601
|
Weinshenker BG, Wingerchuk DM. Neuromyelitis Spectrum Disorders. Mayo Clin Proc 2017; 92:663-679. [PMID: 28385199 DOI: 10.1016/j.mayocp.2016.12.014] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/09/2016] [Accepted: 12/28/2016] [Indexed: 12/22/2022]
Abstract
The understanding of neuromyelitis optica spectrum disorder (NMOSD) has evolved substantially since its initial description over a century ago. The discovery in 2004 of a pathogenic autoantibody biomarker targeting aquaporin 4 IgG revolutionized diagnosis and therapeutic development. Although NMOSD resembles multiple sclerosis (MS), differences were identified and articulated in the late 1990s. New diagnostic criteria incorporating the biomarker as well as better understanding of the clinical and radiologic features of NMOSD now permit accurate diagnosis and differentiation from MS. Aquaporin 4 IgG-associated NMOSD is now regarded as an immune astrocytopathy with lytic and nonlytic effects on astrocytes. A second autoantibody, myelin oligodendrocyte glycoprotein IgG, which targets myelin rather than astrocytes, leads to an NMOSD syndrome with clinical and radiologic features that overlap but are distinct from those of aquaporin 4 IgG-associated NMOSD and MS. We review current understanding of the clinical aspects, pathophysiology, and treatment of NMOSD.
Collapse
|
602
|
Asgari N, Jarius S, Laustrup H, Skejoe HP, Lillevang ST, Weinshenker BG, Voss A. Aquaporin-4-autoimmunity in patients with systemic lupus erythematosus: A predominantly population-based study. Mult Scler 2017; 24:331-339. [PMID: 28326889 DOI: 10.1177/1352458517699791] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Serum immunoglobulin G targeting the astrocyte water channel aquaporin-4 (AQP4) in the central nervous system (CNS) is a biomarker for neuromyelitis optica spectrum disease (NMOSD). Co-existence of NMOSD with systemic lupus erythematosus (SLE) putatively suggests susceptibility to antibody-mediated autoimmune disease. OBJECTIVE To estimate the prevalence of NMOSD in SLE and investigate the immunogenetic background for an association of NMOSD and SLE. METHODS The study included a predominantly population-based cohort with clinical and serological investigations of 208 patients with SLE, followed prospectively since 1995. All patients received immunosuppressive treatment. NMOSD was evaluated retrospectively based on the 2015 International Panel for NMOSD Diagnosis (IPND) criteria. Polymorphisms in programmed cell death protein 1 (PDCD-1) PD-1.3 G/A were genotyped. AGP4-IgG and other autoantibodies, including myelin oligodendrocyte glycoprotein (MOG), was determined blinded to clinical diagnosis. RESULTS Of 208 patients with SLE, 45(22%) had neuropsychiatric (NP) SLE, and CNS involvement predominated in 30 of 45 (67%) patients. Serum AQP4-IgG was detected in 2 of 30 (6.7%) neuropsychiatric SLE (NPSLE) patients both of whom had myelitis and antiphospholipid syndrome; one patient also had myasthenia gravis. None had MOG-IgG. PD-1.3A allele was not associated with SLE nor with NPSLE. CONCLUSION AQP4-IgG autoimmune syndrome may rarely co-exist with SLE, and such patients have other NMOSD-typical syndromes such as myelitis.
Collapse
Affiliation(s)
- Nasrin Asgari
- Neurobiology Research, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark/Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Helle Laustrup
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Hanne Pb Skejoe
- Department of Radiology, Aleris-Hamlet Hospital, Copenhagen, Denmark
| | - Soeren T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | | | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
603
|
What's new in neuromyelitis optica? A short review for the clinical neurologist. J Neurol 2017; 264:2330-2344. [PMID: 28289845 DOI: 10.1007/s00415-017-8445-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
The evolution of neuromyelitis optica spectrum disorder (NMOSD) from a rare, incurable and misunderstood disease with almost universally poor outcomes to its present state in just over a decade is unprecedented in neurology and possibly in medicine. Our knowledge of NMOSD biology has led to the recognition of wider phenotypes, new disease mechanisms, and thus clinical trials of new and effective treatments. This article aims to update readers on the recent developments in NMOSD with particular emphasis on clinical advances, the 2015 diagnostic criteria, biomarkers, imaging, and therapeutic interventions.
