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    "result": {"pageContext":{"archiveDates":["2026-06-10T11:42:34"],"modifiedGmt":"2026-06-10T09:53:54","hasPageContent":true,"contentType":{"name":"research-group","graphqlSingleName":"researchGroup","labels":{"singularName":"Research group","name":"Research groups","menuName":"Research groups","archives":"Research groups"},"hasArchive":true,"uri":"/research-groups-teams/","enum":"RESEARCH_GROUP"},"id":"cG9zdDo0MTEz","databaseId":4113,"uri":"/research-groups-teams/fredrik-piehl-group/","dateGmt":"2026-06-10T09:42:34","author":{"node":{"name":"magdalena"}},"title":"Fredrik Piehl Group","content":"<h1>Fredrik Piehl Group</h1>\n<h2><em>Clinical Neuroimmunology and Immunomodulation</em></h2>\n","contentMedia":[],"contentModularityModules":null,"excerpt":null,"topSidebar":{"modules":[]},"contentArea":{"modules":[{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"uuvmo6p1t","module":{"id":"cG9zdDo0MTE1","databaseId":4115,"title":"About","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p>MS is an autoimmune disease that causes damage to the nerve fibers of the central nervous system (CNS), which is the basis for the permanent neurological disabilities that many patients eventually will develop. In MG autoantibodies disturb the signal transmission between nerve and muscle causing muscle weakness that sometimes can be life-threathening.</p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"ft54651yj","module":{"id":"cG9zdDo0MTE3","databaseId":4117,"title":"Our research","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<h3 id=\"heading-0\" class=\"linked wsui-h2\">Clinical Neuroinflammation and Neurodegeneration</h3>\n<p>We work with different inflammatory diseases of the central and peripheral nervous systems. Our main focus is multiple sclerosis (MS), an autoimmune disease affecting the central nervous system (CNS), but also do research in myasthenia gravis (MG), psychiatric conditions and traumatic brain injuries.</p>\n<p>Currently we have an incomplete understanding of how inflammation in the nervous system is regulated and what significance it may have for ensuing nerve injury.</p>\n<p>Starting from a more experimental approach, our research has now evolved to be mainly clinical. MS is our main focus. Here are objectives are to generate better knowledge of why the adaptive immune system attacks the CNS, what mechanisms are involved, imaging and soluble biomarkers reflecting what is happening and, perhaps most important of all, how we can devise better therapeutic interventions. Our aim is also to address the needs of those affected by MS, and we strive to include our patients as active partners in the research we do. A major line of research is to understand the role of B cells (an immune cell type) in MS, and how this can be translated into treatments with better benefit-risk balance. To this end we examine cells and biofluids, such as serum and cerebrospinal fluid, with advanced methods, but we also study treatment effects and adverse events with epidemiological methods.</p>\n<p>Over the last decade we have performed several studies where we compare the effect and safety of rituximab, a B cell-eliminating drug that is approved for rheumatoid arthritis, but not yet for MS. Somewhat surprisingly, our studies show that rituximab in most instances provide a better benefit-risk balance and tolerability compared with MS-approved drugs. These studies have encouraged more extensive use of rituximab so that it is now the most used MS therapy in Sweden, and at substantial cost savings for the health care system.</p>\n<p>A problem not resolved, however, is why some people with MS continue to worsen even though we use drugs that strongly reduce inflammation. In order to understand why this happens, we need to understand better the neurodegenerative aspects of MS. To do so we study how the levels of different biomarkers change over time and to what degree our current treatments affect these processes. We also actively participate in clinical trials where novel treatments are tested in a clinical setting. This also includes studies of how non-drug interventions can improve symptoms, such as how physical exercise can reduce MS-fatigue.</p>\n<p>Myasthenia gravis (MG) is a neuroinflammatory condition where antibodies block the transmission of signals between nerve and muscle, thereby resulting in muscle fatigue and weakness. Also here B cells play a role, though likely in part different from MS. Fewer approved drug therapies are currently available for MG than MS, and current treatment guidelines are mostly based on empirical evidence rather results from robust trials. However, we have conducted one of the first such trials exclusively in individuals with new onset disease, showing that rituximab started early is associated with improved outcomes. We are now working on several follow up studies to address how the treatment of MG can be further improved.</p>\n<p>Together with several collaborating groups we also conduct research in both traumatic and psychiatric conditions, where we contribute with our expertise in biomarkers.</p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"ojup4qu9l","module":{"id":"cG9zdDo0MTE5","databaseId":4119,"title":"Research projects","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<ul>\n<li>Experimental clinical studies on neuroimmunology, and imaging and soluble biomarkers in MS, and other inflammatory and non-inflammatory conditions.</li>\n<li>Clinical treatment research in MS.</li>\n<li>Clinical treatment research in MG.