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Alfaidi N, Karmastaji S, Matic A, Bril V. FcRn Inhibitor Therapies in Neurologic Diseases. CNS Drugs 2024; 38:425-441. [PMID: 38724842 DOI: 10.1007/s40263-024-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
In the last decade, the landscape of treating autoimmune diseases has evolved with the emergence and approval of novel targeted therapies. Several new biological agents offer selective and target-specific immunotherapy and therefore fewer side effects, such as neonatal Fc receptor (FcRn)-targeting therapy. Neonatal Fc receptor-targeted therapies are engineered to selectively target FcRn through various methods, such as Fc fragments or monoclonal anti-FcRn antibodies. These approaches enhance the breakdown of autoantibodies by blocking the immunoglobulin G recycling pathway. This mechanism reduces overall plasma immunoglobulin levels, including the levels of pathogenic autoantibodies, without affecting the other immunoglobulin class immunoglobulin A, immunoglobulin E, immunoglobulin M, and immunoglobulin D levels. Drugs that inhibit FcRn include efgartigimod, rozanolixizumab, batoclimab, and nipocalimab. These medications can be administered either intravenously or subcutaneously. Numerous clinical trials are currently underway to investigate their effectiveness, safety, and tolerability in various neurological conditions, including myasthenia gravis and other neurological disorders such as chronic inflammatory demyelinating polyneuropathy, myositis, neuromyelitis optica, and myelin oligodendrocyte glycoprotein antibody disease. Positive results from clinical trials of efgartigimod and rozanolixizumab led to their approval for the treatment of generalized myasthenia gravis. Additional clinical trials are still ongoing. Neonatal Fc receptor inhibitor agents seem to be well tolerated. Reported adverse events include headache (most commonly observed with efgartigimod and rozanolixizumab), upper respiratory tract infection, urinary tract infection, diarrhea, pyrexia, and nausea. Additionally, some of these agents may cause transient hypoalbuminemia and hypercholesterolemia notably reported with batoclimab and nipocalimab. In this review, we discuss the available clinical data for FcRN inhibitor agents in treating different neurological autoimmune diseases.
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Affiliation(s)
- Nouf Alfaidi
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, 5EC-309, TGH 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Salama Karmastaji
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, 5EC-309, TGH 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Alexandria Matic
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, 5EC-309, TGH 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Toronto General Hospital, University Health Network, University of Toronto, 5EC-309, TGH 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
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Nakajima A, Yanagimura F, Saji E, Shimizu H, Toyoshima Y, Yanagawa K, Arakawa M, Hokari M, Yokoseki A, Wakasugi T, Okamoto K, Takebayashi H, Fujii C, Itoh K, Takei YI, Ohara S, Yamada M, Takahashi H, Nishizawa M, Igarashi H, Kakita A, Onodera O, Kawachi I. Stage-dependent immunity orchestrates AQP4 antibody-guided NMOSD pathology: a role for netting neutrophils with resident memory T cells in situ. Acta Neuropathol 2024; 147:76. [PMID: 38658413 DOI: 10.1007/s00401-024-02725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the CNS characterized by the production of disease-specific autoantibodies against aquaporin-4 (AQP4) water channels. Animal model studies suggest that anti-AQP4 antibodies cause a loss of AQP4-expressing astrocytes, primarily via complement-dependent cytotoxicity. Nonetheless, several aspects of the disease remain unclear, including: how anti-AQP4 antibodies cross the blood-brain barrier from the periphery to the CNS; how NMOSD expands into longitudinally extensive transverse myelitis or optic neuritis; how multiphasic courses occur; and how to prevent attacks without depleting circulating anti-AQP4 antibodies, especially when employing B-cell-depleting therapies. To address these knowledge gaps, we conducted a comprehensive 'stage-dependent' investigation of immune cell elements in situ in human NMOSD lesions, based on neuropathological techniques for autopsied/biopsied CNS materials. The present study provided three major findings. First, activated or netting neutrophils and melanoma cell adhesion molecule-positive (MCAM+) helper T (TH) 17/cytotoxic T (TC) 17 cells are prominent, and the numbers of these correlate with the size of NMOSD lesions in the initial or early-active stages. Second, forkhead box P3-positive (FOXP3+) regulatory T (Treg) cells are recruited to NMOSD lesions during the initial, early-active or late-active stages, suggesting rapid suppression of proinflammatory autoimmune events in the active stages of NMOSD. Third, compartmentalized resident memory immune cells, including CD103+ tissue-resident memory T (TRM) cells with long-lasting inflammatory potential, are detected under "standby" conditions in all stages. Furthermore, CD103+ TRM cells express high levels of granzyme B/perforin-1 in the initial or early-active stages of NMOSD in situ. We infer that stage-dependent compartmentalized immune traits orchestrate the pathology of anti-AQP4 antibody-guided NMOSD in situ. Our work further suggests that targeting activated/netting neutrophils, MCAM+ TH17/TC17 cells, and CD103+ TRM cells, as well as promoting the expansion of FOXP3+ Treg cells, may be effective in treating and preventing relapses of NMOSD.
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Affiliation(s)
- Akihiro Nakajima
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Fumihiro Yanagimura
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, NHO Niigata National Hospital, 3-52 Akasakamachi, Kashiwazaki, Niigata, 945-8585, Japan
| | - Etsuji Saji
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Yasuko Toyoshima
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, Brain Disease Center, Agano Hospital, 6317-15 Yasuda, Agano, Niigata, 959-2221, Japan
| | - Kaori Yanagawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Musashi Arakawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Musashi Clinic, 20-1 Hakusanura 2, Chuo-Ku, Niigata, 951-8131, Japan
| | - Mariko Hokari
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Akiko Yokoseki
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, Niigata Medical Center, 27-11 Kobari 3, Nishi-Ku, Niigata, 950-2022, Japan
| | - Takahiro Wakasugi
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, NHO Nishiniigata Chuo Hospital, 14-1 Masago 1, Nishi-Ku, Niigata, 950-2085, Japan
| | - Kouichirou Okamoto
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Hirohide Takebayashi
- Division of Neurobiology and Anatomy, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Chihiro Fujii
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan
- Department of Neurology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yo-Ichi Takei
- Department of Neurology, NHO Matsumoto Medical Center, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan
| | - Shinji Ohara
- Department of Neurology, NHO Matsumoto Medical Center, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan
- Department of Neurology, Iida Hospital, 1-15 Odori, Iida, Nagano, 395-8505, Japan
| | - Mitsunori Yamada
- Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Pathology and Laboratory Medicine, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-Ku, Niigata, 950-1101, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Hironaka Igarashi
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan.
- Medical Education Center, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan.
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Arellano G, Loda E, Chen Y, Neef T, Cogswell AC, Primer G, Joy G, Kaschke K, Wills S, Podojil JR, Popko B, Balabanov R, Miller SD. Interferon-γ controls aquaporin 4-specific Th17 and B cells in neuromyelitis optica spectrum disorder. Brain 2024; 147:1344-1361. [PMID: 37931066 PMCID: PMC10994540 DOI: 10.1093/brain/awad373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/27/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a CNS autoimmune inflammatory disease mediated by T helper 17 (Th17) and antibody responses to the water channel protein, aquaporin 4 (AQP4), and associated with astrocytopathy, demyelination and axonal loss. Knowledge about disease pathogenesis is limited and the search for new therapies impeded by the absence of a reliable animal model. In our work, we determined that NMOSD is characterized by decreased IFN-γ receptor signalling and that IFN-γ depletion in AQP4201-220-immunized C57BL/6 mice results in severe clinical disease resembling human NMOSD. Pathologically, the disease causes autoimmune astrocytic and CNS injury secondary to cellular and humoral inflammation. Immunologically, the absence of IFN-γ allows for increased expression of IL-6 in B cells and activation of Th17 cells, and generation of a robust autoimmune inflammatory response. Consistent with NMOSD, the experimental disease is exacerbated by administration of IFN-β, whereas repletion of IFN-γ, as well as therapeutic targeting of IL-17A, IL-6R and B cells, ameliorates it. We also demonstrate that immune tolerization with AQP4201-220-coupled poly(lactic-co-glycolic acid) nanoparticles could both prevent and effectively treat the disease. Our findings enhance the understanding of NMOSD pathogenesis and provide a platform for the development of immune tolerance-based therapies, avoiding the limitations of the current immunosuppressive therapies.
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Affiliation(s)
- Gabriel Arellano
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Eileah Loda
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yanan Chen
- Department of Biology, Loyola University Chicago, Chicago, IL 60660, USA
| | - Tobias Neef
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Andrew C Cogswell
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Grant Primer
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Godwin Joy
- Department of Biology, Loyola University Chicago, Chicago, IL 60660, USA
| | - Kevin Kaschke
- Department of Biology, Loyola University Chicago, Chicago, IL 60660, USA
| | - Samantha Wills
- Department of Biology, Loyola University Chicago, Chicago, IL 60660, USA
| | - Joseph R Podojil
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- COUR Pharmaceutical Development Company, Inc., Northbrook, IL 60077, USA
| | - Brian Popko
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Roumen Balabanov
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Stephen D Miller
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Ortiz S, Pittock SJ, Berthele A, Levy M, Nakashima I, Oreja-Guevara C, Allen K, Mashhoon Y, Parks B, Kim HJ. Immediate and sustained terminal complement inhibition with ravulizumab in patients with anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. Front Neurol 2024; 15:1332890. [PMID: 38356884 PMCID: PMC10865503 DOI: 10.3389/fneur.2024.1332890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Objective To assess the pharmacokinetics and pharmacodynamics of the long-acting terminal complement 5 (C5) inhibitor ravulizumab in adults with anti-aquaporin-4 antibody-positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) in the phase 3, open-label CHAMPION-NMOSD trial (NCT04201262). Methods Patients aged 18 years or older received a weight-based intravenous loading dose of ravulizumab (2,400-3,000 mg) on day 1, followed by weight-based maintenance doses (3,000-3,600 mg) on day 15 and once every 8 weeks thereafter. Pharmacokinetic assessments were maximum observed concentration (Cmax, assessed at the end of the infusion) and concentration at the end of the dosing interval (Ctrough, assessed before dosing) for ravulizumab. Pharmacodynamic assessment was time-matched observed free C5 concentration in serum up to 50 weeks. Results The pharmacokinetic/pharmacodynamic analysis included 58 patients treated with ravulizumab. Serum ravulizumab concentrations at or above the therapeutic threshold (175 μg/mL) were achieved in all patients after administration of the first dose and maintained for 50 weeks. At week 50, the mean (standard deviation) Cmax (n = 51) and Ctrough (n = 52) were 1,887.6 (411.38) and 764.4 (217.68) μg/mL, respectively. Immediate and complete terminal complement inhibition (free C5 serum concentrations < 0.5 μg/mL) was achieved by the end of the first ravulizumab infusion and sustained throughout the treatment period. No treatment-emergent antibodies to ravulizumab were observed. No impact on ravulizumab pharmacokinetics was seen for age, sex, race, hematocrit, hemoglobin, markers of renal and liver impairment, or medications commonly used by patients with NMOSD. Body weight and BMI were significant covariates of ravulizumab pharmacokinetics. Conclusions Serum ravulizumab concentrations were maintained above the therapeutic threshold in all patients through 50 weeks of treatment. Ravulizumab achieved immediate and complete terminal complement inhibition that was sustained throughout the treatment period in adults with AQP4+ NMOSD.