Collapse
|
604
|
Yeshokumar AK, Hopkins S. The Differential Diagnosis and Initial Management of Pediatric Transverse Myelitis. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0120-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
605
|
Stiebel-Kalish H, Lotan I, Brody J, Chodick G, Bialer O, Marignier R, Bach M, Hellmann MA. Retinal Nerve Fiber Layer May Be Better Preserved in MOG-IgG versus AQP4-IgG Optic Neuritis: A Cohort Study. PLoS One 2017; 12:e0170847. [PMID: 28125740 PMCID: PMC5268377 DOI: 10.1371/journal.pone.0170847] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/11/2017] [Indexed: 12/21/2022] Open
Abstract
Background Optic neuritis (ON) in patients with anti-myelin oligodendrocyte glycoprotein (MOG)-IgG antibodies has been associated with a better clinical outcome than anti-aquaporin 4 (AQP4)- IgG ON. Average retinal nerve fiber layer thickness (RNFL) correlates with visual outcome after ON. Objectives The aim of this study was to examine whether anti-MOG-IgG ON is associated with better average RNFL compared to anti-AQP4-IgG ON, and whether this corresponds with a better visual outcome. Methods A retrospective study was done in a consecutive cohort of patients following anti-AQP4-IgG and anti-MOG-IgG ON. A generalized estimating equation (GEE) models analysis was used to compare average RNFL outcomes in ON eyes of patients with MOG-IgG to AQP4-IgG-positive patients, after adjusting for the number of ON events. The final mean visual field defect and visual acuity were compared between ON eyes of MOG-IgG and AQP4-IgG-positive patients. A correlation between average RNFL and visual function was performed in all study eyes. Results Sixteen patients were analyzed; ten AQP4-IgG-positive and six MOG-IgG-positive. The six patients with MOG-IgG had ten ON events with disc edema, five of which were bilateral. In the AQP4-IgG-positive ON events, 1/10 patients had disc edema. Final average RNFL was significantly better in eyes following MOG-IgG-ON (75.33μm), compared to 63.63μm in AQP4-IgG-ON, after adjusting for the number of ON attacks (GEE, p = 0.023). Mean visual field defects were significantly smaller (GEE, p = 0.046) among MOG-IgG positive ON eyes compared to AQP-IgG positive ON eyes, but last visual acuity did not differ between the groups (GEE, p = 0.153). Among all eyes, average RNFL positively correlated with mean visual field defect (GEE, p = 0.00015) and negatively correlated with final visual acuity (GEE, p = 0.00005). Conclusions Following ON, RNFL is better preserved in eyes of patients with MOG-IgG antibodies compared to those with AQP4-IgG antibodies, correlating with better visual outcomes.
Collapse
Affiliation(s)
- Hadas Stiebel-Kalish
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- * E-mail:
| | - Itay Lotan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Immunology Service and Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| | - Judith Brody
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Bialer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Ophthalmology Unit, Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
| | - Romain Marignier
- Service de Neurologie A, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon-Bron, France
| | - Michael Bach
- Eye Center, Medical Center, University of Freiburg, Germany, and Faculty of Medicine, University of Freiburg, Germany
| | - Mark Andrew Hellmann
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuro-Immunology Service and Department of Neurology, Rabin Medical Center, Petah Tikva, Israel
| |
Collapse
|
606
|
Ogawa R, Nakashima I, Takahashi T, Kaneko K, Akaishi T, Takai Y, Sato DK, Nishiyama S, Misu T, Kuroda H, Aoki M, Fujihara K. MOG antibody-positive, benign, unilateral, cerebral cortical encephalitis with epilepsy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e322. [PMID: 28105459 PMCID: PMC5241006 DOI: 10.1212/nxi.0000000000000322] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
Objective: To describe the features of adult patients with benign, unilateral cerebral cortical encephalitis positive for the myelin oligodendrocyte glycoprotein (MOG) antibody. Methods: In this retrospective, cross-sectional study, after we encountered an index case of MOG antibody–positive unilateral cortical encephalitis with epileptic seizure, we tested for MOG antibody using our in-house, cell-based assay in a cohort of 24 consecutive adult patients with steroid-responsive encephalitis of unknown etiology seen at Tohoku University Hospital (2008–2014). We then analyzed the findings in MOG antibody–positive cases. Results: Three more patients, as well as the index case, were MOG antibody–positive, and all were adult men (median age 37 years, range 23–39 years). The main symptom was generalized epileptic seizure with or without abnormal behavior or consciousness disturbance. Two patients also developed unilateral benign optic neuritis (before or after seizure). In all patients, brain MRI demonstrated unilateral cerebral cortical fluid-attenuated inversion recovery hyperintense lesions, which were swollen and corresponded to hyperperfusion on SPECT. CSF studies showed moderate mononuclear pleocytosis with some polymorphonuclear cells and mildly elevated total protein levels, but myelin basic protein was not elevated. A screening of encephalitis-associated autoantibodies, including aquaporin-4, glutamate receptor, and voltage-gated potassium channel antibodies, was negative. All patients received antiepilepsy drugs and fully recovered after high-dose methylprednisolone, and the unilateral cortical MRI lesions subsequently disappeared. No patient experienced relapse. Conclusions: These MOG antibody–positive cases represent unique benign unilateral cortical encephalitis with epileptic seizure. The pathology may be autoimmune, although the findings differ from MOG antibody–associated demyelination and Rasmussen and other known immune-mediated encephalitides.