</li>\n</ul>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"l1djibvee","module":{"id":"cG9zdDo0MTIx","databaseId":4121,"title":"Group leader","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p><strong>Fredrik Piehl</strong>, professor, senior physician, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:fredrik.piehl@ki.se\" data-link-type=\"mailto\">fredrik.piehl@ki.se</a></p>","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"z32a770l9","module":{"id":"cG9zdDo0MTIz","databaseId":4123,"title":"Group members","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p><strong>Susanna Brauner</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:susanna.brauner@ki.se\" data-link-type=\"mailto\">susanna.brauner@ki.se</a></p>\n<p><strong>Simon Englund</strong>, project coordinator, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:simon.englund@ki.se\" data-link-type=\"mailto\">simon.englund@ki.se</a></p>\n<p><strong>Ann Eriksson-Dufva</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:ann.erikssondufva@ki.se\" data-link-type=\"mailto\">ann.erikssondufva@ki.se</a></p>\n<p><strong>Filippo Ferro</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:filippo.ferro@ki.se\" data-link-type=\"mailto\">filippo.ferro@ki.se</a></p>\n<p><strong>Linda Forsberg</strong>, project coordinator, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852487402\" data-link-type=\"tel\">+46852487402,</a> <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:forsberg.linda@ki.se\" data-link-type=\"mailto\">forsberg.linda@ki.se</a></p>\n<p><strong>Lars Fugger</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:lars.fugger@ki.se\" data-link-type=\"mailto\">lars.fugger@ki.se</a></p>\n<p><strong>Albert Hietala</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:albert.hietala@ki.se\" data-link-type=\"mailto\">albert.hietala@ki.se</a></p>\n<p><strong>Mohsen Khademi</strong>, senior lab manager, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:mohsen.khademi@ki.se\" data-link-type=\"mailto\">mohsen.khademi@ki.se</a></p>\n<p><strong>Gavin Li</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:gavin.li@ki.se\" data-link-type=\"mailto\">gavin.li@ki.se</a></p>\n<p><strong>Mingming Li</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:mingming.li@ki.se\" data-link-type=\"mailto\">mingming.li@ki.se</a></p>\n<p><strong>Roland Martin</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:roland.martin@ki.se\" data-link-type=\"mailto\">roland.martin@ki.se</a></p>\n<p><strong>Anna Mattsson</strong>, laboratory assistant, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:anna.g.mattsson@ki.se\" data-link-type=\"mailto\">anna.g.mattsson@ki.se</a></p>\n<p><strong>Tomas Olsson</strong>, senior professor, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:tomas.olsson@ki.se\" data-link-type=\"mailto\">tomas.olsson@ki.se</a></p>\n<p><strong>Andre Ortlieb Guerreiro-Cacais</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:andre.ortlieb@ki.se\" data-link-type=\"mailto\">andre.ortlieb@ki.se</a></p>\n<p><strong>Cynthia Perez</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:cynthia.perez.estrada@ki.se\" data-link-type=\"mailto\">cynthia.perez.estrada@ki.se</a></p>\n<p><strong>Malin Petersson</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:malin.petersson@ki.se\" data-link-type=\"mailto\">malin.petersson@ki.se</a></p>\n<p><strong>Nicolas Ruffin</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:nicolas.ruffin@ki.se\" data-link-type=\"mailto\">nicolas.ruffin@ki.se</a></p>\n<p><strong>Chiara Starvaggi Cucuzza</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:chiara.starvaggi.cucuzza.2@ki.se\" data-link-type=\"mailto\">chiara.starvaggi.cucuzza.2@ki.se</a></p>\n<p><strong>Susanne Sundqvist</strong>, research nurse, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:susanne.sundqvist@ki.se\" data-link-type=\"mailto\">susanne.sundqvist@ki.se</a></p>\n<p><strong>Olafur Sveinsson</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:olafur.sveinsson@ki.se\" data-link-type=\"mailto\">olafur.sveinsson@ki.se</a></p>\n<p><strong>Emily Thorburn</strong>, research assistant, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852482026\" data-link-type=\"tel\">+46852482026</a>, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:emily.thorburn@ki.se\" data-link-type=\"mailto\">emily.thorburn@ki.se</a></p>\n<p><strong>Francesca Trogu</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:francesca.trogu@ki.se\" data-link-type=\"mailto\">francesca.trogu@ki.se</a></p>\n<p><strong>Suvi Virtanen</strong>, project coordinator, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852483217\" data-link-type=\"tel\">+46852483217,</a> <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:suvi.virtanen@ki.se\" data-link-type=\"mailto\">suvi.virtanen@ki.se</a></p>\n<p><strong>Wanqing Wu</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:wanqing.wu@ki.se\" data-link-type=\"mailto\">wanqing.wu@ki.se</a></p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"vf7sn1st1","module":{"id":"cG9zdDo0MTI1","databaseId":4125,"title":"Selected publications","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div>Full publication list in <a href=\"https://scholar.google.dk/citations?user=ZO0XAA4AAAAJ&amp;hl=en\">Google Scholar</a></div>\n<div></div>\n<ul>\n<li><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY-NEUROIMMUNOLOGY &amp; NEUROINFLAMMATION. </span>2023;10(1):e200056 <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/36411076\" data-link-type=\"external\">Sustained Low Relapse Rate With Highly Variable B-Cell