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Affiliation(s)
- Stephan Ortiz
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kerstin Allen
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Yasmin Mashhoon
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Becky Parks
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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Sandhya P, Akaishi T, Fujihara K, Aoki M. A novel association of osmotic demyelination in Sjögren's syndrome prompts revisiting role of aquaporins in CNS demyelinating diseases: A literature review. Mult Scler Relat Disord 2023; 69:104466. [PMID: 36584554 DOI: 10.1016/j.msard.2022.104466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Primary Sjögren's syndrome (SS) is a chronic systemic autoimmune disease with varied neurological manifestations. SS is associated with anti-aquaporin-4 antibody (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD), a demyelinating autoimmune disorder of the central nervous system (CNS). Intriguingly, there are reports of osmotic demyelinating syndrome (ODS), a supposedly non-inflammatory disorder, in the context of SS and renal tubular acidosis (RTA), both of which are not yet established risk factors for ODS. METHODS A literature search was undertaken to identify case reports of ODS in patients with SS. Details of the clinical and laboratory features of these patients were compiled. Additionally, we searched for NMOSD in patients with SS. We looked for co-existing RTA in patients with SS-ODS as well as SS-NMOSD. We also screened for reports of ODS in RTA without underlying SS. RESULTS & DISCUSSION We identified 15 patients (all women, median age 40 years) with ODS in SS, and all of these patients had comorbid RTA. There were only three reported cases of ODS in RTA without underlying SS. We identified a total of 67 patients with SS-NMOSD, of whom only 3 (4.5%) had RTA. Hence, unlike NMOSD, the development of ODS in SS requires a prolonged osmotic or electrolyte abnormality caused by the comorbid RTA. The 15 patients with ODS and SS -RTA, showed heterogeneous clinical manifestations and outcomes. The most common symptom was quadriparesis, seen in 14 of the 15 patients. Eleven of the 15 patients had one of the following features, either alone or in combination: worsening of the sensorium, extensor plantar response, dysphagia/dysarthria, and facial palsy. The latter four manifestations were present at the onset in 7 patients and later in the course of the illness in the remaining 4 patients. Ocular palsy was seen in only four of the 15 patients and was a late manifestation. One patient who had extensive long-segment myelitis and subsequent ODS died, but most patients recovered without significant sequelae. None had hyponatremia, while all patients had hypokalemia and/or hypernatremia. Hypokalemia causing nephrogenic diabetes insipidus (NDI) followed by rapid rise in sodium and the resultant osmotic stress could potentially explain the occurrence of ODS in SS-RTA. Aquaporin (AQP) in astrocytes is implicated in ODS, and renal AQP is downregulated in NDI. Antibodies against AQPs are present in some patients with SS. Defective AQP is therefore a common link underlying all the connected diseases, namely SS, NDI, and ODS, raising the possibility of immune-mediated AQP dysfunction in the pathogenesis. CONCLUSION The hitherto unreported association between SS-RTA and ODS may implicate SS and/or RTA in the development of ODS. In the setting of SS-RTA, ODS must be suspected when a patient with flaccid quadriparesis does not respond to the correction of potassium or develops additional neurological features along with a rise in sodium. Defective functions of AQPs may be a possible mechanism linking demyelinating CNS lesions, SS, and RTA. Studies evaluating AQP functions and serum antibodies against AQPs in these conditions are warranted.
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Affiliation(s)
- Pulukool Sandhya
- Department of Rheumatology, St Stephen's Hospital, Delhi-110054, India.
| | - Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Berthele A, Levy M, Wingerchuk DM, Pittock SJ, Shang S, Kielhorn A, Royston M, Sabatella G, Palace J. A single relapse induces worsening of disability and health-related quality of life in patients with neuromyelitis optica spectrum disorder. Front Neurol 2023; 14:1099376. [PMID: 37114235 PMCID: PMC10126826 DOI: 10.3389/fneur.2023.1099376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Background Cumulative damage from multiple relapses in neuromyelitis optica spectrum disorder (NMOSD) is associated with poor health-related quality of life (HRQoL) and long-term disability in patients positive for anti-aquaporin 4 antibodies (AQP4+). This study assessed the effect of an individual relapse on HRQoL and disability outcomes in AQP4+ NMOSD. Methods Post hoc analyses of data pooled from the PREVENT study and its open-label extension, which evaluated the efficacy and safety of eculizumab in AQP4+ NMOSD, examined the effect of a single relapse on 3 disability and 4 HRQoL outcome measures. Assuming the effect of 1 relapse extends to multiple relapses, an extrapolation was done to assess the effect of 2 relapses on these outcomes. Results In 27 patients (placebo: n = 20; eculizumab: n = 7) experiencing an independently adjudicated relapse, 1 relapse led to significantly worse disability (modified Rankin Scale and Expanded Disability Status Scale [EDSS]) and HRQoL (36-item Short-Form Health Survey mental and physical component summaries; European Quality of Life 5-Dimension questionnaire 3-Level visual analogue scale and utility index) scores. In 4 of 7 outcomes, clinically meaningful worsening was more likely for relapsing versus non-relapsing patients (n = 116). Extrapolating the effect of 2 relapses predicted that clinically meaningful worsening was more likely in 6 out of 7 outcomes, including EDSS, for patients experiencing multiple relapses versus patients experiencing no relapses. Conclusion Findings from these clinical trial data demonstrate that a single NMOSD relapse can worsen disability and HRQoL, underscoring the role of relapse prevention in improving long-term outcomes in patients with AQP4+ NMOSD.
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Affiliation(s)
- Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, München, Germany
- *Correspondence: Achim Berthele,
| | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, Mass General Neurology, Boston, MA, United States
| | | | | | - Shulian Shang
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Adrian Kielhorn
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Minying Royston
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Guido Sabatella
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, United Kingdom
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Tabansky I, Tanaka AJ, Wang J, Zhang G, Dujmovic I, Mader S, Jeganathan V, DeAngelis T, Funaro M, Harel A, Messina M, Shabbir M, Nursey V, DeGouvia W, Laurent M, Blitz K, Jindra P, Gudesblatt M, King A, Drulovic J, Yunis E, Brusic V, Shen Y, Keskin DB, Najjar S, Stern JNH. Rare variants and HLA haplotypes associated in patients with neuromyelitis optica spectrum disorders. Front Immunol 2022; 13:900605. [PMID: 36268024 PMCID: PMC9578444 DOI: 10.3389/fimmu.2022.900605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are rare, debilitating autoimmune diseases of the central nervous system. Many NMOSD patients have antibodies to Aquaporin-4 (AQP4). Prior studies show associations of NMOSD with individual Human Leukocyte Antigen (HLA) alleles and with mutations in the complement pathway and potassium channels. HLA allele associations with NMOSD are inconsistent between populations, suggesting complex relationships between the identified alleles and risk of disease. We used a retrospective case-control approach to identify contributing genetic variants in patients who met the diagnostic criteria for NMOSD and their unaffected family members. Potentially deleterious variants identified in NMOSD patients were compared to members of their families who do not have the disease and to existing databases of human genetic variation. HLA sequences from patients from Belgrade, Serbia, were compared to the frequency of HLA haplotypes in the general population in Belgrade. We analyzed exome sequencing on 40 NMOSD patients and identified rare inherited variants in the complement pathway and potassium channel genes. Haplotype analysis further detected two haplotypes, HLA-A*01, B*08, DRB1*03 and HLA-A*01, B*08, C*07, DRB1*03, DQB1*02, which were more prevalent in NMOSD patients than in unaffected individuals. In silico modeling indicates that HLA molecules within these haplotypes are predicted to bind AQP4 at several sites, potentially contributing to the development of autoimmunity. Our results point to possible autoimmune and neurodegenerative mechanisms that cause NMOSD, and can be used to investigate potential NMOSD drug targets.
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Affiliation(s)
- Inna Tabansky
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Neurobiology and Behavior, The Rockefeller University, New York, NY, United States
| | - Akemi J. Tanaka
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Jiayao Wang
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States
- Department of Biomedical Informatics and Department of Systems Biology, Columbia University, New York, NY, United States
| | - Guanglan Zhang
- Department of Computer Science, Boston University, Boston, MA, United States
| | - Irena Dujmovic
- Clinical Center of Serbia University School of Medicine, Belgrade, Serbia
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Simone Mader
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Biomedical Center and University Hospitals, Ludwig Maximilian University Munich, Munich, Germany
| | - Venkatesh Jeganathan
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Tracey DeAngelis
- Department of Neurology, Neurological Associates of Long Island, New Hyde Park, NY, United States
| | - Michael Funaro
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Asaff Harel
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Mark Messina
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Maya Shabbir
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Vishaan Nursey
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - William DeGouvia
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Micheline Laurent
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Karen Blitz
- Department of Neurology, South Shore Neurologic Associates, Patchogue, NY, United States
| | - Peter Jindra
- Division of Abdominal Transplantation, Baylor College of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mark Gudesblatt
- Biomedical Center and University Hospitals, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Alejandra King
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
| | - Jelena Drulovic
- Clinical Center of Serbia University School of Medicine, Belgrade, Serbia
| | - Edmond Yunis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Vladimir Brusic
- School of Computer Science, University of Nottingham Ningbo China, Ningbo, China
| | - Yufeng Shen
- Department of Biomedical Informatics and Department of Systems Biology, Columbia University, New York, NY, United States
| | - Derin B. Keskin
- Department of Translational Immuno-Genomics for Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Souhel Najjar
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Joel N. H. Stern
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- *Correspondence: Joel N. H. Stern, ;
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9
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Stathopoulos P, Dalakas MC. The role of complement and complement therapeutics in neuromyelitis optica spectrum disorders. Expert Rev Clin Immunol 2022; 18:933-945. [PMID: 35899480 DOI: 10.1080/1744666x.2022.2105205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are characterized in the majority of cases by the presence of IgG1 autoantibodies against aquaporin 4 (AQP4) and myelin-oligodendrocyte glycoprotein (MOG), both capable of activating complement. AREAS COVERED We review evidence of complement involvement in NMOSD pathophysiology from pathological, in vitro, in vivo, human studies, and clinical trials. EXPERT OPINION In AQP4 NMOSD, complement deposition is a prominent pathological feature, while in vitro and in vivo studies have demonstrated complement-dependent pathogenicity of AQP4 antibodies. Consistent with these studies, the anti-C5 monoclonal antibody eculizumab was remarkably effective and safe in a phase 2/3 trial of AQP4-NMOSD patents leading to FDA-approved indication. Several other anti-complement agents, either approved or in trials for other neuro-autoimmunities, like myasthenia, CIDP, and GBS, are also relevant to NMOSD generating an exciting group of evolving immunotherapies. Limited but compelling in vivo and in vitro data suggest that anti-complement therapeutics may be also applicable to a subset of MOG NMOSD patients with severe disease. Overall, anticomplement agents, along with the already approved anti-IL6 and anti-CD19 monoclonal antibodies sartralizumab and inebilizumab, are rapidly changing the therapeutic algorithm in NMOSD, a previously difficult-to-treat autoimmune neurological disorder.
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Affiliation(s)
- Panos Stathopoulos
- Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.,Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece
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10
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Mader S, Brimberg L, Vo A, Strohl JJ, Crawford JM, Bonnin A, Carrión J, Campbell D, Huerta TS, La Bella A, Berlin R, Dewey SL, Hellman M, Eidelberg D, Dujmovic I, Drulovic J, Bennett JL, Volpe BT, Huerta PT, Diamond B. In utero exposure to maternal anti-aquaporin-4 antibodies alters brain vasculature and neural dynamics in male mouse offspring. Sci Transl Med 2022; 14:eabe9726. [PMID: 35442708 PMCID: PMC9973562 DOI: 10.1126/scitranslmed.abe9726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The fetal brain is constantly exposed to maternal IgG before the formation of an effective blood-brain barrier (BBB). Here, we studied the consequences of fetal brain exposure to an antibody to the astrocytic protein aquaporin-4 (AQP4-IgG) in mice. AQP4-IgG was cloned from a patient with neuromyelitis optica spectrum disorder (NMOSD), an autoimmune disease that can affect women of childbearing age. We found that embryonic radial glia cells in neocortex express AQP4. These cells are critical for blood vessel and BBB formation through modulation of the WNT signaling pathway. Male fetuses exposed to AQP4-IgG had abnormal cortical vasculature and lower expression of WNT signaling molecules Wnt5a and Wnt7a. Positron emission tomography of adult male mice exposed in utero to AQP4-IgG revealed increased blood flow and BBB leakiness in the entorhinal cortex. Adult male mice exposed in utero to AQP4-IgG had abnormal cortical vessels, fewer dendritic spines in pyramidal and stellate neurons, and more S100β+ astrocytes in the entorhinal cortex. Behaviorally, they showed impairments in the object-place memory task. Neural recordings indicated that their grid cell system, within the medial entorhinal cortex, did not map the local environment appropriately. Collectively, these data implicate in utero binding of AQP4-IgG to radial glia cells as a mechanism for alterations of the developing male brain and adds NMOSD to the conditions in which maternal IgG may cause persistent brain dysfunction in offspring.