Collapse
Affiliation(s)
- Ryo Ogawa
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Ichiro Nakashima
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Toshiyuki Takahashi
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Kimihiko Kaneko
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Tetsuya Akaishi
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yoshiki Takai
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Douglas Kazutoshi Sato
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Shuhei Nishiyama
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Tatsuro Misu
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Hiroshi Kuroda
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Masashi Aoki
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Kazuo Fujihara
- Department of Neurology (R.O., I.N., T.T., K.K., T.A., Y.T., D.K.S., S.N., T.M., H.K., M.A., K.F.), Tohoku University Graduate School of Medicine, Sendai; Department of Neurology (T.T.), Yonezawa National Hospital, Yamagata, Japan; Brain Institute (D.K.S.), The Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil; Department of Multiple Sclerosis Therapeutics (K.F.), Fukushima Medical University; and Multiple Sclerosis & Neuromyelitis Optica Center (K.F.), Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| |
Collapse
|
607
|
Zhou L, Huang Y, Li H, Fan J, Zhangbao J, Yu H, Li Y, Lu J, Zhao C, Lu C, Wang M, Quan C. MOG-antibody associated demyelinating disease of the CNS: A clinical and pathological study in Chinese Han patients. J Neuroimmunol 2017; 305:19-28. [PMID: 28284341 DOI: 10.1016/j.jneuroim.2017.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 01/26/2023]
Abstract
We aim to evaluate the clinical relevance of MOG-ab in a cohort of Chinese Han adults with CNS inflammatory demyelinating diseases (IDDs). MOG-ab and AQP4-ab were examined through a fixed cell based indirect immune-fluorescence assay in 86 patients with CNS-IDDs. MOG-ab was positive in 12 patients, while AQP4-ab was positive in 31 patients; none double positives. Optic neuritis (ON) was the most frequent symptom at onset (75.0%) or during the whole disease course (83.3%) of MOG-ab associated IDDs (MOG-IDDs); 79.5% of the episodes involved only the optic nerve in MOG-IDDs. MOG-ab related ON (MOG-ON) usually caused severe visual impairment, longitudinally extensive optic nerve lesion with anterior enhancement and perineural soft tissue enhancement, responded well to steroid, but still could leave remarkable thinning of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). MOG-IDDs had less spinal cord involvement compared to AQP4-ab mediated NMO/SD. Heterogeneous brain lesions existed in 66.7% of the patients with MOG-IDDs. Large, edematous white matter lesions were observed with the pathological feature of obvious demyelination yet preservation of astrocyte and axon, fundamentally different from the astrocytopathy typically seen in NMO/SD. Our investigations suggest that MOG-ab mediates a distinct disease entity separate from NMO/SD.
Collapse
Affiliation(s)
- Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Yongheng Huang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Jie Fan
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Jingzi Zhangbao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Hai Yu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China; Department of Neurology, Jing'an District Centre Hospital of Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Min Wang
- Department of Ophthalmology, Eye and ENT Hospital, Shanghai Medical College, Fudan University, China.