Repopulation Dynamics With Extended Rituximab Dosing Intervals in Multiple Sclerosis </a>Starvaggi Cucuzza C; Longinetti E; Ruffin N; Evertsson B; Kockum I; Jagodic M; Al Nimer F; Frisell T; Piehl F</li>\n</ul>\n</div>\n<ul class=\"rims-list no-bullets\">\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2022;79(11):1105-1112</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/36121672\" data-link-type=\"external\">Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis The RINOMAX Randomized Clinical Trial</a></div>\n<div class=\"rims-publication__authors\">Piehl F; Eriksson-Dufva A; Budzianowska A; Feresiadou A; Hansson W; Hietala MA; Hakansson I; Johansson R; Jons D; Kmezic I; Lindberg C; Lindh J; Lundin F; Nygren I; Punga AR; Press R; Samuelsson K; Sundstrom P; Wickberg O; Brauner S; Frisell T</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">LANCET NEUROLOGY. </span>2022;21(8):693-703</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/35841908\" data-link-type=\"external\">Safety and efficacy of rituximab versus dimethyl fumarate in patients with relapsing-remitting multiple sclerosis or clinically isolated syndrome in Sweden: a rater-blinded, phase 3, randomised controlled trial</a></div>\n<div class=\"rims-publication__authors\">Svenningsson A; Frisell T; Burman J; Salzer J; Fink K; Hallberg S; Hambraeus J; Axelsson M; Al Nimer F; Sundstrom P; Gunnarsson M; Johansson R; Mellergard J; Rosenstein I; Ayad A; Sjoblom I; Risedal A; de Flon P; Gilland E; Lindeberg J; Shawket F; Piehl F; Lycke J</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Review: </span><span class=\"rims-publication__journal\">JOURNAL OF INTERNAL MEDICINE. </span>2021;289(6):771-791</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33258193\" data-link-type=\"external\">Current and emerging disease-modulatory therapies and treatment targets for multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2021;96(11):e1574-e1584</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33514645\" data-link-type=\"external\">Safety of Alemtuzumab and Autologous Hematopoietic Stem Cell Transplantation Compared to Noninduction Therapies for Multiple Sclerosis</a></div>\n<div class=\"rims-publication__authors\">Alping P; Burman J; Lycke J; Frisell T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">SCIENTIFIC REPORTS. </span>2021;11(1):1669</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33462306\" data-link-type=\"external\">Differential effects on blood and cerebrospinal fluid immune protein markers and kynurenine pathway metabolites from aerobic physical exercise in healthy subjects</a></div>\n<div class=\"rims-publication__authors\">Isung J; Granqvist M; Trepci A; Huang J; Schwieler L; Kierkegaard M; Erhardt S; Jokinen J; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Editorial comment: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2020;95(12):509-510</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32759197\" data-link-type=\"external\">Is the treatment of myasthenia gravis improving? Why not ask our patients?</a></div>\n<div class=\"rims-publication__authors\">Piehl F; Wolfe GI</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NATURE COMMUNICATIONS. </span>2020;11(1):4071</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32792491\" data-link-type=\"external\">Gsta4 controls apoptosis of differentiating adult oligodendrocytes during homeostasis and remyelination via the mitochondria-associated Fas-Casp8-Bid-axis</a></div>\n<div class=\"rims-publication__authors\">Carlstrom KE; Zhu K; Ewing E; Krabbendam IE; Harris RA; Falcao AM; Jagodic M; Castelo-Branco G; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2020;77(8):974-981</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32364568\" data-link-type=\"external\">Comparison Between Rituximab Treatment for New-Onset Generalized Myasthenia Gravis and Refractory Generalized Myasthenia Gravis</a></div>\n<div class=\"rims-publication__authors\">Brauner S; Eriksson-Dufva A; Hietala MA; Frisell T; Press R; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2020;94(11):e1201-e1212</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32047070\" data-link-type=\"external\">Blood neurofilament light levels segregate treatment effects in multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Delcoigne B; Manouchehrinia A; Barro C; Benkert P; Michalak Z; Kappos L; Leppert D; Tsai JA; Plavina T; Kieseier BC; Lycke J; Alfredsson L; Kockum I; Kuhle J; Olsson T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Review: </span><span class=\"rims-publication__journal\">MULTIPLE SCLEROSIS JOURNAL. </span>2020;26(2):137-152</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31237800\" data-link-type=\"external\">Rituximab treatment for multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Ineichen BV; Moridi T; Granberg T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2020;77(2):184-191</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31589278\" data-link-type=\"external\">Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies</a></div>\n<div class=\"rims-publication__authors\">Luna G; Alping P; Burman J; Fink K; Fogdell-Hahn A; Gunnarsson M; Hillert J; Langer-Gould A; Lycke J; Nilsson P; Salzer J; Svenningsson A; Vrethem M; Olsson T; Piehl F; Frisell T</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NATURE COMMUNICATIONS. </span>2019;10(1):3081</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31300673\" data-link-type=\"external\">Therapeutic efficacy of dimethyl fumarate in relapsing-remitting multiple sclerosis associates