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Affiliation(s)
- Simone Mader
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Institute of Clinical Neuroimmunology, Biomedical Center of the Ludwig Maximilian University of Munich, Munich 82152, Germany
| | - Lior Brimberg
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - An Vo
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Joshua J. Strohl
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, NY 11030, USA
| | - Alexandre Bonnin
- Department of Physiology and Neurosciences, Zilkha Neurogenetic Institute, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Joseph Carrión
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Delcora Campbell
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Tomás S. Huerta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Andrea La Bella
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Roseann Berlin
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Stephen L. Dewey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Matthew Hellman
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - David Eidelberg
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Irena Dujmovic
- Clinical Center of Serbia University School of Medicine, Belgrade, 11000, Serbia
- Department of Neurology, University of North Carolina, School of Medicine, Chapel Hill, NC 27517, USA
| | - Jelena Drulovic
- Clinical Center of Serbia University School of Medicine, Belgrade, 11000, Serbia
| | - Jeffrey L. Bennett
- Department of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Denver, School of Medicine, Denver, CO 80045, USA
| | - Bruce T. Volpe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Patricio T. Huerta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Betty Diamond
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
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11
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McCombe JA, Pittock SJ. Anti-complement Agents for Autoimmune Neurological Disease. Neurotherapeutics 2022; 19:711-728. [PMID: 35553024 PMCID: PMC9294087 DOI: 10.1007/s13311-022-01223-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 01/06/2023] Open
Abstract
In recent years, there has been increasing recognition of the diversity of autoimmune neurological diseases affecting all levels of the nervous system. A growing understanding of disease pathogenesis has enabled us to better target specific elements of the immune system responsible for the cell dysfunction and cell destruction seen in these diseases. This is no better demonstrated than in the development of complement directed therapies for the treatment of complement mediated autoimmune neurological conditions. Herein, we describe the basic elements of the complement cascade, provide an overview of select autoimmune neurological diseases whose pathogenesis is mediated by complement, the effector system of autoantigen bound autoantibodies, and discuss the complement directed therapies trialed in the treatment of these diseases. Several complement-directed therapies have demonstrated benefit in the treatment of autoimmune neurological diseases; we also review the trials resulting in the approval of these therapies for the treatment of AChR Ab-positive myasthenia gravis (MG) and neuromyelitis spectrum disorder. Finally, on the heels of the recent successes described, we discuss possibilities for the future, including additional targeted therapies with greater ease of administration, improved risk profiles, and other possible uses for therapeutics targeting elements of the complement cascade.
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Affiliation(s)
- Jennifer A McCombe
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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12
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Sakai T, Kondo M, Kawana Y, Inoue R. [A case of neuromyelitis optica spectrum disorders associated with primary biliary cholangitis: a twelve year follow-up study]. Rinsho Shinkeigaku 2022; 62:190-197. [PMID: 35228461 DOI: 10.5692/clinicalneurol.cn-001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report the case of a 51-year-old woman who developed neuromyelitis optica spectrum disorders (NMOSD) associated with primary biliary cholangitis (PBC). When she was 38 years old, she subacutely developed headache and urinary retention. A diffusion weighted image (DWI) on brain MRI showed high signal intensity in the left temporal white matter, and T2 weighted image (T2WI) on spine MRI showed high signal intensities in the spinal cord. After the initial event, follow-ups at 2, 6 and 9 months revealed that she developed neurological symptoms, and T2WI on spine MRI showed high signal intensities in the cervical and thoracic regions of the spinal cord. On each episode, she was treated a course of intravenous methylprednisolone which resulted in improvement of her symptoms. At the age of 39 years, the serum levels of biliary enzymes began to elevate, and the serum levels were markedly elevated after the age of 40 years. When she was 40 years old, she developed optic neuritis of the right eye. At the age of 41 years, spine MRI again showed the cervical and thoracic spinal cord lesions. At the age of 51 years, she subacutely developed dizziness and urinary retention. DWI on brain MRI showed high signal intensities in the pons and medulla oblongata, and T2WI on spine MRI showed longitudinally extensive high signal intensities in the spinal cord, specifically between the C3 and C5 vertebral levels. The serological tests for autoantibodies revealed positive anti-aquaporine 4 antibody (AQP4-Ab), positive anti-mitochondrial antibody subtype M2 (AM2-Ab) and positive anti-nuclear antibody, and the interleukin-6 (IL-6) level was elevated in the cerebrospinal fluid. Simultaneous occurrence of AQP4-Ab-positive NMOSD and AM2-Ab-positive PBC is extremely rare, and has never been reported in Japan. The present case is the first case with simultaneous occurrence of AQP4-Ab-positive NMOSD and AM2-Ab-positive PBC in Japan. We suspect that IL-6, plasmablast and cytotoxic T lymphocyte were involved with the occurrence of NMOSD with PBC in the present case.
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Affiliation(s)
- Toshiyuki Sakai
- Department of Neurology, Saiseikai Matsusaka General Hospital
| | - Masahide Kondo
- Department of Neurology, Saiseikai Matsusaka General Hospital
| | - Yosuke Kawana
- Department of Neurology, Saiseikai Matsusaka General Hospital
| | - Ryuichi Inoue
- Department of Neurology, Saiseikai Matsusaka General Hospital
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13
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Dinoto A, Sechi E, Flanagan EP, Ferrari S, Solla P, Mariotto S, Chen JJ. Serum and Cerebrospinal Fluid Biomarkers in Neuromyelitis Optica Spectrum Disorder and Myelin Oligodendrocyte Glycoprotein Associated Disease. Front Neurol 2022; 13:866824. [PMID: 35401423 PMCID: PMC8983882 DOI: 10.3389/fneur.2022.866824] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
The term neuromyelitis optica spectrum disorder (NMOSD) describes a group of clinical-MRI syndromes characterized by longitudinally extensive transverse myelitis, optic neuritis, brainstem dysfunction and/or, less commonly, encephalopathy. About 80% of patients harbor antibodies directed against the water channel aquaporin-4 (AQP4-IgG), expressed on astrocytes, which was found to be both a biomarker and a pathogenic cause of NMOSD. More recently, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), have been found to be a biomarker of a different entity, termed MOG antibody-associated disease (MOGAD), which has overlapping, but different pathogenesis, clinical features, treatment response, and prognosis when compared to AQP4-IgG-positive NMOSD. Despite important refinements in the accuracy of AQP4-IgG and MOG-IgG testing assays, a small proportion of patients with NMOSD still remain negative for both antibodies and are called “seronegative” NMOSD. Whilst major advances have been made in the diagnosis and treatment of these conditions, biomarkers that could help predict the risk of relapses, disease activity, and prognosis are still lacking. In this context, a number of serum and/or cerebrospinal fluid biomarkers are emerging as potentially useful in clinical practice for diagnostic and treatment purposes. These include antibody titers, cytokine profiles, complement factors, and markers of neuronal (e.g., neurofilament light chain) or astroglial (e.g., glial fibrillary acidic protein) damage. The aim of this review is to summarize current evidence regarding the role of emerging diagnostic and prognostic biomarkers in patients with NMOSD and MOGAD.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Solla
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- *Correspondence: Sara Mariotto
| | - John J. Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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14
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Liu J, Tan G, Li B, Zhang J, Gao Y, Cao Y, Jia Z, Sugimoto K. Serum Aquaporin 4-Immunoglobulin G Titer and Neuromyelitis Optica Spectrum Disorder Activity and Severity: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:746959. [PMID: 34744983 PMCID: PMC8565925 DOI: 10.3389/fneur.2021.746959] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Aquaporin 4-immunoglobulin G (AQP4-IgG) plays a major role in the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD). Seropositive status for this antibody has become one of the required indicators for NMOSD diagnosis. Objective: Our goal was to systematically review and perform a meta-analysis of the current works of literature evaluating the clinical relevance of serum AQP4-IgG titer in patients with NMOSD. We sought to determine whether AQP4-IgG could indicate disease activity or severity, in addition to its diagnostic value in NMOSD. Methods: Electronic databases were searched for published literature, yielding 4,402 hits. Of the 124 full articles screened, 17 were included in the qualitative analysis and 14 in the meta-analysis. Results: There were no significant differences in serum AQP4-IgG titers between the relapse and remission phases in patients with NMOSD [standard mean difference (SMD): 0.32, 95% CI (-0.10, 0.74), p = 0.14]. Subgroup meta-analysis of AQP4-IgG detected by cell-based assays (CBA), an AQP4-IgG testing method recommended by the 2015 international consensus diagnostic criteria for NMOSD, confirmed the aforementioned result [SMD: 0.27, 95% CI (-0.01, 0.55), p = 0.06]. Moreover, the serum AQP4-IgG titer was positively correlated with the number of involved spinal cord segments [correlation coefficient (COR): 0.70, 95% CI (0.28-0.89), p = 0.003] and the Expanded Disability Status Scale (EDSS) score [COR: 0.54, 95% CI (0.06-0.82), p = 0.03] in the attack phase in patients with NMOSD. Conclusions: The present study systematically assessed the association between serum AQP4-IgG titer and NMOSD activity and severity. The results demonstrated that the serum AQP4-IgG titer was not associated with disease activity but indicated the disease severity in the attack phase in patients with NMOSD. A further meta-analysis with a larger number of studies that employed standardized AQP4-IgG assays and detected attack-remission paired samples from the same patients with detailed medication information will be required to confirm our findings and shed more light on optimizing clinical AQP4-IgG monitoring. Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208209], PROSPERO, identifier [CRD42020208209].
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Affiliation(s)
- Jia Liu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Guojun Tan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingze Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanbo Cao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kazuo Sugimoto
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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15
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Schmetzer O, Lakin E, Roediger B, Duchow A, Asseyer S, Paul F, Siebert N. Anti-aquaporin 4 IgG Is Not Associated With Any Clinical Disease Characteristics in Neuromyelitis Optica Spectrum Disorder. Front Neurol 2021; 12:635419. [PMID: 33776892 PMCID: PMC7994757 DOI: 10.3389/fneur.2021.635419] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a clinically defined, inflammatory central nervous system (CNS) disease of unknown cause, associated with humoral autoimmune findings such as anti-aquaporin 4 (AQP4)-IgG. Recent clinical trials showed a benefit of anti-B cell and anti-complement-antibodies in NMOSD, suggesting relevance of anti-AQP4-IgG in disease pathogenesis. Objective: AQP4-IgG in NMOSD is clearly defined, yet up to 40% of the patients are negative for AQP4-IgG. This may indicate that AQP4-IgG is not disease-driving in NMOSD or defines a distinct patient endotype. Methods: We established a biobank of 63 clinically well-characterized NMOSD patients with an extensive annotation of 351 symptoms, patient characteristics, laboratory results and clinical scores. We used phylogenetic clustering, heatmaps, principal component and longitudinal causal interference analyses to test for the relevance of anti-AQP4-IgG. Results: Anti-AQP4-IgG was undetectable in 29 (46%) of the 63 NMOSD patients. Within anti-AQP4-IgG-positive patients, anti-AQP4-IgG titers did not correlate with clinical disease activity. Comparing anti-AQP4-IgG-positive vs. -negative patients did not delineate any clinically defined subgroup. However, anti-AQP4-IgG positive patients had a significantly (p = 0.022) higher rate of additional autoimmune diagnoses. Conclusion: Our results challenge the assumption that anti-AQP4-IgG alone plays a disease-driving role in NMOSD. Anti-AQP4-IgG might represent an epiphenomenon associated with NMOSD, may represent one of several immune mechanisms that collectively contribute to the pathogenesis of this disease or indeed, anti-AQP4-IgG might be the relevant factor in only a subgroup of patients.