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China.
| |
Collapse
|
608
|
Pandit L, Nakashima I, Mustafa S, Takahashi T, Kaneko K. Anti Myelin Oligodendrocyte Glycoprotein associated Immunoglobulin G (AntiMOG-IgG)-associated Neuromyelitis Optica Spectrum Disorder with Persistent Disease Activity and Residual Cognitive Impairment. Ann Indian Acad Neurol 2017; 20:411-413. [PMID: 29184347 PMCID: PMC5682748 DOI: 10.4103/aian.aian_250_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Antibodies targeting myelin oligodendrocyte glycoprotein (MOG) have been recently reported in association with idiopathic inflammatory central nervous system disorders. Initially believed to be a benign disorder, anti MOG-IgG was noted to cause steroid responsive recurrent optic neuritis and isolated longitudinally extensive myelitis. However, there is growing evidence that the disease may be predominantly relapsing, often producing severe visual loss and involving regions other than the spinal cord and optic nerve. We report an adolescent male with an aggressive disease course previously undescribed in anti MOG-IgG-associated disease that left him with residual cognitive dysfunction.
Collapse
Affiliation(s)
- Lekha Pandit
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Ichiro Nakashima
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Sharik Mustafa
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimhiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
609
|
Han J, Yang MG, Zhu J, Jin T. Complexity and wide range of neuromyelitis optica spectrum disorders: more than typical manifestations. Neuropsychiatr Dis Treat 2017; 13:2653-2660. [PMID: 29118581 PMCID: PMC5659226 DOI: 10.2147/ndt.s147360] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neuromyelitis optica (NMO), considered to be mediated by autoantibodies, often cause severely disabling disorders of the central nervous system, and predominantly cause optic nerve damage and longitudinally extensive transverse myelitis. Remarkable progress has been made in deciphering NMO pathogenesis during the past decade. In 2015, the International Panel for NMO Diagnosis proposed the unifying term "NMO spectrum disorders" (NMOSD) and the updated NMOSD criteria reflects a wide range of disease and maintains reasonable specificity. Moreover, cumulative findings have indicated that NMOSD are frequently associated with multiple autoimmune diseases, thereby presenting complex clinical symptoms that make this disease more difficult to recognize. Notably, most neurologists do not heed these symptoms or comorbid conditions in patients with NMOSD. Whereas previous reviews have focused on pathogenesis, treatment, and prognosis in NMOSD, we summarize the present knowledge with particular emphasis on atypical manifestations and autoimmune comorbidities in patients with NMOSD. Furthermore, we emphasized the identification of these atypical characteristics to enable a broader and better understanding of NMOSD, and improve early accurate diagnosis and therapeutic decision making.
Collapse
Affiliation(s)
- Jinming Han
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Meng-Ge Yang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tao Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
610
|
The MRZ reaction as a highly specific marker of multiple sclerosis: re-evaluation and structured review of the literature. J Neurol 2016; 264:453-466. [PMID: 28005176 DOI: 10.1007/s00415-016-8360-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND It has long been known that the majority of patients with multiple sclerosis (MS) display an intrathecal, polyspecific humoral immune response to a broad panel of neurotropic viruses. This response has measles virus, rubella virus and varicella zoster virus as its most frequent constituents and is thus referred to as the MRZ reaction (MRZR). OBJECTIVE Re-evaluation of the specificity of MRZR as a marker of MS. METHODS Structured review of the existing English-, German- and Spanish-language literature on MRZR testing, with evaluation of MRZR in a cohort of 43 unselected patients with MS and other neurological diseases as a proof of principle. RESULTS A positive MRZ reaction, defined as a positive intrathecal response to at least two of the three viral agents, was found in 78% of MS patients but only in 3% of the controls (p < 0.00001), corresponding to specificity of 97%. Median antibody index values were significantly lower in non-MS patients (measles, p < 0.0001; rubella, p < 0.006; varicella zoster, p < 0.02). The 30 identified original studies on MRZR reported results from 1478 individual MRZR tests. A positive MRZR was reported for 458/724 (63.3%) tests in patients with MS but only for 19/754 (2.5%) tests in control patients (p < 0.000001), corresponding to cumulative specificity of 97.5% (CI 95% 96-98.4), cumulative sensitivity of 63.3% (CI 95% 59.6-66.8) (or 67.4% [CI 95% 63.5-71.1] in the adult MS subgroup), a positive likelihood ratio of 25.1 (CI 95% 16-39.3) and a negative likelihood ratio of 0.38 (CI 95% 0.34-0.41). Of particular note, MRZR was absent in 52/53 (98.1%) patients with neuromyelitis optica or MOG-IgG-positive encephalomyelitis, two important differential diagnoses of MS. CONCLUSION MRZR is the most specific laboratory marker of MS reported to date. If present, MRZR substantially increases the likelihood of the diagnosis of MS. Prospective and systematic studies on the diagnostic and prognostic impact of MRZR testing are highly warranted.