with ROS pathway in monocytes</a></div>\n<div class=\"rims-publication__authors\">Carlstrom KE; Ewing E; Granqvist M; Gyllenberg A; Aeinehband S; Enoksson SL; Checa A; Badam TVS; Huang J; Gomez-Cabrero D; Gustafsson M; Al Nimer F; Wheelock CE; Kockum I; Olsson T; Jagodic M; Piehl F</div>\n</div>\n</li>\n</ul>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}}]},"displaySettings":{"postSingleShowFeaturedImage":null},"researchGroupType":"group","children":{"nodes":[]},"menuOrder":null,"language":"en","contentNode":{"archiveDates":["2026-06-10T11:42:34"],"modifiedGmt":"2026-06-10T09:53:54","hasPageContent":true,"contentType":{"node":{"name":"research-group","graphqlSingleName":"researchGroup"}},"id":"cG9zdDo0MTEz","databaseId":4113,"uri":"/research-groups-teams/fredrik-piehl-group/","dateGmt":"2026-06-10T09:42:34","author":{"node":{"name":"magdalena"}},"title":"Fredrik Piehl Group","content":"<h1>Fredrik Piehl Group</h1>\n<h2><em>Clinical Neuroimmunology and Immunomodulation</em></h2>\n","contentMedia":[],"contentModularityModules":null,"excerpt":null,"topSidebar":{"modules":[]},"contentArea":{"modules":[{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"uuvmo6p1t","module":{"id":"cG9zdDo0MTE1","databaseId":4115,"title":"About","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p>MS is an autoimmune disease that causes damage to the nerve fibers of the central nervous system (CNS), which is the basis for the permanent neurological disabilities that many patients eventually will develop. In MG autoantibodies disturb the signal transmission between nerve and muscle causing muscle weakness that sometimes can be life-threathening.</p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"ft54651yj","module":{"id":"cG9zdDo0MTE3","databaseId":4117,"title":"Our research","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<h3 id=\"heading-0\" class=\"linked wsui-h2\">Clinical Neuroinflammation and Neurodegeneration</h3>\n<p>We work with different inflammatory diseases of the central and peripheral nervous systems. Our main focus is multiple sclerosis (MS), an autoimmune disease affecting the central nervous system (CNS), but also do research in myasthenia gravis (MG), psychiatric conditions and traumatic brain injuries.</p>\n<p>Currently we have an incomplete understanding of how inflammation in the nervous system is regulated and what significance it may have for ensuing nerve injury.</p>\n<p>Starting from a more experimental approach, our research has now evolved to be mainly clinical. MS is our main focus. Here are objectives are to generate better knowledge of why the adaptive immune system attacks the CNS, what mechanisms are involved, imaging and soluble biomarkers reflecting what is happening and, perhaps most important of all, how we can devise better therapeutic interventions. Our aim is also to address the needs of those affected by MS, and we strive to include our patients as active partners in the research we do. A major line of research is to understand the role of B cells (an immune cell type) in MS, and how this can be translated into treatments with better benefit-risk balance. To this end we examine cells and biofluids, such as serum and cerebrospinal fluid, with advanced methods, but we also study treatment effects and adverse events with epidemiological methods.</p>\n<p>Over the last decade we have performed several studies where we compare the effect and safety of rituximab, a B cell-eliminating drug that is approved for rheumatoid arthritis, but not yet for MS. Somewhat surprisingly, our studies show that rituximab in most instances provide a better benefit-risk balance and tolerability compared with MS-approved drugs. These studies have encouraged more extensive use of rituximab so that it is now the most used MS therapy in Sweden, and at substantial cost savings for the health care system.</p>\n<p>A problem not resolved, however, is why some people with MS continue to worsen even though we use drugs that strongly reduce inflammation. In order to understand why this happens, we need to understand better the neurodegenerative aspects of MS. To do so we study how the levels of different biomarkers change over time and to what degree our current treatments affect these processes. We also actively participate in clinical trials where novel treatments are tested in a clinical setting. This also includes studies of how non-drug interventions can improve symptoms, such as how physical exercise can reduce MS-fatigue.</p>\n<p>Myasthenia gravis (MG) is a neuroinflammatory condition where antibodies block the transmission of signals between nerve and muscle, thereby resulting in muscle fatigue and weakness. Also here B cells play a role, though likely in part different from MS. Fewer approved drug therapies are currently available for MG than MS, and current treatment guidelines are mostly based on empirical evidence rather results from robust trials. However, we have conducted one of the first such trials exclusively in individuals with new onset disease, showing that rituximab started early is associated with improved outcomes. We are now working on several follow up studies to address how the treatment of MG can be further improved.</p>\n<p>Together with several collaborating groups we also conduct research in both traumatic and psychiatric conditions, where we contribute with our expertise in biomarkers.</p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"ojup4qu9l","module":{"id":"cG9zdDo0MTE5","databaseId":4119,"title":"Research projects","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<ul>\n<li>Experimental clinical studies on neuroimmunology, and imaging and soluble biomarkers in MS, and other inflammatory and non-inflammatory conditions.