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Affiliation(s)
- Oliver Schmetzer
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Lakin
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ben Roediger
- Novartis Institutes for Biomedical Research - Autoimmunity, Transplantation and Inflammation, Basel, Switzerland
| | - Ankelien Duchow
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Susanna Asseyer
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nadja Siebert
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, NeuroCure Clinical Research Center (NCRC) and Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Zou A, Ramanathan S, Dale RC, Brilot F. Single-cell approaches to investigate B cells and antibodies in autoimmune neurological disorders. Cell Mol Immunol 2021; 18:294-306. [PMID: 32728203 PMCID: PMC8027387 DOI: 10.1038/s41423-020-0510-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Autoimmune neurological disorders, including neuromyelitis optica spectrum disorder, anti-N-methyl-D-aspartate receptor encephalitis, anti-MOG antibody-associated disorders, and myasthenia gravis, are clearly defined by the presence of autoantibodies against neurological antigens. Although these autoantibodies have been heavily studied for their biological activities, given the heterogeneity of polyclonal patient samples, the characteristics of a single antibody cannot be definitively assigned. This review details the findings of polyclonal serum and CSF studies and then explores the advances made by single-cell technologies to the field of antibody-mediated neurological disorders. High-resolution single-cell methods have revealed abnormalities in the tolerance mechanisms of several disorders and provided further insight into the B cells responsible for autoantibody production. Ultimately, several factors, including epitope specificity and binding affinity, finely regulate the pathogenic potential of an autoantibody, and a deeper appreciation of these factors may progress the development of targeted immunotherapies for patients.
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Affiliation(s)
- Alicia Zou
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- School of Medical Sciences, Discipline of Applied Medical Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Novel insights into pathophysiology and therapeutic possibilities reveal further differences between AQP4-IgG- and MOG-IgG-associated diseases. Curr Opin Neurol 2021; 33:362-371. [PMID: 32304439 DOI: 10.1097/wco.0000000000000813] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent insights into the pathogenesis and therapeutic options for patients with MOG- or AQP4-antibodies. RECENT FINDINGS Although AQP4-IgG are linked to NMOSD, MOG-IgG-associated diseases (MOGAD) include a broader clinical spectrum of autoimmune diseases of the central nervous system (CNS). Details of membrane assembly of AQP4-IgG required for complement activation have been uncovered. Affinity-purified MOG-IgG from patients were shown to be pathogenic by induction of demyelination when the blood--brain barrier (BBB) was breached and by enhancement of activation of cognate T cells. A high-affinity AQP4-IgG, given peripherally, could induce NMOSD-like lesions in rats in the absence of BBB breach. Circulating AQP4-specific and MOG-specific B cells were identified and suggest differences in origin of MOG-antibodies or AQP4-antibodies. Patients with MOG-IgG show a dichotomy concerning circulating MOG-specific B cells; whether this is related to differences in clinical response of anti-CD20 therapy remains to be analyzed. Clinical trials of AQP4-IgG-positive NMOSD patients showed success with eculizumab (preventing cleavage of complement factor C5, thereby blocking formation of chemotactic C5a and membrane attack complex C9neo), inebilizumab (depleting CD19 + B cells), and satralizumab (anti-IL-6R blocking IL-6 actions). SUMMARY New insights into pathological mechanisms and therapeutic responses argue to consider NMOSD with AQP4-IgG and MOGAD as separate disease entities.
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Levy M, Fujihara K, Palace J. New therapies for neuromyelitis optica spectrum disorder. Lancet Neurol 2020; 20:60-67. [PMID: 33186537 DOI: 10.1016/s1474-4422(20)30392-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder is an autoimmune disease of the CNS that primarily affects the optic nerves and spinal cord. Most patients have serum antibodies targeting the aquaporin-4 water channel expressed on the end-feet of astrocytes. Although the prevalence of neuromyelitis optica spectrum disorder is limited to around 1-2 people per 100 000, severe immune-mediated attacks can quickly lead to blindness and paralysis if undiagnosed and untreated. However, diagnosis is straightforward when the highly specific serum aquaporin-4 antibodies are detected with cell-based assays. RECENT DEVELOPMENTS Four randomised controlled trials have tested the efficacy of three new therapies (eculizumab, satralizumab, and inebilizumab) for patients with neuromyelitis optica spectrum disorder that all showed a benefit in preventing future attacks. These therapies have different targets within the immune pathogenic process, and the four trials have similarities and differences that mean they might change the therapeutic landscape for people with neuromyelitis optica spectrum disorder in different ways. Efficacy, safety, tolerability, and practical considerations, including potential cost, differ for each drug and might affect the rate of use in real-world populations of patients with neuromyelitis optica spectrum disorder. WHERE NEXT?: Despite the rarity of neuromyelitis optica spectrum disorder, a relative abundance of preventive treatment options now exists. In the future, trials should focus on areas of unmet need, including aquaporin-4 seronegative disease, and on development of treatments for acute relapses and for recovery from autoimmune attacks in the CNS.
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Affiliation(s)
- Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, School of Medicine, Fukushima Medical University, Koriyama, Japan; Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital and University of Oxford, Oxford, UK
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Jarius S, Paul F, Weinshenker BG, Levy M, Kim HJ, Wildemann B. Neuromyelitis optica. Nat Rev Dis Primers 2020; 6:85. [PMID: 33093467 DOI: 10.1038/s41572-020-0214-9] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica (NMO; also known as Devic syndrome) is a clinical syndrome characterized by attacks of acute optic neuritis and transverse myelitis. In most patients, NMO is caused by pathogenetic serum IgG autoantibodies to aquaporin 4 (AQP4), the most abundant water-channel protein in the central nervous system. In a subset of patients negative for AQP4-IgG, pathogenetic serum IgG antibodies to myelin oligodendrocyte glycoprotein, an antigen in the outer myelin sheath of central nervous system neurons, are present. Other causes of NMO (such as paraneoplastic disorders and neurosarcoidosis) are rare. NMO was previously associated with a poor prognosis; however, treatment with steroids and plasma exchange for acute attacks and with immunosuppressants (in particular, B cell-depleting agents) for attack prevention has greatly improved the long-term outcomes. Recently, a number of randomized controlled trials have been completed and the first drugs, all therapeutic monoclonal antibodies, have been approved for the treatment of AQP4-IgG-positive NMO and its formes frustes.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Ceglie G, Papetti L, Valeriani M, Merli P. Hematopoietic Stem Cell Transplantation in Neuromyelitis Optica-Spectrum Disorders (NMO-SD): State-of-the-Art and Future Perspectives. Int J Mol Sci 2020; 21:ijms21155304. [PMID: 32722601 PMCID: PMC7432050 DOI: 10.3390/ijms21155304] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory disorders of the central nervous system (CNS). Understanding of the molecular basis of these diseases in the last decades has led to an important improvement in the treatment of this disease, in particular, to the use of immunotherapeutic approaches, such as monoclonal antibodies and Hematopoietic Stem Cell Transplantation (HSCT). The aim of this review is to summarize the pathogenesis, biological basis and new treatment options of these disorders, with a particular focus on HSCT applications. Different HSCT strategies are being explored in NMOSD, both autologous and allogeneic HSCT, with the new emergence of therapeutic effects such as an induction of tolerance to auto-antigens and graft versus autoimmunity effects that can be exploited to hopefully treat a disease that still has prognosis.
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Affiliation(s)
- Giulia Ceglie
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Laura Papetti
- Department of Neurology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.P.); (M.V.)
| | - Massimiliano Valeriani
- Department of Neurology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (L.P.); (M.V.)
| | - Pietro Merli
- Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
- Correspondence: ; Tel.: +39-06-6859-2623
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21
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Monoclonal Antibody-Based Treatments for Neuromyelitis Optica Spectrum Disorders: From Bench to Bedside. Neurosci Bull 2020; 36:1213-1224. [PMID: 32533450 DOI: 10.1007/s12264-020-00525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/10/2020] [Indexed: 12/20/2022] Open
Abstract
Neuromyelitis optica (NMO)/NMO spectrum disorder (NMOSD) is a chronic, recurrent, antibody-mediated, inflammatory demyelinating disease of the central nervous system, characterized by optic neuritis and transverse myelitis. The binding of NMO-IgG with astrocytic aquaporin-4 (AQP4) functions directly in the pathogenesis of >60% of NMOSD patients, and causes astrocyte loss, secondary inflammatory infiltration, demyelination, and neuron death, potentially leading to paralysis and blindness. Current treatment options, including immunosuppressive agents, plasma exchange, and B-cell depletion, are based on small retrospective case series and open-label studies. It is noteworthy that monoclonal antibody (mAb) therapy is a better option for autoimmune diseases due to its high efficacy and tolerability. Although the pathophysiological mechanisms of NMOSD remain unknown, increasingly, therapeutic studies have focused on mAbs, which target B cell depletion, complement and inflammation cascade inactivation, blood-brain-barrier protection, and blockade of NMO-IgG-AQP4 binding. Here, we review the targets, characteristics, mechanisms of action, development, and potential efficacy of mAb trials in NMOSD, including preclinical and experimental investigations.
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22
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Jitprapaikulsan J, Fryer JP, Majed M, Smith CY, Jenkins SM, Cabre P, Hinson SR, Weinshenker BG, Mandrekar J, Chen JJ, Lucchinetti CF, Jiao Y, Segan J, Schmeling JE, Mills J, Flanagan EP, McKeon A, Pittock SJ. Clinical utility of AQP4-IgG titers and measures of complement-mediated cell killing in NMOSD. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/4/e727. [PMID: 35413004 PMCID: PMC7286655 DOI: 10.1212/nxi.0000000000000727] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/15/2020] [Indexed: 11/15/2022]
Abstract
ObjectiveTo investigate whether aquaporin-4–immunoglobulin G (AQP4-IgG) titers and measures of complement-mediated cell killing are clinically useful to predict the occurrence of relapse, relapse severity, and/or disability in neuromyelitis optica spectrum disorder (NMOSD).MethodsWe studied 336 serial serum specimens from 82 AQP4-lgG–seropositive patients. NMOSD activity at blood draw was defined as preattack (24 [7.1%], drawn within 30 days preceding an attack), attack (108 [32.1%], drawn on attack onset or within 30 days after), or remission (199 [59.2%], drawn >90 days after attack onset and >30 days preceding a relapse). For each specimen, we documented the attack type and severity and immunotherapy status. Complement-mediated cell killing was quantitated by flow cytometry using an M23-AQP4 cell-based assay.ResultsThe estimated logarithmic means of AQP4-IgG titers in preattack, attack, and remission samples were 3.302, 3.657, and 3.458, respectively, p = 0.21. Analyses of 81 attack/remission pairs in 42 patients showed no significant titer differences (3.736 vs 3.472, p = 0.15). Analyses of 13 preattack/attack pairs in 9 patients showed no significant titer differences (3.994 vs 3.889, p = 0.67). Of 5 patients who converted to seronegative status, 2 continued to have attacks. Titers for major and minor attacks (n = 70) were not significantly different (3.905 vs 3.676, p = 0.47). Similarly, measures (titers) of complement-mediated cell killing were not significantly associated with disease course, attack severity, or disability at 5 years.Conclusions and relevanceAQP4-IgG titer and complement-mediated cell killing lack significant prognostic or predictive utility in NMOSD. Although titers may drop in the setting of immunotherapy, seroconversion to negative status does not preclude ongoing clinical attacks.Classification of evidenceThis study provides Class II evidence that in patients with NMOSD, AQP4-IgG titers and measures of complement-mediated cell killing activity do not predict relapses, relapse severity, or disability.
