博士(医科学) / 乙第13003号 / 論医科博第3号 / 新制||医科||5(附属図書館) / 32931 / (主査)教授 杉田 昌彦, 教授 生田 宏一, 教授 三森 経世 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

In the demyelinating autoimmune disease multiple sclerosis (MS) there is a great need for validated prognostic biomarkers that can give information about both prognosis and disease course. So far only clinical parameters have been shown to predict future outcome. CXCL13 is a potent B cell chemoattractant that has been suggested to be a potential biomarker candidate. The aim of this study was to investigate the usefulness of CXCL13 as a prognostic biomarker for MS. Clinical, paraclinical, laboratory and MRI data about a large group of MS patients and controls were collected. CXCL13 levels in cerebrospinal fluid (CSF) samples from these patients were determined by standard enzymelinked immunosorbent assay (ELISA). In general CXCL13 were increased in CSF in MS, especially in relapsing-remitting MS during relapses, i.e. with ongoing inflammations in the central nervous system. CXCL13 is a good candidate prognostic marker for MS, since newly diagnosed MS with high CXCL13 levels showed worsened disease course within five years. Most importantly, MS conversion occurred in higher rate in possible MS patients with high concentrations of CXCL13 in CSF, and in a shorter time point. This observation may support an early treatment decision in these patients. In conclusion, this study provides support for an association between CXCL13 levels in the CSF and later development of disease severity in MS.