</li>\n<li>Clinical treatment research in MS.</li>\n<li>Clinical treatment research in MG.</li>\n</ul>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"l1djibvee","module":{"id":"cG9zdDo0MTIx","databaseId":4121,"title":"Group leader","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p><strong>Fredrik Piehl</strong>, professor, senior physician, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:fredrik.piehl@ki.se\" data-link-type=\"mailto\">fredrik.piehl@ki.se</a></p>","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"z32a770l9","module":{"id":"cG9zdDo0MTIz","databaseId":4123,"title":"Group members","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<p><strong>Susanna Brauner</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:susanna.brauner@ki.se\" data-link-type=\"mailto\">susanna.brauner@ki.se</a></p>\n<p><strong>Simon Englund</strong>, project coordinator, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:simon.englund@ki.se\" data-link-type=\"mailto\">simon.englund@ki.se</a></p>\n<p><strong>Ann Eriksson-Dufva</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:ann.erikssondufva@ki.se\" data-link-type=\"mailto\">ann.erikssondufva@ki.se</a></p>\n<p><strong>Filippo Ferro</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:filippo.ferro@ki.se\" data-link-type=\"mailto\">filippo.ferro@ki.se</a></p>\n<p><strong>Linda Forsberg</strong>, project coordinator, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852487402\" data-link-type=\"tel\">+46852487402,</a> <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:forsberg.linda@ki.se\" data-link-type=\"mailto\">forsberg.linda@ki.se</a></p>\n<p><strong>Lars Fugger</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:lars.fugger@ki.se\" data-link-type=\"mailto\">lars.fugger@ki.se</a></p>\n<p><strong>Albert Hietala</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:albert.hietala@ki.se\" data-link-type=\"mailto\">albert.hietala@ki.se</a></p>\n<p><strong>Mohsen Khademi</strong>, senior lab manager, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:mohsen.khademi@ki.se\" data-link-type=\"mailto\">mohsen.khademi@ki.se</a></p>\n<p><strong>Gavin Li</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:gavin.li@ki.se\" data-link-type=\"mailto\">gavin.li@ki.se</a></p>\n<p><strong>Mingming Li</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:mingming.li@ki.se\" data-link-type=\"mailto\">mingming.li@ki.se</a></p>\n<p><strong>Roland Martin</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:roland.martin@ki.se\" data-link-type=\"mailto\">roland.martin@ki.se</a></p>\n<p><strong>Anna Mattsson</strong>, laboratory assistant, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:anna.g.mattsson@ki.se\" data-link-type=\"mailto\">anna.g.mattsson@ki.se</a></p>\n<p><strong>Tomas Olsson</strong>, senior professor, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:tomas.olsson@ki.se\" data-link-type=\"mailto\">tomas.olsson@ki.se</a></p>\n<p><strong>Andre Ortlieb Guerreiro-Cacais</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:andre.ortlieb@ki.se\" data-link-type=\"mailto\">andre.ortlieb@ki.se</a></p>\n<p><strong>Cynthia Perez</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:cynthia.perez.estrada@ki.se\" data-link-type=\"mailto\">cynthia.perez.estrada@ki.se</a></p>\n<p><strong>Malin Petersson</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:malin.petersson@ki.se\" data-link-type=\"mailto\">malin.petersson@ki.se</a></p>\n<p><strong>Nicolas Ruffin</strong>, senior research specialist, docent, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:nicolas.ruffin@ki.se\" data-link-type=\"mailto\">nicolas.ruffin@ki.se</a></p>\n<p><strong>Chiara Starvaggi Cucuzza</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:chiara.starvaggi.cucuzza.2@ki.se\" data-link-type=\"mailto\">chiara.starvaggi.cucuzza.2@ki.se</a></p>\n<p><strong>Susanne Sundqvist</strong>, research nurse, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:susanne.sundqvist@ki.se\" data-link-type=\"mailto\">susanne.sundqvist@ki.se</a></p>\n<p><strong>Olafur Sveinsson</strong>, affiliated to research, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:olafur.sveinsson@ki.se\" data-link-type=\"mailto\">olafur.sveinsson@ki.se</a></p>\n<p><strong>Emily Thorburn</strong>, research assistant, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852482026\" data-link-type=\"tel\">+46852482026</a>, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:emily.thorburn@ki.se\" data-link-type=\"mailto\">emily.thorburn@ki.se</a></p>\n<p><strong>Francesca Trogu</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:francesca.trogu@ki.se\" data-link-type=\"mailto\">francesca.trogu@ki.se</a></p>\n<p><strong>Suvi Virtanen</strong>, project coordinator, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"tel:+46852483217\" data-link-type=\"tel\">+46852483217,</a> <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:suvi.virtanen@ki.se\" data-link-type=\"mailto\">suvi.virtanen@ki.se</a></p>\n<p><strong>Wanqing Wu</strong>, PhD student, <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"mailto:wanqing.wu@ki.se\" data-link-type=\"mailto\">wanqing.wu@ki.se</a></p>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}},{"align":null,"background":null,"columnWidth":"","hidden":false,"key":"vf7sn1st1","module":{"id":"cG9zdDo0MTI1","databaseId":4125,"title":"Selected