Collapse
|
611
|
Pache F, Zimmermann H, Mikolajczak J, Schumacher S, Lacheta A, Oertel FC, Bellmann-Strobl J, Jarius S, Wildemann B, Reindl M, Waldman A, Soelberg K, Asgari N, Ringelstein M, Aktas O, Gross N, Buttmann M, Ach T, Ruprecht K, Paul F, Brandt AU. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 4: Afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients. J Neuroinflammation 2016; 13:282. [PMID: 27802824 PMCID: PMC5088645 DOI: 10.1186/s12974-016-0720-6] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patients with aquaporin-4 antibody (AQP4-IgG)-negative neuromyelitis optica spectrum disorders (NMOSD). The objective of this study was to describe optic neuritis (ON)-induced neuro-axonal damage in the retina of MOG-IgG-positive patients in comparison with AQP4-IgG-positive NMOSD patients. METHODS Afferent visual system damage following ON was bilaterally assessed in 16 MOG-IgG-positive patients with a history of ON and compared with that in 16 AQP4-IgG-positive NMOSD patients. In addition, 16 healthy controls matched for age, sex, and disease duration were analyzed. Study data included ON history, retinal optical coherence tomography, visual acuity, and visual evoked potentials. RESULTS Eight MOG-IgG-positive patients had a previous diagnosis of AQP4-IgG-negative NMOSD with ON and myelitis, and eight of (mainly recurrent) ON. Twenty-nine of the 32 eyes of the MOG-IgG-positive patients had been affected by at least one episode of ON. Peripapillary retinal nerve fiber layer thickness (pRNFL) and ganglion cell and inner plexiform layer volume (GCIP) were significantly reduced in ON eyes of MOG-IgG-positive patients (pRNFL = 59 ± 23 μm; GCIP = 1.50 ± 0.34 mm3) compared with healthy controls (pRNFL = 99 ± 6 μm, p < 0.001; GCIP = 1.97 ± 0.11 mm3, p < 0.001). Visual acuity was impaired in eyes after ON in MOG-IgG-positive patients (0.35 ± 0.88 logMAR). There were no significant differences in any structural or functional visual parameters between MOG-IgG-positive and AQP4-IgG-positive patients (pRNFL: 59 ± 21 μm; GCIP: 1.41 ± 0.27 mm3; Visual acuity = 0.72 ± 1.09 logMAR). Importantly, MOG-IgG-positive patients had a significantly higher annual ON relapse rate than AQP4-IgG-positive patients (median 0.69 vs. 0.29 attacks/year, p = 0.004), meaning that on average a single ON episode caused less damage in MOG-IgG-positive than in AQP4-IgG-positive patients. pRNFL and GCIP loss correlated with the number of ON episodes in MOG-IgG-positive patients (p < 0.001), but not in AQP4-IgG-positive patients. CONCLUSIONS Retinal neuro-axonal damage and visual impairment after ON in MOG-IgG-positive patients are as severe as in AQP4-IgG-positive NMOSD patients. In MOG-IgG-positive patients, damage accrual may be driven by higher relapse rates, whereas AQP4-IgG-positive patients showed fewer but more severe episodes of ON. Given the marked damage in some of our MOG-IgG-positive patients, early diagnosis and timely initiation and close monitoring of immunosuppressive therapy are important.
