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Should Aquaporin-4 Antibody Test Be Performed in all Patients With Isolated Optic Neuritis? J Neuroophthalmol 2022; 42:454-461. [PMID: 36255079 DOI: 10.1097/wno.0000000000001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Optic neuritis (ON) may be the initial manifestation of neuromyelitis optica spectrum disorder (NMOSD). Aquaporin-4 antibody (AQP4 Ab) is used to diagnose NMOSD. This has implications on prognosis and is important for optimal management. We aim to evaluate if clinical features can distinguish AQP4 Ab seropositive and seronegative ON patients. METHODS We reviewed patients with first episode of isolated ON from Tan Tock Seng Hospital and Singapore National Eye Centre who tested for AQP4 Ab from 2008 to 2017. Demographic and clinical data were compared between seropositive and seronegative patients. RESULTS Among 106 patients (120 eyes) with first episode of isolated ON, 23 (26 eyes; 22%) were AQP4 Ab positive and 83 (94 eyes; 78%) were AQP4 Ab negative. At presentation, AQP4 Ab positive patients had older mean onset age (47.9 ± 13.6 vs 36.8 ± 12.6 years, P < 0.001), worse nadir VA (OR 1.714; 95% CI, 1.36 to 2.16; P < 0.001), less optic disc swelling (OR 5.04; 95% CI, 1.682 to 15.073; p = 0.004), and higher proportions of concomitant anti-Ro antibody (17% vs 4%, p = 0.038) and anti-La antibody (17% vs 1%, p = 0.008). More AQP4 Ab positive patients received steroid-sparing immunosuppressants (74% vs 19%, p < 0.001) and plasma exchange (13% vs 0%, p = 0.009). AQP4 Ab positive patients had worse mean logMAR VA (visual acuity) at 12 months (0.70 ± 0.3 vs 0.29 ± 0.5, p = 0.051) and 36 months (0.37±0.4 vs 0.14 ± 0.2, p = 0.048) follow-up. CONCLUSION Other than older onset age and retrobulbar optic neuritis, clinical features are non-discriminatory for NMOSD. We propose a low threshold for AQP4 Ab serology testing in inflammatory ON patients, particularly in high NMOSD prevalence populations, to minimize diagnostic and treatment delays.
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Zhang X, Liu X, Yu H, Deng B, Zhang Y, Chen X. Longitudinal evaluation of clinical characteristics of Chinese neuromyelitis optica spectrum disorder patients with different AQP4-IgG serostatus. Mult Scler Relat Disord 2022; 62:103786. [DOI: 10.1016/j.msard.2022.103786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Redenbaugh V, Flanagan EP. Monoclonal Antibody Therapies Beyond Complement for NMOSD and MOGAD. Neurotherapeutics 2022; 19:808-822. [PMID: 35267170 PMCID: PMC9294102 DOI: 10.1007/s13311-022-01206-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 01/09/2023] Open
Abstract
Aquaporin-4 (AQP4)-IgG seropositive neuromyelitis optica spectrum disorders (AQP4-IgG seropositive NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-IgG-associated disease (MOGAD) are inflammatory demyelinating disorders distinct from each other and from multiple sclerosis (MS).While anti-CD20 treatments can be used to treat MS and AQP4-IgG seropositive NMOSD, some MS medications are ineffective or could exacerbate AQP4-IgG seropositive NMOSD including beta-interferons, natalizumab, and fingolimod. AQP4-IgG seropositive NMOSD has a relapsing course in most cases, and preventative maintenance treatments should be started after the initial attack. Rituximab, eculizumab, inebilizumab, and satralizumab all have class 1 evidence for use in AQP4-IgG seropositive NMOSD, and the latter three have been approved by the US Food and Drug Administration (FDA). MOGAD is much more likely to be monophasic than AQP4-IgG seropositive NMOSD, and preventative therapy is usually reserved for those who have had a disease relapse. There is a lack of any class 1 evidence for MOGAD preventative treatment. Observational benefit has been suggested from oral immunosuppressants, intravenous immunoglobulin (IVIg), rituximab, and tocilizumab. Randomized placebo-controlled trials are urgently needed in this area.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA.