publications","hideTitle":false,"contentType":{"node":{"name":"mod-text"}},"content":"<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div>Full publication list in <a href=\"https://scholar.google.dk/citations?user=ZO0XAA4AAAAJ&amp;hl=en\">Google Scholar</a></div>\n<div></div>\n<ul>\n<li><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY-NEUROIMMUNOLOGY &amp; NEUROINFLAMMATION. </span>2023;10(1):e200056 <a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/36411076\" data-link-type=\"external\">Sustained Low Relapse Rate With Highly Variable B-Cell Repopulation Dynamics With Extended Rituximab Dosing Intervals in Multiple Sclerosis </a>Starvaggi Cucuzza C; Longinetti E; Ruffin N; Evertsson B; Kockum I; Jagodic M; Al Nimer F; Frisell T; Piehl F</li>\n</ul>\n</div>\n<ul class=\"rims-list no-bullets\">\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2022;79(11):1105-1112</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/36121672\" data-link-type=\"external\">Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis The RINOMAX Randomized Clinical Trial</a></div>\n<div class=\"rims-publication__authors\">Piehl F; Eriksson-Dufva A; Budzianowska A; Feresiadou A; Hansson W; Hietala MA; Hakansson I; Johansson R; Jons D; Kmezic I; Lindberg C; Lindh J; Lundin F; Nygren I; Punga AR; Press R; Samuelsson K; Sundstrom P; Wickberg O; Brauner S; Frisell T</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">LANCET NEUROLOGY. </span>2022;21(8):693-703</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/35841908\" data-link-type=\"external\">Safety and efficacy of rituximab versus dimethyl fumarate in patients with relapsing-remitting multiple sclerosis or clinically isolated syndrome in Sweden: a rater-blinded, phase 3, randomised controlled trial</a></div>\n<div class=\"rims-publication__authors\">Svenningsson A; Frisell T; Burman J; Salzer J; Fink K; Hallberg S; Hambraeus J; Axelsson M; Al Nimer F; Sundstrom P; Gunnarsson M; Johansson R; Mellergard J; Rosenstein I; Ayad A; Sjoblom I; Risedal A; de Flon P; Gilland E; Lindeberg J; Shawket F; Piehl F; Lycke J</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Review: </span><span class=\"rims-publication__journal\">JOURNAL OF INTERNAL MEDICINE. </span>2021;289(6):771-791</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33258193\" data-link-type=\"external\">Current and emerging disease-modulatory therapies and treatment targets for multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2021;96(11):e1574-e1584</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33514645\" data-link-type=\"external\">Safety of Alemtuzumab and Autologous Hematopoietic Stem Cell Transplantation Compared to Noninduction Therapies for Multiple Sclerosis</a></div>\n<div class=\"rims-publication__authors\">Alping P; Burman J; Lycke J; Frisell T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">SCIENTIFIC REPORTS. </span>2021;11(1):1669</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/33462306\" data-link-type=\"external\">Differential effects on blood and cerebrospinal fluid immune protein markers and kynurenine pathway metabolites from aerobic physical exercise in healthy subjects</a></div>\n<div class=\"rims-publication__authors\">Isung J; Granqvist M; Trepci A; Huang J; Schwieler L; Kierkegaard M; Erhardt S; Jokinen J; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Editorial comment: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2020;95(12):509-510</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32759197\" data-link-type=\"external\">Is the treatment of myasthenia gravis improving? Why not ask our patients?</a></div>\n<div class=\"rims-publication__authors\">Piehl F; Wolfe GI</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NATURE COMMUNICATIONS. </span>2020;11(1):4071</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32792491\" data-link-type=\"external\">Gsta4 controls apoptosis of differentiating adult oligodendrocytes during homeostasis and remyelination via the mitochondria-associated Fas-Casp8-Bid-axis</a></div>\n<div class=\"rims-publication__authors\">Carlstrom KE; Zhu K; Ewing E; Krabbendam IE; Harris RA; Falcao AM; Jagodic M; Castelo-Branco G; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2020;77(8):974-981</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32364568\" data-link-type=\"external\">Comparison Between Rituximab Treatment for New-Onset Generalized Myasthenia Gravis and Refractory Generalized Myasthenia Gravis</a></div>\n<div class=\"rims-publication__authors\">Brauner S; Eriksson-Dufva A; Hietala MA; Frisell T; Press R; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NEUROLOGY. </span>2020;94(11):e1201-e1212</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/32047070\" data-link-type=\"external\">Blood neurofilament light levels segregate treatment effects in multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Delcoigne B; Manouchehrinia A; Barro C; Benkert P; Michalak Z; Kappos L; Leppert D; Tsai JA; Plavina T; Kieseier BC; Lycke J; Alfredsson L; Kockum I; Kuhle J; Olsson T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Review: </span><span class=\"rims-publication__journal\">MULTIPLE SCLEROSIS JOURNAL. </span>2020;26(2):137-152</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31237800\" data-link-type=\"external\">Rituximab treatment for multiple sclerosis</a></div>\n<div class=\"rims-publication__authors\">Ineichen BV; Moridi T; Granberg T; Piehl F</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">JAMA NEUROLOGY. </span>2020;77(2):184-191</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31589278\" data-link-type=\"external\">Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies</a></div>\n<div