Collapse
Affiliation(s)
- Florence Pache
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Janine Mikolajczak
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sophie Schumacher
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna Lacheta
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Frederike C. Oertel
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amy Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA
| | - Kerstin Soelberg
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Nasrin Asgari
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Nikolai Gross
- Department of Ophthalmology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Mathias Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Thomas Ach
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander U. Brandt
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - in cooperation with the Neuromyelitis Optica Study Group (NEMOS)
- NeuroCure Clinical Research Center (NCRC), Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Division of Neurology, Children’s Hospital of Philadelphia, Pennsylvania, USA
- Department of Neurology, Vejle Hospital, Vejle, Denmark
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Ophthalmology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Department of Neurology, University of Würzburg, Würzburg, Germany
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
612
|
Jarius S, Kleiter I, Ruprecht K, Asgari N, Pitarokoili K, Borisow N, Hümmert MW, Trebst C, Pache F, Winkelmann A, Beume LA, Ringelstein M, Stich O, Aktas O, Korporal-Kuhnke M, Schwarz A, Lukas C, Haas J, Fechner K, Buttmann M, Bellmann-Strobl J, Zimmermann H, Brandt AU, Franciotta D, Schanda K, Paul F, Reindl M, Wildemann B. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 3: Brainstem involvement - frequency, presentation and outcome. J Neuroinflammation 2016; 13:281. [PMID: 27802825 PMCID: PMC5088671 DOI: 10.1186/s12974-016-0719-z] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) are present in a subset of aquaporin-4 (AQP4)-IgG-negative patients with optic neuritis (ON) and/or myelitis. Little is known so far about brainstem involvement in MOG-IgG-positive patients. Objective To investigate the frequency, clinical and paraclinical features, course, outcome, and prognostic implications of brainstem involvement in MOG-IgG-positive ON and/or myelitis. Methods Retrospective case study. Results Among 50 patients with MOG-IgG-positive ON and/or myelitis, 15 (30 %) with a history of brainstem encephalitis were identified. All were negative for AQP4-IgG. Symptoms included respiratory insufficiency, intractable nausea and vomiting (INV), dysarthria, dysphagia, impaired cough reflex, oculomotor nerve palsy and diplopia, nystagmus, internuclear ophthalmoplegia (INO), facial nerve paresis, trigeminal hypesthesia/dysesthesia, vertigo, hearing loss, balance difficulties, and gait and limb ataxia; brainstem involvement was asymptomatic in three cases. Brainstem inflammation was already present at or very shortly after disease onset in 7/15 (47 %) patients. 16/21 (76.2 %) brainstem attacks were accompanied by acute myelitis and/or ON. Lesions were located in the pons (11/13), medulla oblongata (8/14), mesencephalon (cerebral peduncles; 2/14), and cerebellar peduncles (5/14), were adjacent to the fourth ventricle in 2/12, and periaqueductal in 1/12; some had concomitant diencephalic (2/13) or cerebellar lesions (1/14). MRI or laboratory signs of blood-brain barrier damage were present in 5/12. Cerebrospinal fluid pleocytosis was found in 11/14 cases, with neutrophils in 7/11 (3-34 % of all CSF white blood cells), and oligoclonal bands in 4/14. Attacks were preceded by acute infection or vaccination in 5/15 (33.3 %). A history of teratoma was noted in one case. The disease followed a relapsing course in 13/15 (87 %); the brainstem was involved more than once in 6. Immunosuppression was not always effective in preventing relapses. Interferon-beta was followed by new attacks in two patients. While one patient died from central hypoventilation, partial or complete recovery was achieved in the remainder following treatment with high-dose steroids and/or plasma exchange. Brainstem involvement was associated with a more aggressive general disease course (higher relapse rate, more myelitis attacks, more frequently supratentorial brain lesions, worse EDSS at last follow-up). Conclusions Brainstem involvement is present in around one third of MOG-IgG-positive patients with ON and/or myelitis. Clinical manifestations are diverse and may include symptoms typically seen in AQP4-IgG-positive neuromyelitis optica, such as INV and respiratory insufficiency, or in multiple sclerosis, such as INO. As MOG-IgG-positive brainstem encephalitis may take a serious or even fatal course, particular attention should be paid to signs or symptoms of additional brainstem involvement in patients presenting with MOG-IgG-positive ON and/or myelitis.