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Affiliation(s)
- Jiraporn Jitprapaikulsan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - James P Fryer
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Masoud Majed
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Philippe Cabre
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Shannon R Hinson
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Brian G Weinshenker
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Yujuan Jiao
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Jessica Segan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John E Schmeling
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John Mills
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN.
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Wu Y, Cai Y, Liu M, Zhu D, Guan Y. The Potential Immunoregulatory Roles of Vitamin D in Neuromyelitis Optica Spectrum Disorder. Mult Scler Relat Disord 2020; 43:102156. [PMID: 32474282 DOI: 10.1016/j.msard.2020.102156] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 01/09/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoantibody-mediated disease affecting the central nervous system (CNS). Its pathogenesis involves both innate and acquired immune reactions; specific antibody (Aquaporin-4 antibody) and inflammatory cells cause direct damage on lesion sites, while B cell-T cell interactions facilitate the demyelination. However, its etiology is still not fully understood. Vitamin D deficiency is present in numerous autoimmune diseases, including NMOSD. Evidence suggests that low vitamin D levels mayassociate with disease activity and relapse rate in NMOSD, indicating the participation in the pathogenesis of NMOSD. The immunoregulatory roles of vitamin D in both numerous autoimmune diseases and experimental autoimmune encephalomyelitis (EAE) models are increasingly recognized. Recent studies have revealed vitamin D modulation in cytokine production, immune cell development and differentiation, as well as antibody production. By enhancing an anti-inflammatory environment and suppressing the overactivated autoimmune process, vitamin D shows its potential immunoregulatory roles in NMOSD, which could possibly introduce a new therapy for NMOSD patients.
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Affiliation(s)
- Yifan Wu
- Department of Neurology, Renji Hospital, School of medicine, Shanghai Jiaotong University, No.127, Pujian Road, Shanghai 200127, China
| | - Yu Cai
- Department of Neurology, Renji Hospital, School of medicine, Shanghai Jiaotong University, No.127, Pujian Road, Shanghai 200127, China
| | - Mingyuan Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Road, Shanghai 200437, China
| | - Desheng Zhu
- Department of Neurology, Renji Hospital, School of medicine, Shanghai Jiaotong University, No.127, Pujian Road, Shanghai 200127, China
| | - Yangtai Guan
- Department of Neurology, Renji Hospital, School of medicine, Shanghai Jiaotong University, No.127, Pujian Road, Shanghai 200127, China.
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Duan T, Verkman AS. Experimental animal models of aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorders: progress and shortcomings. Brain Pathol 2019; 30:13-25. [PMID: 31587392 DOI: 10.1111/bpa.12793] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) is a heterogeneous group of neuroinflammatory conditions associated with demyelination primarily in spinal cord and optic nerve, and to a lesser extent in brain. Most NMOSD patients are seropositive for IgG autoantibodies against aquaporin-4 (AQP4-IgG), the principal water channel in astrocytes. There has been interest in establishing experimental animal models of seropositive NMOSD (herein referred to as NMO) in order to elucidate NMO pathogenesis mechanisms and to evaluate drug candidates. An important outcome of early NMO animal models was evidence for a pathogenic role of AQP4-IgG. However, available animal models of NMO, based largely on passive transfer to rodents of AQP4-IgG or transfer of AQP4-sensitized T cells, often together with pro-inflammatory maneuvers, only partially recapitulate the clinical and pathological features of human NMO, and are inherently biased toward humoral or cellular immune mechanisms. This review summarizes current progress and shortcomings in experimental animal models of seropositive NMOSD, and opines on the import of advancing animal models.
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Affiliation(s)
- Tianjiao Duan
- Departments of Medicine and Physiology, University of California, San Francisco, CA, 94143.,Department of Neurology, Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Alan S Verkman
- Departments of Medicine and Physiology, University of California, San Francisco, CA, 94143
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25
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Burt RK, Balabanov R, Han X, Burns C, Gastala J, Jovanovic B, Helenowski I, Jitprapaikulsan J, Fryer JP, Pittock SJ. Autologous nonmyeloablative hematopoietic stem cell transplantation for neuromyelitis optica. Neurology 2019; 93:e1732-e1741. [PMID: 31578302 DOI: 10.1212/wnl.0000000000008394] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine if autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT) could be a salvage therapy for neuromyelitis optica spectrum disorder (NMOSD). METHODS Thirteen patients were enrolled in a prospective open-label cohort study (11 NMOSD aquaporin-4-immunoglobulin G [AQP4-IgG]-positive, 1 NMOSD without AQP4, and 1 NMOSD AQP4-IgG-positive with neuropsychiatric systemic lupus erythematosus [SLE]). Following stem cell mobilization with cyclophosphamide (2 g/m2) and filgrastim, patients were treated with cyclophosphamide (200 mg/kg) divided as 50 mg/kg IV on day -5 to day -2, rATG (thymoglobulin) given IV at 0.5 mg/kg on day -5, 1 mg/kg on day -4, and 1.5 mg/kg on days -3, -2, and -1 (total dose 6 mg/kg), and rituximab 500 mg IV on days -6 and +1. Unselected peripheral blood stem cells were infused on day 0. AQP4-IgG antibody status was determined by Clinical Laboratory Improvement Amendments-validated ELISA or flow cytometry assays. Cell-killing activity was measured using a flow cytometry-based complement assay. RESULTS Median follow-up was 57 months. The patient with coexistent SLE died of complications of active lupus 10 months after HSCT. For the 12 patients with NMOSD without other active coexisting autoimmune diseases, 11 patients are more than 5 years post-transplant, and 80% are relapse-free off all immunosuppression (p < 0.001). At 1 and 5 years after HSCT, Expanded Disability Status Scale score improved from a baseline mean of 4.4 to 3.3 (p < 0.01) at 5 years. The Neurologic Rating Scale score improved after HSCT from a baseline mean of 69.5 to 85.7 at 5 years (p < 0.01). The Short Form-36 health survey for quality of life total score improved from mean 34.2 to 62.1 (p = 0.001) at 5 years. In the 11 patients whose baseline AQP4-IgG serostatus was positive, 9 patients became seronegative by the immunofluorescence or cell-binding assays available at the time; complement activating and cell-killing ability of patient serum was switched off in 6 of 7 patients with before and after HSCT testing. Two patients remained AQP4-IgG-seropositive (with persistent complement activating and cell-killing ability) and relapsed within 2 years of HSCT. No patient with seronegative conversion relapsed. CONCLUSION Prolonged drug-free remission with AQP4-IgG seroconversion to negative following nonmyeloablative autologous HSCT warrants further investigation.
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Affiliation(s)
- Richard K Burt
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN.
| | - Roumen Balabanov
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Xiaoqiang Han
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Carol Burns
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Joseph Gastala
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Borko Jovanovic
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Irene Helenowski
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Jiraporn Jitprapaikulsan
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - James P Fryer
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
| | - Sean J Pittock
- From the Division of Immunotherapy, Department of Medicine (R.K.B., X.H., C.B.), and Departments of Neurology (R.B.), Radiology (J.G.), and Preventive Medicine (B.J., I.H.), Northwestern University Feinberg School of Medicine, Chicago, IL; and the Departments of Neurology (J.J., S.J.P.) and Laboratory Medicine and Pathology (J.J., J.P.F., S.J.P.) and Center for Multiple Sclerosis and Autoimmune Neurology (S.J.P.), Mayo Clinic College of Medicine, Rochester, MN
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Chamberlain JL, Huda S, Whittam DH, Matiello M, Morgan BP, Jacob A. Role of complement and potential of complement inhibitors in myasthenia gravis and neuromyelitis optica spectrum disorders: a brief review. J Neurol 2019; 268:1643-1664. [PMID: 31482201 DOI: 10.1007/s00415-019-09498-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
The complement system is a powerful member of the innate immune system. It is highly adept at protecting against pathogens, but exists in a delicate balance between its protective functions and overactivity, which can result in autoimmune disease. A cascade of complement proteins that requires sequential activation, and numerous complement regulators, exists to regulate a proportionate response to pathogens. In spite of these mechanisms there is significant evidence for involvement of the complement system in driving the pathogenesis of variety of diseases including neuromyelitis optica spectrum disorders (NMOSD) and myasthenia gravis (MG). As an amplification cascade, there are an abundance of molecular targets that could be utilized for therapeutic intervention. Clinical trials assessing complement pathway inhibition in both these conditions have recently been completed and include the first randomized placebo-controlled trial in NMOSD showing positive results. This review aims to review and update the reader on the complement system and the evolution of complement-based therapeutics in these two disorders.
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Affiliation(s)
| | - Saif Huda
- Department of Neurology, The Walton Centre, Lower Lane, Liverpool, L9 7LJ, UK
| | - Daniel H Whittam
- Department of Neurology, The Walton Centre, Lower Lane, Liverpool, L9 7LJ, UK
| | - Marcelo Matiello
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - B Paul Morgan
- School of Medicine, Henry Wellcome Building for Biomedical Research, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK
| | - Anu Jacob
- Department of Neurology, The Walton Centre, Lower Lane, Liverpool, L9 7LJ, UK.,University of Liverpool, Liverpool, UK
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Duan T, Smith AJ, Verkman AS. Complement-independent bystander injury in AQP4-IgG seropositive neuromyelitis optica produced by antibody-dependent cellular cytotoxicity. Acta Neuropathol Commun 2019; 7:112. [PMID: 31296268 PMCID: PMC6621951 DOI: 10.1186/s40478-019-0766-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022] Open
Abstract
Cellular injury in AQP4-IgG seropositive neuromyelitis spectrum disorder (herein called NMO) involves AQP4-IgG binding to astrocytes, resulting in astrocyte injury by complement-dependent cytotoxicity (CDC) and antibody-dependent cellular cytotoxicity (ADCC) mechanisms. The rapid disease progression, severe tissue damage, and abundant leukocyte infiltration seen in some NMO patients suggest a more direct mechanism for demyelination and neurologic deficit than secondary injury from astrocyte loss. Here, we report evidence for an ‘ADCC bystander mechanism’ in NMO involving injury to nearby cells by leukocytes following their activation by AQP4-bound AQP4-IgG on astrocytes. In model cocultures containing AQP4-expressing and null CHO cells, AQP4-IgG and complement killed bystander null cells to ~ 100 μm away from AQP4-expressing cells; AQP4-IgG and NK cells produced bystander killing to ~ 300 μm, with perforin deposition seen on injured null cells. Bystander cytotoxicity was also seen with neutrophil-mediated ADCC and in astrocyte-neuron cocultures. Mechanistic studies, including real-time imaging, suggested that leukocytes activated by an AQP4-dependent ADCC mechanism injure bystander cells by direct targeted exocytosis on neighboring cells and not by diffusion of soluble granule contents. In support of this conclusion, ADCC bystander injury was preferentially reduced by an RGDS peptide that inhibits integrin adhesion. Evidence for ADCC bystander injury to oligodendrocytes and neurons was also found in mice following intracerebral injection of AQP4-IgG and NK cells, which was inhibited by RGDS peptide. These results establish a novel cellular pathogenesis mechanism in AQP4-IgG seropositive NMO and provide evidence that inflammatory mechanisms can cause widespread tissue damage in NMO independently of the secondary effects from astrocyte loss.