class=\"rims-publication__authors\">Luna G; Alping P; Burman J; Fink K; Fogdell-Hahn A; Gunnarsson M; Hillert J; Langer-Gould A; Lycke J; Nilsson P; Salzer J; Svenningsson A; Vrethem M; Olsson T; Piehl F; Frisell T</div>\n</div>\n</li>\n<li class=\"rims-list__item\">\n<div class=\"rims-publication\" data-once=\"rims-profile-authors-all rims-authors-tabby\">\n<div><span class=\"rims-publication__type\">Article: </span><span class=\"rims-publication__journal\">NATURE COMMUNICATIONS. </span>2019;10(1):3081</div>\n<div><a class=\"wsui-link wsui-is-interactive css-1xpmzv4\" href=\"https://www.ncbi.nlm.nih.gov/pubmed/31300673\" data-link-type=\"external\">Therapeutic efficacy of dimethyl fumarate in relapsing-remitting multiple sclerosis associates with ROS pathway in monocytes</a></div>\n<div class=\"rims-publication__authors\">Carlstrom KE; Ewing E; Granqvist M; Gyllenberg A; Aeinehband S; Enoksson SL; Checa A; Badam TVS; Huang J; Gomez-Cabrero D; Gustafsson M; Al Nimer F; Wheelock CE; Kockum I; Olsson T; Jagodic M; Piehl F</div>\n</div>\n</li>\n</ul>\n","contentMedia":[],"contentModularityModules":null,"modTextOptions":{"expandable":null,"hideBoxFrame":null,"theme":"transparent","links":null}}}]},"displaySettings":{"postSingleShowFeaturedImage":null},"researchGroupType":"group","children":{"nodes":[]},"menuOrder":null},"textContent":"Fredrik Piehl Group\nClinical Neuroimmunology and Immunomodulation\n\nAbout\nMS is an autoimmune disease that causes damage to the nerve fibers of the central nervous system (CNS), which is the basis for the permanent neurological disabilities that many patients eventually will develop. In MG autoantibodies disturb the signal transmission between nerve and muscle causing muscle weakness that sometimes can be life-threathening.\n\nOur research\nClinical Neuroinflammation and Neurodegeneration\nWe work with different inflammatory diseases of the central and peripheral nervous systems. Our main focus is multiple sclerosis (MS), an autoimmune disease affecting the central nervous system (CNS), but also do research in myasthenia gravis (MG), psychiatric conditions and traumatic brain injuries.\nCurrently we have an incomplete understanding of how inflammation in the nervous system is regulated and what significance it may have for ensuing nerve injury.\nStarting from a more experimental approach, our research has now evolved to be mainly clinical. MS is our main focus. Here are objectives are to generate better knowledge of why the adaptive immune system attacks the CNS, what mechanisms are involved, imaging and soluble biomarkers reflecting what is happening and, perhaps most important of all, how we can devise better therapeutic interventions. Our aim is also to address the needs of those affected by MS, and we strive to include our patients as active partners in the research we do. A major line of research is to understand the role of B cells (an immune cell type) in MS, and how this can be translated into treatments with better benefit-risk balance. To this end we examine cells and biofluids, such as serum and cerebrospinal fluid, with advanced methods, but we also study treatment effects and adverse events with epidemiological methods.\nOver the last decade we have performed several studies where we compare the effect and safety of rituximab, a B cell-eliminating drug that is approved for rheumatoid arthritis, but not yet for MS. Somewhat surprisingly, our studies show that rituximab in most instances provide a better benefit-risk balance and tolerability compared with MS-approved drugs. These studies have encouraged more extensive use of rituximab so that it is now the most used MS therapy in Sweden, and at substantial cost savings for the health care system.\nA problem not resolved, however, is why some people with MS continue to worsen even though we use drugs that strongly reduce inflammation. In order to understand why this happens, we need to understand better the neurodegenerative aspects of MS. To do so we study how the levels of different biomarkers change over time and to what degree our current treatments affect these processes. We also actively participate in clinical trials where novel treatments are tested in a clinical setting. This also includes studies of how non-drug interventions can improve symptoms, such as how physical exercise can reduce MS-fatigue.\nMyasthenia gravis (MG) is a neuroinflammatory condition where antibodies block the transmission of signals between nerve and muscle, thereby resulting in muscle fatigue and weakness. Also here B cells play a role, though likely in part different from MS. Fewer approved drug therapies are currently available for MG than MS, and current treatment guidelines are mostly based on empirical evidence rather results from robust trials. However, we have conducted one of the first such trials exclusively in individuals with new onset disease, showing that rituximab started early is associated with improved outcomes. We are now working on several follow up studies to address how the treatment of MG can be further improved.\nTogether with several collaborating groups we also conduct research in both traumatic and psychiatric conditions, where we contribute with our expertise in biomarkers.\n\nResearch projects\n\nExperimental clinical studies on neuroimmunology, and imaging and soluble biomarkers in MS, and other inflammatory and non-inflammatory conditions.\nClinical treatment research in MS.\nClinical treatment research in MG.