Collapse
Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - Ingo Kleiter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology and Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Nadja Borisow
- Department of Neurology, NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Florence Pache
- Department of Neurology, NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | | | | | | | - Oliver Stich
- Department of Neurology, Albert Ludwigs University, Freiburg, Germany
| | - Orhan Aktas
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - Mirjam Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Alexander Schwarz
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Carsten Lukas
- Department of Neuroradiology, Ruhr University Bochum, Bochum, Germany
| | - Jürgen Haas
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Kai Fechner
- Institute of Experimental Immunology, affiliated to Euroimmun AG, Lübeck, Germany
| | - Mathias Buttmann
- Department of Neurology, Julius Maximilians University, Würzburg, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Hanna Zimmermann
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Alexander U Brandt
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Kathrin Schanda
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Friedemann Paul
- Department of Neurology, NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Markus Reindl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | | |
Collapse
|
613
|
Jarius S, Ringelstein M, Haas J, Serysheva II, Komorowski L, Fechner K, Wandinger KP, Albrecht P, Hefter H, Moser A, Neuen-Jacob E, Hartung HP, Wildemann B, Aktas O. Inositol 1,4,5-trisphosphate receptor type 1 autoantibodies in paraneoplastic and non-paraneoplastic peripheral neuropathy. J Neuroinflammation 2016; 13:278. [PMID: 27776522 PMCID: PMC5078930 DOI: 10.1186/s12974-016-0737-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, we described a novel autoantibody, anti-Sj/ITPR1-IgG, that targets the inositol 1,4,5-trisphosphate receptor type 1 (ITPR1) in patients with cerebellar ataxia. However, ITPR1 is expressed not only by Purkinje cells but also in the anterior horn of the spinal cord, in the substantia gelatinosa and in the motor, sensory (including the dorsal root ganglia) and autonomic peripheral nervous system, suggesting that the clinical spectrum associated with autoimmunity to ITPR1 may be broader than initially thought. Here we report on serum autoantibodies to ITPR1 (up to 1:15,000) in three patients with (radiculo)polyneuropathy, which in two cases was associated with cancer (ITPR1-expressing adenocarcinoma of the lung, multiple myeloma), suggesting a paraneoplastic aetiology. METHODS Serological and other immunological studies, and retrospective analysis of patient records. RESULTS The clinical findings comprised motor, sensory (including severe pain) and autonomic symptoms. While one patient presented with subacute symptoms mimicking Guillain-Barré syndrome (GBS), the symptoms progressed slowly in two other patients. Electrophysiology revealed delayed F waves; a decrease in motor and sensory action potentials and conduction velocities; delayed motor latencies; signs of denervation, indicating sensorimotor radiculopolyneuropathy of the mixed type; and no conduction blocks. ITPR1-IgG belonged to the complement-activating IgG1 subclass in the severely affected patient but exclusively to the IgG2 subclass in the two more mildly affected patients. Cerebrospinal fluid ITPR1-IgG was found to be of predominantly extrathecal origin. A 3H-thymidine-based proliferation assay confirmed the presence of ITPR1-reactive lymphocytes among peripheral blood mononuclear cells (PBMCs). Immunophenotypic profiling of PBMCs protein demonstrated predominant proliferation of B cells, CD4 T cells and CD8 memory T cells following stimulation with purified ITPR1 protein. Patient ITPR1-IgG bound both to peripheral nervous tissue and to lung tumour tissue. A nerve biopsy showed lymphocyte infiltration (including cytotoxic CD8 cells), oedema, marked axonal loss and myelin-positive macrophages, indicating florid inflammation. ITPR1-IgG serum titres declined following tumour removal, paralleled by clinical stabilization. CONCLUSIONS Our findings expand the spectrum of clinical syndromes associated with ITPR1-IgG and suggest that autoimmunity to ITPR1 may underlie peripheral nervous system diseases (including GBS) in some patients and may be of paraneoplastic origin in a subset of cases.