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Bonnan M, Mejdoubi M, Cabre P. Fulminant and fatal onset of pan-aquaporinopathy. Mult Scler Relat Disord 2019; 34:116-118. [PMID: 31255987 DOI: 10.1016/j.msard.2019.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/16/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
Early administration of high-dose steroids and plasma exchange (PE) offers the best chance of treating neuromyelitis optica spectrum disease (NMOSD) attacks, but up to 20% of patients fail to respond. We report the case of a first devastating NMOSD attack leading to death despite optimal treatment. While receiving steroids during a bilateral blinding optic neuritis, this female patient suffered a severe attack involving the spinal cord and circumventricular organs (CVOs), including the pineal gland. Early adjunctive daily PE failed to prevent sudden death. AQP4-antibodies were strongly positive. To our knowledge, this is the first case of exceptionally severe monophasic NMOSD leading to full-blown lesions in all AQP4-expressing sites. Lesions of the periventricular ependyma and CVOs are highly exceptional and the involvement of the pineal gland, which is also a CVO, is novel. Moreover, the patient's condition continued to worsen until death, without any sign of recovery. We term this unexpected outcome the 'anti-Lazarus effect'. Although the mechanisms of resistance to treatment remain elusive, very early initiation of immunosuppressive drugs or adjunctive salvage therapies could be envisioned to manage these devastating attacks.
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Affiliation(s)
- Mickael Bonnan
- Service de Neurologie, Centre Hospitalier de Pau, 4 Bd Hauterive, 64000 Pau, France.
| | - Mehdi Mejdoubi
- Service de Radiologie, Hôpital Zobda Quitman, 97261 Fort-de-France, French West Indies
| | - Philippe Cabre
- Service de Neurologie, Hôpital Zobda Quitman, 97261 Fort-de-France, French West Indies
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Gata-Garcia A, Diamond B. Maternal Antibody and ASD: Clinical Data and Animal Models. Front Immunol 2019; 10:1129. [PMID: 31191521 PMCID: PMC6547809 DOI: 10.3389/fimmu.2019.01129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/03/2019] [Indexed: 12/26/2022] Open
Abstract
Over the past several decades there has been an increasing interest in the role of environmental factors in the etiology of neuropsychiatric and neurodevelopmental disorders. Epidemiologic studies have shifted from an exclusive focus on the identification of genetic risk alleles for such disorders to recognizing and understanding the contribution of xenobiotic exposures, infections, and the maternal immune system during the prenatal and early post-natal periods. In this review we discuss the growing literature regarding the effects of maternal brain-reactive antibodies on fetal brain development and their contribution to the development of neuropsychiatric and neurodevelopmental disorders. Autoimmune diseases primarily affect women and are more prevalent in mothers of children with neurodevelopmental disorders. For example, mothers of children with Autism Spectrum Disorder (ASD) are significantly more likely to have an autoimmune disease than women of neurotypically developing children. Moreover, they are four to five times more likely to harbor brain-reactive antibodies than unselected women of childbearing age. Many of these women exhibit no apparent clinical consequence of harboring these antibodies, presumably because the antibodies never access brain tissue. Nevertheless, these maternal brain-reactive antibodies can access the fetal brain, and some may be capable of altering brain development when present during pregnancy. Several animal models have provided evidence that in utero exposure to maternal brain-reactive antibodies can permanently alter brain anatomy and cause persistent behavioral or cognitive phenotypes. Although this evidence supports a contribution of maternal brain-reactive antibodies to neurodevelopmental disorders, an interplay between antibodies, genetics, and other environmental factors is likely to determine the specific neurodevelopmental phenotypes and their severity. Additional modulating factors likely also include the microbiome, sex chromosomes, and gonadal hormones. These interactions may help to explain the sex-bias observed in neurodevelopmental disorders. Studies on this topic provide a unique opportunity to learn how to identify and protect at risk pregnancies while also deciphering critical pathways in neurodevelopment.
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Affiliation(s)
- Adriana Gata-Garcia
- Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Betty Diamond
- Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, United States
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Zhu W, Wang Z, Hu S, Gong Y, Liu Y, Song H, Ding X, Fu Y, Yan Y. Human C5-specific single-chain variable fragment ameliorates brain injury in a model of NMOSD. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e561. [PMID: 31044149 PMCID: PMC6467685 DOI: 10.1212/nxi.0000000000000561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/05/2019] [Indexed: 12/01/2022]
Abstract
Objective Using phage display, we sought to screen single-chain variable fragments (scFvs) against complement C5 to treat neuromyelitis optica spectrum disorder (NMOSD). Methods After 5 rounds of phage display, we isolated individual clones and identified phage clones specifically binding to C5 using ELISA. Using aquaporin-4 (AQP4)-transfected cells in vitro, we confirmed whether these scFvs prevented complement-dependent cytotoxicity (CDC) caused by the serum of patients with NMOSD and human complement (hC). We selected an NMOSD mouse model, in which intracerebral NMOSD immunoglobulin G (IgG) and hC injections induce NMOSD-like lesions in vivo. Results We obtained scFvs to test specificity and blocking efficiency. The scFv C5B3 neutralized C5 in the complement activation pathway, which prevented AQP4-IgG-mediated CDC in AQP4-transfected cells. In an NMOSD mouse model, C5B3 prevented AQP4 and astrocyte loss, decreased demyelination, and reduced inflammatory infiltration and membrane attack complex formation in lesions. Conclusions We used phage display to screen C5B3 against C5, which was effective in inhibiting cytotoxicity in vitro and preventing CNS pathology in vivo.
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Affiliation(s)
- Wenli Zhu
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhen Wang
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Suying Hu
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Gong
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuanchu Liu
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huanhuan Song
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Ding
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Fu
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry (W.Z., Z.W., S.H., Y.G., Y.L., H.S., X.D., Y.F., Y.Y.), National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an; Department of Neurology (W.Z.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (Z.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
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Soltys J, Liu Y, Ritchie A, Wemlinger S, Schaller K, Schumann H, Owens GP, Bennett JL. Membrane assembly of aquaporin-4 autoantibodies regulates classical complement activation in neuromyelitis optica. J Clin Invest 2019; 129:2000-2013. [PMID: 30958797 DOI: 10.1172/jci122942] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 02/26/2019] [Indexed: 01/29/2023] Open
Abstract
Neuromyelitis optica (NMO) is an autoimmune CNS disorder mediated by pathogenic aquaporin-4 (AQP4) water channel autoantibodies (AQP4-IgG). Although AQP4-IgG-driven complement-dependent cytotoxicity (CDC) is critical for the formation of NMO lesions, the molecular mechanisms governing optimal classical pathway activation are unknown. We investigated the molecular determinants driving CDC in NMO using recombinant AQP4-specific autoantibodies (AQP4 rAbs) derived from affected patients. We identified a group of AQP4 rAbs targeting a distinct extracellular loop C epitope that demonstrated enhanced CDC on target cells. Targeted mutations of AQP4 rAb Fc domains that enhance or diminish C1q binding or antibody Fc-Fc interactions showed that optimal CDC was driven by the assembly of multimeric rAb platforms that increase multivalent C1q binding and facilitate C1q activation. A peptide that blocks antibody Fc-Fc interaction inhibited CDC induced by AQP4 rAbs and polyclonal NMO patient sera. Super-resolution microscopy revealed that AQP4 rAbs with enhanced CDC preferentially formed organized clusters on supramolecular AQP4 orthogonal arrays, linking epitope-dependent multimeric assembly with enhanced C1q binding and activation. The resulting model of AQP4-IgG CDC provides a framework for understanding classical complement activation in human autoantibody-mediated disorders and identifies a potential new therapeutic avenue for treating NMO.
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Affiliation(s)
- John Soltys
- Neuroscience and Medical Scientist Training Programs
| | | | | | | | | | | | | | - Jeffrey L Bennett
- Neuroscience and Medical Scientist Training Programs.,Department of Neurology, and.,Department of Ophthalmology, University of Colorado at Anschutz Medical Campus, Aurora, Colorado, USA
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Weber MS, Derfuss T, Metz I, Brück W. Defining distinct features of anti-MOG antibody associated central nervous system demyelination. Ther Adv Neurol Disord 2018; 11:1756286418762083. [PMID: 29623106 PMCID: PMC5881972 DOI: 10.1177/1756286418762083] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Extensive research over the last decades basically failed to identify a common cause of noninfectious inflammatory central nervous system (CNS) demyelinating disease. To a great extent, this may reflect that the group of inflammatory CNS demyelinating disorders likely contains multiple pathogenetically distinct disease entities. Indeed, the greatest success so far in deciphering the pathogenesis of a CNS demyelinating disorder resulted from the discovery of anti-aquaporin (AQP)-4 antibodies (ab), which allowed progressive delineation of neuromyelitis optica (NMO), formerly considered a variant of the most common CNS demyelinating disorder, multiple sclerosis (MS), as a distinct disease. Nowadays, AQP-4+ NMO is considered an autoimmune astrocytopathy, in which CNS demyelination occurs only as a consequence of a primary destruction of astrocytes. Delineating these patients concomitantly revealed that not all patients presenting with clinically NMO-suggestive disease phenotype express AQP-4 ab, which created the pathogenetically undefined category of NMO spectrum disorders (NMOSD). Recent investigations discovered that a subgroup of these AQP-4– NMOSD patients produce an ab response against myelin oligodendrocyte glycoprotein (MOG), a molecule expressed on the outer lamella of the myelin sheath. Using pathophysiologically meaningful cell-based assays, this humoral response is extremely rare in adult MS and absent in classical AQP-4+ NMO, sharply differentiating the evolving group from both established disorders. In this review, we summarize available clinical, immunological and histopathological data on patients with MOG+ CNS demyelinating disease. By comparing this clearly distinct cohort to AQP-4+ NMO as well as MS, we propose that MOG+ CNS demyelinating disease represents a distinct novel disease entity. In addition to its diagnostic value, we furthermore provide mechanistic insight on how this peripheral anti-MOG ab response may be of pathogenetic relevance in triggering acute flares of inflammatory CNS demyelination.
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Affiliation(s)
- Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center, Georg August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Imke Metz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
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The IL-10-producing regulatory B cells (B10 cells) and regulatory T cell subsets in neuromyelitis optica spectrum disorder. Neurol Sci 2018; 39:543-549. [PMID: 29349658 DOI: 10.1007/s10072-018-3248-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/05/2018] [Indexed: 01/07/2023]
Abstract
B cells contribute to the pathogenesis of neuromyelitis optica (NMO) by producing Aquaporin 4-specific autoantibodies (AQP4-ab); on the other hand, there are certain B cells that suppress immune responses by producing regulatory cytokines, such as IL-10. In this study, we investigated the presence of IL-10-producing Breg cells among lymphocyte subsets. Twenty-two seropositive NMO spectrum disorder (NMOSD) patients (29 samples) and 13 healthy controls (HCs) (14 samples) were enrolled. All NMOSD patients have received one or more immunosuppressive drugs. The phenotype and frequency of B cell and T cell subsets in the peripheral blood were measured by flow cytometry. We defined Breg cells as IL-10-producing B (B10) cells, which are CD19+CD39+CD1d+IL-10+. The potential relations were evaluated between specific lymphocyte subsets and AQP4-ab intensity measured by the cell-based indirect immunofluorescence assay. The frequency of B10 cells was higher in patients with NMOSD regardless of the disease status than that in HCs (attack samples; p = 0.009 and remission samples; p < 0.001, respectively). In addition, the frequency of IL-17+ Treg cells among Treg cells was higher during remission than during an attack (uncorrected p = 0.032). Among the lymphocyte subsets, B10 cells alone showed a positive correlation with the intensity of AQP4-ab positivity (ρ [rho] = 0.402 and p = 0.031). It was suggested that the suppressive subsets including B10 and IL-17+ Treg cells might have important roles in controlling disease status in NMOSD. Further functional studies may help to elucidate the immunological role of B10 and IL-17+ Treg cells in NMOSD.