\n\n\nGroup leader\nFredrik Piehl, professor, senior physician, fredrik.piehl@ki.se\nGroup members\nSusanna Brauner, senior research specialist, docent, susanna.brauner@ki.se\nSimon Englund, project coordinator, PhD student, simon.englund@ki.se\nAnn Eriksson-Dufva, PhD student, ann.erikssondufva@ki.se\nFilippo Ferro, PhD student, filippo.ferro@ki.se\nLinda Forsberg, project coordinator, +46852487402, forsberg.linda@ki.se\nLars Fugger, affiliated to research, lars.fugger@ki.se\nAlbert Hietala, affiliated to research, albert.hietala@ki.se\nMohsen Khademi, senior lab manager, mohsen.khademi@ki.se\nGavin Li, PhD student, gavin.li@ki.se\nMingming Li, PhD student, mingming.li@ki.se\nRoland Martin, affiliated to research, roland.martin@ki.se\nAnna Mattsson, laboratory assistant, anna.g.mattsson@ki.se\nTomas Olsson, senior professor, tomas.olsson@ki.se\nAndre Ortlieb Guerreiro-Cacais, senior research specialist, docent, andre.ortlieb@ki.se\nCynthia Perez, affiliated to research, cynthia.perez.estrada@ki.se\nMalin Petersson, PhD student, malin.petersson@ki.se\nNicolas Ruffin, senior research specialist, docent, nicolas.ruffin@ki.se\nChiara Starvaggi Cucuzza, PhD student, chiara.starvaggi.cucuzza.2@ki.se\nSusanne Sundqvist, research nurse, susanne.sundqvist@ki.se\nOlafur Sveinsson, affiliated to research, olafur.sveinsson@ki.se\nEmily Thorburn, research assistant, +46852482026, emily.thorburn@ki.se\nFrancesca Trogu, PhD student, francesca.trogu@ki.se\nSuvi Virtanen, project coordinator, PhD student, +46852483217, suvi.virtanen@ki.se\nWanqing Wu, PhD student, wanqing.wu@ki.se\n\nSelected publications\n\nFull publication list in Google Scholar\n\n\nArticle: NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION. 2023;10(1):e200056 Sustained Low Relapse Rate With Highly Variable B-Cell Repopulation Dynamics With Extended Rituximab Dosing Intervals in Multiple Sclerosis Starvaggi Cucuzza C; Longinetti E; Ruffin N; Evertsson B; Kockum I; Jagodic M; Al Nimer F; Frisell T; Piehl F\n\n\n\n\n\nArticle: JAMA NEUROLOGY. 2022;79(11):1105-1112\nEfficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis The RINOMAX Randomized Clinical Trial\nPiehl F; Eriksson-Dufva A; Budzianowska A; Feresiadou A; Hansson W; Hietala MA; Hakansson I; Johansson R; Jons D; Kmezic I; Lindberg C; Lindh J; Lundin F; Nygren I; Punga AR; Press R; Samuelsson K; Sundstrom P; Wickberg O; Brauner S; Frisell T\n\n\n\n\nArticle: LANCET NEUROLOGY. 2022;21(8):693-703\nSafety and efficacy of rituximab versus dimethyl fumarate in patients with relapsing-remitting multiple sclerosis or clinically isolated syndrome in Sweden: a rater-blinded, phase 3, randomised controlled trial\nSvenningsson A; Frisell T; Burman J; Salzer J; Fink K; Hallberg S; Hambraeus J; Axelsson M; Al Nimer F; Sundstrom P; Gunnarsson M; Johansson R; Mellergard J; Rosenstein I; Ayad A; Sjoblom I; Risedal A; de Flon P; Gilland E; Lindeberg J; Shawket F; Piehl F; Lycke J\n\n\n\n\nReview: JOURNAL OF INTERNAL MEDICINE. 2021;289(6):771-791\nCurrent and emerging disease-modulatory therapies and treatment targets for multiple sclerosis\nPiehl F\n\n\n\n\nArticle: NEUROLOGY. 2021;96(11):e1574-e1584\nSafety of Alemtuzumab and Autologous Hematopoietic Stem Cell Transplantation Compared to Noninduction Therapies for Multiple Sclerosis\nAlping P; Burman J; Lycke J; Frisell T; Piehl F\n\n\n\n\nArticle: SCIENTIFIC REPORTS. 2021;11(1):1669\nDifferential effects on blood and cerebrospinal fluid immune protein markers and kynurenine pathway metabolites from aerobic physical exercise in healthy subjects\nIsung J; Granqvist M; Trepci A; Huang J; Schwieler L; Kierkegaard M; Erhardt S; Jokinen J; Piehl F\n\n\n\n\nEditorial comment: NEUROLOGY. 2020;95(12):509-510\nIs the treatment of myasthenia gravis improving? Why not ask our patients?\nPiehl F; Wolfe GI\n\n\n\n\nArticle: NATURE COMMUNICATIONS. 2020;11(1):4071\nGsta4 controls apoptosis of differentiating adult oligodendrocytes during homeostasis and remyelination via the mitochondria-associated Fas-Casp8-Bid-axis\nCarlstrom KE; Zhu K; Ewing E; Krabbendam IE; Harris RA; Falcao AM; Jagodic M; Castelo-Branco G; Piehl F\n\n\n\n\nArticle: JAMA NEUROLOGY. 2020;77(8):974-981\nComparison Between Rituximab Treatment for New-Onset Generalized Myasthenia Gravis and Refractory Generalized Myasthenia Gravis\nBrauner S; Eriksson-Dufva A; Hietala MA; Frisell T; Press R; Piehl F\n\n\n\n\nArticle: NEUROLOGY. 2020;94(11):e1201-e1212\nBlood neurofilament light levels segregate treatment effects in multiple sclerosis\nDelcoigne B; Manouchehrinia A; Barro C; Benkert P; Michalak Z; Kappos L; Leppert D; Tsai JA; Plavina T; Kieseier BC; Lycke J; Alfredsson L; Kockum I; Kuhle J; Olsson T; Piehl F\n\n\n\n\nReview: MULTIPLE SCLEROSIS JOURNAL. 2020;26(2):137-152\nRituximab treatment for multiple sclerosis\nIneichen BV; Moridi T; Granberg T; Piehl F\n\n\n\n\nArticle: JAMA NEUROLOGY. 2020;77(2):184-191\nInfection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies\nLuna G; Alping P; Burman J; Fink K; Fogdell-Hahn A; Gunnarsson M; Hillert J; Langer-Gould A; Lycke J; Nilsson P; Salzer J; Svenningsson A; Vrethem M; Olsson T; Piehl F; Frisell T\n\n\n\n\nArticle: NATURE COMMUNICATIONS. 2019;10(1):3081\nTherapeutic efficacy of dimethyl fumarate in relapsing-remitting multiple sclerosis associates with ROS pathway in monocytes\nCarlstrom KE; Ewing E; Granqvist M; Gyllenberg A; Aeinehband S; Enoksson SL; Checa A; Badam TVS; Huang J; Gomez-Cabrero D; Gustafsson M; Al Nimer F; Wheelock CE; Kockum I; Olsson T; Jagodic M; Piehl F\n\n\n\n","isIncludedInSearch":true}},
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