Collapse
Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jürgen Haas
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Irina I Serysheva
- Department of Biochemistry and Molecular Biology, The University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX, 77030, USA
| | - Lars Komorowski
- Institute of Experimental Immunology, affiliated to Euroimmun AG, Seekamp 31, 23560, Lübeck, Germany
| | - Kai Fechner
- Institute of Experimental Immunology, affiliated to Euroimmun AG, Seekamp 31, 23560, Lübeck, Germany
| | - Klaus-Peter Wandinger
- Department of Neurology, University of Schleswig Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Harald Hefter
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Andreas Moser
- Department of Neurology, University of Schleswig Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Eva Neuen-Jacob
- Department of Neuropathology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
614
|
Jarius S, Ruprecht K, Kleiter I, Borisow N, Asgari N, Pitarokoili K, Pache F, Stich O, Beume LA, Hümmert MW, Trebst C, Ringelstein M, Aktas O, Winkelmann A, Buttmann M, Schwarz A, Zimmermann H, Brandt AU, Franciotta D, Capobianco M, Kuchling J, Haas J, Korporal-Kuhnke M, Lillevang ST, Fechner K, Schanda K, Paul F, Wildemann B, Reindl M. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 1: Frequency, syndrome specificity, influence of disease activity, long-term course, association with AQP4-IgG, and origin. J Neuroinflammation 2016; 13:279. [PMID: 27788675 PMCID: PMC5084340 DOI: 10.1186/s12974-016-0717-1] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 01/18/2023] Open
Abstract
Background Antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) have been suggested to play a role in a subset of patients with neuromyelitis optica and related disorders. Objective To assess (i) the frequency of MOG-IgG in a large and predominantly Caucasian cohort of patients with optic neuritis (ON) and/or myelitis; (ii) the frequency of MOG-IgG among AQP4-IgG-positive patients and vice versa; (iii) the origin and frequency of MOG-IgG in the cerebrospinal fluid (CSF); (iv) the presence of MOG-IgG at disease onset; and (v) the influence of disease activity and treatment status on MOG-IgG titers. Methods 614 serum samples from patients with ON and/or myelitis and from controls, including 92 follow-up samples from 55 subjects, and 18 CSF samples were tested for MOG-IgG using a live cell-based assay (CBA) employing full-length human MOG-transfected HEK293A cells. Results MOG-IgG was detected in 95 sera from 50 patients with ON and/or myelitis, including 22/54 (40.7 %) patients with a history of both ON and myelitis, 22/103 (21.4 %) with a history of ON but no myelitis and 6/45 (13.3 %) with a history of longitudinally extensive transverse myelitis but no ON, and in 1 control patient with encephalitis and a connective tissue disorder, all of whom were negative for AQP4-IgG. MOG-IgG was absent in 221 further controls, including 83 patients with AQP4-IgG-seropositive neuromyelitis optica spectrum disorders and 85 with multiple sclerosis (MS). MOG-IgG was found in 12/18 (67 %) CSF samples from MOG-IgG-seropositive patients; the MOG-IgG-specific antibody index was negative in all cases, indicating a predominantly peripheral origin of CSF MOG-IgG. Serum and CSF MOG-IgG belonged to the complement-activating IgG1 subclass. MOG-IgG was present already at disease onset. The antibodies remained detectable in 40/45 (89 %) follow-up samples obtained over a median period of 16.5 months (range 0–123). Serum titers were higher during attacks than during remission (p < 0.0001), highest during attacks of simultaneous myelitis and ON, lowest during acute isolated ON, and declined following treatment. Conclusions To date, this is the largest cohort studied for IgG to human full-length MOG by means of an up-to-date CBA. MOG-IgG is present in a substantial subset of patients with ON and/or myelitis, but not in classical MS. Co-existence of MOG-IgG and AQP4-IgG is highly uncommon. CSF MOG-IgG is of extrathecal origin. Serum MOG-IgG is present already at disease onset and remains detectable in the long-term course. Serum titers depend on disease activity and treatment status.
Collapse
Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Otto Meyerhof Center, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - Klemens Ruprecht
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
| | - Ingo Kleiter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Nadja Borisow
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology and Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Florence Pache
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Oliver Stich
- Department of Neurology, Albert Ludwigs University, Freiburg, Germany
| | | | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Orhan Aktas
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | | | - Mathias Buttmann
- Department of Neurology, Julius Maximilians University, Würzburg, Germany
| | - Alexander Schwarz
- Molecular Neuroimmunology Group, Otto Meyerhof Center, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Hanna Zimmermann
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
| | - Alexander U Brandt
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
| | | | - Marco Capobianco
- Centro di Riferimento Regionale SM, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Joseph Kuchling
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
| | - Jürgen Haas
- Molecular Neuroimmunology Group, Otto Meyerhof Center, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Mirjam Korporal-Kuhnke
- Molecular Neuroimmunology Group, Otto Meyerhof Center, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | | | - Kai Fechner
- Institute of Experimental Immunology, affiliated to Euroimmun AG, Lübeck, Germany
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Otto Meyerhof Center, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | |
Collapse
|