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Kapadia M, Bijelić D, Zhao H, Ma D, Stojanovich L, Milošević M, Andjus P, Šakić B. Effects of sustained i.c.v. infusion of lupus CSF and autoantibodies on behavioral phenotype and neuronal calcium signaling. Acta Neuropathol Commun 2017; 5:70. [PMID: 28882191 PMCID: PMC5590168 DOI: 10.1186/s40478-017-0473-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a potentially fatal autoimmune disease that is often accompanied by brain atrophy and diverse neuropsychiatric manifestations of unknown origin. More recently, it was observed that cerebrospinal fluid (CSF) from patients and lupus-prone mice can be neurotoxic and that acute administration of specific brain-reactive autoantibodies (BRAs) can induce deficits in isolated behavioral tasks. Given the chronic and complex nature of CNS SLE, the current study examines broad behavioral performance and neuronal Ca2+ signaling in mice receiving a sustained infusion of cerebrospinal fluid (CSF) from CNS SLE patients and putative BRAs (anti-NR2A, anti-ribosomal P, and anti-α-tubulin). A 2-week intracerebroventricular (i.c.v.) infusion of CSF altered home-cage behavior and induced olfactory dysfunction, excessive immobility in the forced swim test, and perseveration in a learning task. Conversely, sustained administration of purified BRAs produced relatively mild, both inhibitory and stimulatory effects on olfaction, spatial learning/memory, and home-cage behavior. In vitro studies revealed that administration of some CSF samples induces a rapid influx of extracellular Ca2+ into murine neurons, an effect that could be partially mimicked with the commercial anti-NR2A antibody and blocked with selective N-methyl-D-aspartate (NMDA) receptor antagonists. The current findings confirm that the CSF from CNS SLE patients can be neuroactive and support the hypothesis that intrathecal BRAs induce synergistically diverse effects on all domains of behavior. In addition, anti-NMDA receptor antibodies may alter Ca2+ homeostasis of central neurons, thus accounting for excitotoxicity and contributing to the heterogeneity of psychiatric manifestations in CNS SLE and other autoantibody-related brain disorders.
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Anti-aquaporin-4 titer is not predictive of disease course in neuromyelitis optica spectrum disorder: A multicenter cohort study. Mult Scler Relat Disord 2017; 17:198-201. [PMID: 29055457 DOI: 10.1016/j.msard.2017.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease associated with a serological antibody to aquaporin-4 (AQP4) detectable in up to 80% of patients. The enzyme-linked immunosorbent assay (ELISA) is one of the most popular methods of testing for anti-AQP4 antibodies that results with a titer in which < 3 Units/ml is negative, 3-5 is borderline and 5+ is positive. The value of the positive titer in predicting long term disease course is currently unknown. METHODS This is a retrospective analysis of NMOSD patients from five centers around the world: Baltimore, USA, Philadelphia, USA, Shanghai, China, Berlin, Germany, and Medellin, Columbia, where ELISA titers on anti-AQP4 antibody testing is available. Inclusion criteria include a diagnosis of NMOSD and seropositive anti-AQP4 antibody test with titer = /> 3 Units/ml. Patients were stratified into three groups by titer: 3-30 Units/ml (low), 31-100 Units/ml (medium), and 101+ Units/ml (high). Demographic factors such as age at onset, race, and sex were collected along with clinical features such as annualized relapse rate, duration of disease, location of relapses, and treatment history. RESULTS A total of 139 NMOSD patients met criteria for inclusion in this study, stratified into three groups by titer: 42 subjects with low titers of 3-30 Units/ml, 30 subjects with medium titers of 31-100 Units/ml and 67 subjects with high titers of 101 or greater ELISA Units/ml. The average age at onset, sex and race distribution were not significantly different among the groups. The number of patients untreated in each group was similar (< 25%) as was the average annualized relapse rate (0.591-0.821 relapses/year). With an average of 10 years follow up, the average disability level was not different among the three titer groups (EDSS range 3.03-3.48). The distribution of lesions, as well as their preventive treatment regimens did not differ significantly. CONCLUSION Beyond a positive/borderline/negative result, the titer of the anti-AQP4 antibody ELISA assay is not predictive in the disease course for patients with NMOSD. Low titer patients experience the same disease course as medium-titer and high-titer anti-AQP4 antibody patients with NMOSD.
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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.
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Flanagan EP, Pittock SJ. Diagnosis and management of spinal cord emergencies. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:319-335. [PMID: 28187806 DOI: 10.1016/b978-0-444-63600-3.00017-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Most spinal cord injury is seen with trauma. Nontraumatic spinal cord emergencies are discussed in this chapter. These myelopathies are rare but potentially devastating neurologic disorders. In some situations prior comorbidity (e.g., advanced cancer) provides a clue, but in others (e.g., autoimmune myelopathies) it may come with little warning. Neurologic examination helps distinguish spinal cord emergencies from peripheral nervous system emergencies (e.g., Guillain-Barré), although some features overlap. Neurologic deficits are often severe and may quickly become irreversible, highlighting the importance of early diagnosis and treatment. Emergent magnetic resonance imaging (MRI) of the entire spine is the imaging modality of choice for nontraumatic spinal cord emergencies and helps differentiate extramedullary compressive causes (e.g., epidural abscess, metastatic compression, epidural hematoma) from intramedullary etiologies (e.g., transverse myelitis, infectious myelitis, or spinal cord infarct). The MRI characteristics may give a clue to the diagnosis (e.g., flow voids dorsal to the cord in dural arteriovenous fistula). However, additional investigations (e.g., aquaporin-4-IgG) are often necessary to diagnose intramedullary etiologies and guide treatment. Emergency decompressive surgery is necessary for many extramedullary compressive causes, either alone or in combination with other treatments (e.g., radiation) and preoperative neurologic deficit is the best predictor of outcome.
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Affiliation(s)
- E P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Shi K, Wang Z, Liu Y, Gong Y, Fu Y, Li S, Wood K, Hao J, Zhang GX, Shi FD, Yan Y. CFHR1-Modified Neural Stem Cells Ameliorated Brain Injury in a Mouse Model of Neuromyelitis Optica Spectrum Disorders. THE JOURNAL OF IMMUNOLOGY 2016; 197:3471-3480. [DOI: 10.4049/jimmunol.1600135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023]
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Shan Y, Tan S, Zhang L, Huang J, Sun X, Wang Y, Cai W, Qiu W, Hu X, Lu Z. Serum 25-hydroxyvitamin D 3 is associated with disease status in patients with neuromyelitis optica spectrum disorders in south China. J Neuroimmunol 2016; 299:118-123. [PMID: 27725109 DOI: 10.1016/j.jneuroim.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 01/20/2023]
Abstract
Here, we investigated the relationship between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and neuromyelitis optica spectrum disorder (NMOSD). Patients with NMOSD had lower 25(OH)D3 levels than healthy people, with lower levels in patients in the acute phase than those in remission. An inverse correlation was found between 25(OH)D3 and Expanded Disability Status Scale scores of patients during attacks. Higher serum 25(OH)D3 levels were associated with greater amelioration of symptoms during corticosteroid therapy. These results indicate that decreased vitamin D may be involved in NMOSD pathogenesis, and that 25(OH)D3 serum levels may reflect the severity of NMOSD in the acute phase.
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Affiliation(s)
- Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Sha Tan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Lei Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, No 52 Meihuadong Road, Zhuhai City, China
| | - Jianhua Huang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China.
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Hardy TA, Reddel SW, Barnett MH, Palace J, Lucchinetti CF, Weinshenker BG. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 2016; 15:967-981. [DOI: 10.1016/s1474-4422(16)30043-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/02/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023]
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Koarada S, Tada Y. Roles of plasmablasts in IgG4-related disease and various immune-based diseases. World J Rheumatol 2016; 6:16-22. [DOI: 10.5499/wjr.v6.i1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/23/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory disease with multiple organ disorders. Recently, in IgG4-RD, increased circulating plasmablasts have been found. The subsets of plasmablasts are negative for RP105 (CD180). A large population of B cells lacking RP105 (RP105-negative B cells) are found in patients with active with systemic lupus erythematosus and other systemic autoimmune diseases, including dermatomyositis, and Sjögren’s syndrome. In other conditions, such as neuromyelitis optica, Kawasaki’s disease, primary biliary cirrhosis and aging, RP105 expression on B cells and monocytes also alters. We review the basic science and clinical significance of RP105-negative B cells including plasmablasts in various immune-based diseases. RP105-negative B cells, especially plasmablasts, play crucial roles in both systemic and organ-specific autoimmune and inflammatory disorders.
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Jasiak-Zatonska M, Kalinowska-Lyszczarz A, Michalak S, Kozubski W. The Immunology of Neuromyelitis Optica-Current Knowledge, Clinical Implications, Controversies and Future Perspectives. Int J Mol Sci 2016; 17:273. [PMID: 26950113 PMCID: PMC4813137 DOI: 10.3390/ijms17030273] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/31/2016] [Accepted: 02/16/2016] [Indexed: 01/07/2023] Open
Abstract
Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%-25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.
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Affiliation(s)
- Michalina Jasiak-Zatonska
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland.
| | - Alicja Kalinowska-Lyszczarz
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland.
| | - Slawomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland.
- Neuroimmunological Unit, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawinskiego St., 02-106 Warsaw, Poland.
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland.
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Lamichhane D, Weinstein A. Probable systemic lupus erythematosus with cell-bound complement activation products (CB-CAPS). Lupus 2016; 25:1050-3. [PMID: 26911153 DOI: 10.1177/0961203316635287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/01/2016] [Indexed: 11/15/2022]
Abstract
Complement activation is a key feature of systemic lupus erythematosus (SLE). Detection of cell-bound complement activation products (CB-CAPS) occurs more frequently than serum hypocomplementemia in definite lupus. We describe a patient with normocomplementemic probable SLE who did not fulfill ACR classification criteria for lupus, but the diagnosis was supported by the presence of CB-CAPS.
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Affiliation(s)
- D Lamichhane
- Division of Rheumatology, MedStar Washington Hospital Center, Washington, DC, USA
| | - A Weinstein
- Division of Rheumatology, MedStar Washington Hospital Center, Washington, DC, USA Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
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Abstract
Autoimmune myelopathies are a heterogeneous group of immune-mediated spinal cord disorders with a broad differential diagnosis. They encompass myelopathies with an immune attack on the spinal cord (e.g., aquaporin-4-IgG (AQP4-IgG) seropositive neuromyelitis optica (NMO) and its spectrum disorders (NMOSD)), myelopathies occurring with systemic autoimmune disorders (which may also be due to coexisting NMO/NMOSD), paraneoplastic autoimmune myelopathies, postinfectious autoimmune myelopathies (e.g., acute disseminated encephalomyelitis), and myelopathies thought to be immune-related (e.g., multiple sclerosis and spinal cord sarcoidosis). Spine magnetic resonance imaging is extremely useful in the evaluation of autoimmune myelopathies as the location of signal change, length of the lesion, gadolinium enhancement pattern, and evolution over time narrow the differential diagnosis considerably. The recent discovery of multiple novel neural-specific autoantibodies accompanying autoimmune myelopathies has improved their classification. These autoantibodies may be pathogenic (e.g., AQP4-IgG) or nonpathogenic and more reflective of a cytotoxic T-cell-mediated autoimmune response (collapsin response mediator protein-5(CRMP5)-IgG). The presence of an autoantibody may help guide cancer search, assist treatment decisions, and predict outcome/relapse. With paraneoplastic myelopathies the initial goal is detection and treatment of the underlying cancer. The aim of immunotherapy in all autoimmune myelopathies is to maximize reversibility, maintain benefits (while preventing relapse), and minimize side effects.
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Kitley J, Woodhall M, Leite MI, Palace J, Vincent A, Waters P. Aquaporin-4 antibody isoform binding specificities do not explain clinical variations in NMO. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e121. [PMID: 26140280 PMCID: PMC4476052 DOI: 10.1212/nxi.0000000000000121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/20/2015] [Indexed: 11/15/2022]
Abstract
Objective: To assess the clinical relevance of the differential binding of antibodies against the 2 main aquaporin-4 (AQP4) isoforms in neuromyelitis optica (NMO) patient sera using stably transfected human embryonic kidney cells. Methods: Flow cytometry of human embryonic kidney cells stably transfected with either M23 or M1 AQP4 was used to measure antibody endpoint titers in 52 remission samples and 26 relapse samples from 34 patients with clinically well-characterized AQP4 antibody–positive NMO/NMO spectrum disorder. Results: The AQP4 M23 (40–61,440) and AQP4 M1 (<20–20,480) titers varied widely between patients, as did the M23:M1 antibody ratio (1–192). In 76 of 78 samples, binding to M23 was higher than binding to M1, including during relapses and remissions (p < 0.0001), and the M23:M1 ratio was relatively constant within an individual patient. Titers usually fell after immunosuppression, but the titers at which relapses occurred varied markedly; no threshold level for relapses could be identified, and relapses could occur without a rise in titers. Relapse severity did not correlate with M23 or M1 antibody titers, although there was a correlation between the earliest M23 titers and annualized relapse rates. The M23:M1 ratio and absolute M23 and M1 titers did not relate to age at disease onset, ethnicity, disease severity, phenotype, or relapses at different anatomical sites. Conclusion: Relative AQP4 antibody binding to M23 and M1 isoforms differs between patients but there is no consistent association between these differences and clinical characteristics of disease. Nevertheless, the M23 isoform provided a slightly more sensitive substrate for AQP4-antibody assays, particularly for follow-up studies.
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Affiliation(s)
- Joanna Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jackie Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Weinshenker BG, Barron G, Behne JM, Bennett JL, Chin PS, Cree BAC, de Seze J, Flor A, Fujihara K, Greenberg B, Higashi S, Holt W, Khan O, Knappertz V, Levy M, Melia AT, Palace J, Smith TJ, Sormani MP, Van Herle K, VanMeter S, Villoslada P, Walton MK, Wasiewski W, Wingerchuk DM, Yeaman MR. Challenges and opportunities in designing clinical trials for neuromyelitis optica. Neurology 2015; 84:1805-15. [PMID: 25841026 PMCID: PMC4424131 DOI: 10.1212/wnl.0000000000001520] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/21/2015] [Indexed: 12/31/2022] Open
Abstract
Current management of neuromyelitis optica (NMO) is noncurative and only partially effective. Immunosuppressive or immunomodulatory agents are the mainstays of maintenance treatment. Safer, better-tolerated, and proven effective treatments are needed. The perceived rarity of NMO has impeded clinical trials for this disease. However, a diagnostic biomarker and recognition of a wider spectrum of NMO presentations has expanded the patient population from which study candidates might be recruited. Emerging insights into the pathogenesis of NMO have provided rationale for exploring new therapeutic targets. Academic, pharmaceutical, and regulatory communities are increasingly interested in meeting the unmet needs of patients with NMO. Clinical trials powered to yield unambiguous outcomes and designed to facilitate rapid evaluation of an expanding pipeline of experimental agents are needed. NMO-related disability occurs incrementally as a result of attacks; thus, limiting attack frequency and severity are critical treatment goals. Yet, the severity of NMO and perception that currently available agents are effective pose challenges to study design. We propose strategies for NMO clinical trials to evaluate agents targeting recovery from acute attacks and prevention of relapses, the 2 primary goals of NMO treatment. Aligning the interests of all stakeholders is an essential step to this end.
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Affiliation(s)
- Brian G Weinshenker
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Gerard Barron
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Jacinta M Behne
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Jeffery L Bennett
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Peter S Chin
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Bruce A C Cree
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Jerome de Seze
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Armando Flor
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Kazuo Fujihara
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Benjamin Greenberg
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Sayumi Higashi
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - William Holt
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Omar Khan
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Volker Knappertz
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Michael Levy
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Angela T Melia
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Jacqueline Palace
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Terry J Smith
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Maria Pia Sormani
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Katja Van Herle
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Susan VanMeter
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Pablo Villoslada
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Marc K Walton
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Warren Wasiewski
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Dean M Wingerchuk
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
| | - Michael R Yeaman
- From the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN; MedImmune Ltd. (G.B., A.F.), Riverside Building, Granta Park, Great Abington, Cambridge, UK; Guthy-Jackson Foundation (J.M.B., K.V.H.), San Diego, CA; Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; Novartis Pharmaceuticals Corporation (P.S.C.), East Hanover, NJ; Department of Neurology (B.A.C.C.), University of California San Francisco; CIC (Clinical Investigation Center) INSERM and UMR 1119 (J.d.S.), INSERM, Federation de Medecine Translationelle de Strasbourg, Université de Strasbourg; Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University, Sendai, Japan; Department of Neurology (B.G.), University of Texas Southwestern; Chugai Pharma USA (S.H., A.T.M.), Berkeley Heights, NJ; PPD Inc. (W.H.), Wilmington, NC; Department of Neurology (O.K.), Wayne State University, Detroit, MI; Teva Pharmaceuticals (V.K.), Frazer, PA; Department of Neurology (V.K.), Heinrich-Heine University, Dusseldorf, Germany; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology (J.P.), Oxford University Hospital Trust, UK; Department of Ophthalmology and Visual Sciences (T.J.S.), Kellogg Eye Center, and Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; Department of Health Science (M.P.S.), University of Genoa, Italy; David Geffen School of Medicine at UCLA (K.V.H.), Los Angeles, CA; GlaxoSmithKline (S.V.), Research Triangle Park, NC; Center of Neuroimmunology (P.V.), Institute of Biomedical Research August Pi Sunyer (IDIBAPS)-Hospital Clinic Barcelona, Villarroel, Spain; United States Food and Drug Administration (M.K.W.), Center for Drug Evaluation and Research, Silver Spring, MD; Alexion Pharmaceuticals Inc. (W.W.), Cheshire, CT; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Medicine (M.R.Y.), Divisions of M
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Dubey D, Kieseier BC, Hartung HP, Hemmer B, Miller-Little WA, Stuve O. Clinical management of multiple sclerosis and neuromyelitis optica with therapeutic monoclonal antibodies: approved therapies and emerging candidates. Expert Rev Clin Immunol 2014; 11:93-108. [PMID: 25495182 DOI: 10.1586/1744666x.2015.992881] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Therapeutic monoclonal antibodies (mAbs) are a relatively novel class of drugs that has substantially advanced immunotherapy for patients with multiple sclerosis. The advantage of these agents is that they bind specifically and exclusively to predetermined proteins or cells. Natalizumab was the first mAb in neurology to obtain approval. It is also considered one of the most potent options for annualized relapse rate reduction among available therapeutic options. Alemtuzumab is currently also approved in several countries. Several mAbs have been tested in clinical studies in multiple sclerosis. Here, we review the history of drug development of therapeutic mAbs and their classification. Furthermore, we outline the putative mechanisms of action, clinical evidence and safety of approved mAbs and those in different stages of clinical development in multiple sclerosis and neuromyelitis optica.
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Li YJ, Zhang F, Qi Y, Chang GQ, Fu Y, Su L, Shen Y, Sun N, Borazanci A, Yang C, Shi FD, Yan Y. Association of circulating follicular helper T cells with disease course of NMO spectrum disorders. J Neuroimmunol 2014; 278:239-46. [PMID: 25468778 DOI: 10.1016/j.jneuroim.2014.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/05/2014] [Accepted: 11/09/2014] [Indexed: 10/24/2022]
Abstract
While follicular helper T (Tfh) cells have been shown to be involved in many autoimmune diseases, the association of Tfh cells with the disease activity of neuromyelitis optica spectrum disorders (NMOSDs) remains unclear. In this study, the CD4(+)CXCR5(+)PD-1(+) Tfh cell population in peripheral blood mononuclear cells (PBMCs) obtained from NMOSD patients, age- and gender-matched healthy controls, and multiple sclerosis patients was compared by flow cytometry. The serum levels of IL-21, IL-6, IL-17, TNF-α and IL-10 were analyzed by ELISA assays. We found that in NMOSD, the Tfh cell frequency is higher than that of healthy subjects and multiple sclerosis (MS) patients. There are more Tfh cells in the relapsing stage than the remitting stage of NMOSD, thus demonstrating the close association of the Tfh cell population with disease activity. Methylprednisolone, which is used to control disease relapses, significantly decreased the proportion of Tfh cells in NMOSD patients.
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Affiliation(s)
- Yu-Jing Li
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fang Zhang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yuan Qi
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Guo-Qiang Chang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Fu
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lei Su
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yi Shen
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Na Sun
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Aimee Borazanci
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Chunsheng Yang
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fu-Dong Shi
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China; Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Yaping Yan
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Biomarkers for neuromyelitis optica. Clin Chim Acta 2014; 440:64-71. [PMID: 25444748 DOI: 10.1016/j.cca.2014.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 02/06/2023]
Abstract
Neuromyelitis optica (NMO) is an acquired, heterogeneous inflammatory disorder, which is characterized by recurrent optic neuritis and longitudinally extensive spinal cord lesions. The discovery of the serum autoantibody marker, anti-aquaporin 4 (anti-AQP4) antibody, revolutionizes our understanding of pathogenesis of NMO. In addition to anti-AQP4 antibody, other biomarkers for NMO are also reported. These candidate biomarkers are particularly involved in T helper (Th)17 and astrocytic damages, which play a critical role in the development of NMO lesions. Among them, IL-6 in the peripheral blood is associated with anti-AQP4 antibody production. Glial fibrillary acidic protein (GFAP) in CSF demonstrates good correlations with clinical severity of NMO relapses. Detecting these useful biomarkers may be useful in the diagnosis and evaluation of disease activity of NMO. Development of compounds targeting these biomarkers may provide novel therapeutic strategies for NMO. This article will review the related biomarker studies in NMO and discuss the potential therapeutics targeting these biomarkers.
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50
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Kim SH, Huh SY, Hyun JW, Jeong IH, Lee SH, Joung A, Kim HJ. A longitudinal brain magnetic resonance imaging study of neuromyelitis optica spectrum disorder. PLoS One 2014; 9:e108320. [PMID: 25259647 PMCID: PMC4178152 DOI: 10.1371/journal.pone.0108320] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/19/2014] [Indexed: 01/10/2023] Open
Abstract
Brain involvement is commonly seen in patients with neuromyelitis optica spectrum disorder (NMOSD). However, little is known about the chronic changes of acute brain lesions on MRI over time. Here, our objective was to evaluate how acute brain MRI lesions in NMOSD changed on follow-up MRI. We reviewed the MRIs of 63 patients with NMOSD who had acute brain lesions and follow-up MRI over an interval of at least 3 months. Of the 211 acute brain lesions, 24% of lesions disappeared completely on T2-weighed images (WI) and a decrease in size ≥50% on T2-WI was observed in 58% of lesions on follow-up MRI. However, 47% of lesions revealed focal T1-hypointensity and, in particular, 18% showed focal cystic changes. Cystic changes were observed most commonly in corticospinal tract and corpus callosal lesions whereas the vast majority of lesions in the cerebellum, basal ganglia and temporal white matter resolved completely. MRI remission on T2-WI occurred in 82% of lesions, while approximately half of the lesions presented foci of T1-hypointensity, which may be considered a severe tissue injury over time. The extent of brain injury following an acute brain lesion in NMOSD may depend on the location of the lesion.
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Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - So-Young Huh
- Department of Neurology, Kosin University School of Medicine, Busan, Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - In Hye Jeong
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Sang Hyun Lee
- Department of Radiology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - AeRan Joung
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
- * E-mail:
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