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Clinical and prognostic aspects of patients with the Neuromyelitis Optica Spectrum Disorder (NMOSD) from a cohort in Northeast Brazil. BMC Neurol 2022; 22:95. [PMID: 35296261 PMCID: PMC8925163 DOI: 10.1186/s12883-022-02621-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/11/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Neuromyelitis optica spectrum disorders (NMOSD) is a rare inflammatory and demyelinating disease of the central nervous system (CNS) more frequent in women and Afro-descendants. No previous epidemiological or prognostic study has been conducted in the region of the state of Bahia, Brazilian Northeast. Objective To evaluate clinical and prognostic aspects in patients with NMOSD from a cohort in northeastern Brazil. Material and methods A single-center retrospective study was conducted with consecutive patients diagnosed with NMOSD. Clinical and epidemiological characteristics were described. The degree of disability was expressed by the Expanded Disability Status Scale (EDSS). Worsening disability were analyzed through negative binomial regression adjusted for disease duration. Results Ninety-one patients were included, 72 (79.1%) female and 67 (73.6%) afro descendants. Mean age at onset was 36 (± 14) years and 73.3% were anti-aquaporin-4 antibody positive. Isolated transverse myelitis (32.9%) and isolated optic neuritis (22.4%) were the most frequent initial clinical syndromes. After multivariate analysis, optic neuritis (RR = 0.45; 95% CI = 0.23 – 0.88; p = 0.020) and dyslipidemia (RR = 0.40; 95% CI = 0.20 – 0.83; p = 0.014) were associated with slower disease progression. Area postrema involvement (RR = 6.70; 95% CI = 3.31 – 13.54; p < 0.001) and age at onset (RR = 1.03; 95% CI = 1.01 – 1.05; p = 0.003) were associated with faster disease progression. Conclusions In the first clinical and prognostic study in northeastern Brazil, we identified area postrema involvement, age at onset, optic neuritis at fist syndrome and dyslipidemia as the main prognostic factors associated with disease progression. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02621-5. • Isolated transverse myelitis was the most frequent initial clinical syndrome. • Optic neuritis as first clinical syndrome was independently associated with better prognostic. • Age at onset were associated with faster disease progression. • Hashimoto's thyroiditis was the most frequent autoimmune disease in NMOSD.
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Paz ÉS, Maciel PMCT, D'Almeida JAC, Silva BYDC, Sampaio HADC, Pinheiro ADV, Carioca AAF, de Melo MLP. Excess weight, central adiposity and pro-inflammatory diet consumption in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2021; 54:103110. [PMID: 34214879 DOI: 10.1016/j.msard.2021.103110] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/18/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To characterize the nutritional status and the consumed Dietary Inflammatory Index (DII) by individuals with Neuromyelitis Optica Spectrum Disorder (NMOSD). METHODS Anthropometric, clinical data (Expanded Disability Status Scale, EDSS) anthropometric data (Body Mass Index - BMI; Waist Circumference - WC; Waist-to-hip ratio - WHR; and percentage of fat mass -%FM) and data on food consumption (24-hour recall) were collected to determine the Dietary Inflammatory Index (DII), according to Shivappa et al. For the statistical analysis, descriptive measures and statistical tests were used, with the significance level set at p <0.05. RESULTS There was a higher prevalence of females (86.8%). The abdominal fat accumulation in individuals was demonstrated in 57.9%, 73.0%, 70.3% and 30.0%, according to BMI, WC, WHR and%FM, respectively. There was no correlation between the EDSS score and the nutritional status, but there was a positive correlation between the administered corticosteroid dose and BMI (r = 0.55; p = 0.002), WC (r = 0.55; p = 0.003) and WHR (r = 0.41; p = 0.033). The mean DII was 4.99 (± 1.09), indicating the consumption of a pro-inflammatory diet. There was a difference in the DII according to gender (p <001). In the case-control segment, there was a significant difference in the DII between the groups (β = 2.51; 95% CI: 1.73; 3.27) and a higher risk of developing the disease when the DII was ≥4.41 (OR = 30.25; 95% CI: 6.70; 136.47). CONCLUSIONS Diets with high inflammatory potential are associated with increased risk of NMOSD.
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Affiliation(s)
- Éllen Sousa Paz
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil
| | - Paula Maria Cals Theophilo Maciel
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil
| | - José Artur Costa D'Almeida
- Multiple Sclerosis Interdisciplinary Center, Neurology Department, Fortaleza General Hospital (HGF-SUS), Fortaleza, Brazil. R. Ávila Goularte, #900 Papicu, Fortaleza, CE, Brazil
| | - Bruna Yhang da Costa Silva
- Federal Institute of Education, Science and Technology of Ceará, Limoeiro do Norte, Brazil Rua Estevão Remígio de Freitas, #1145 Monsenhor Otávio, Limoeiro do Norte, CE, Brazil; Postgraduate Program in Collective Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil
| | - Helena Alves de Carvalho Sampaio
- Postgraduate Program in Collective Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil
| | - Alexandre Danton Viana Pinheiro
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil
| | - Antônio Augusto Ferreira Carioca
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil; Undergraduate Course in Nutrition, University of Fortaleza, Av. Washington Soares, #1321 Edson Queiroz, Fortaleza, CE, 60811-905, Brazil
| | - Maria Luisa Pereira de Melo
- Postgraduate Program in Nutrition and Health, Ceara State University (UECE), Fortaleza, Brazil. Dr. Silas Munguba Avenue, #1700 Campus do Itaperi, Fortaleza, CE, Brazil; Multiple Sclerosis Interdisciplinary Center, Neurology Department, Fortaleza General Hospital (HGF-SUS), Fortaleza, Brazil. R. Ávila Goularte, #900 Papicu, Fortaleza, CE, Brazil.
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[A Case of Neuromyelitis Optica Spectrum Disorder Who Relapsed Under Oral Corticosteroid Treatment with Multiple Cerebrospinal Lesions and Severe Neurological Deficits]. J UOEH 2021; 43:255-261. [PMID: 34092770 DOI: 10.7888/juoeh.43.255] [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: 11/21/2022]
Abstract
We present a case of a 59-year-old female who had been treated for optic neuritis 2 years before being transferred to our hospital. She had been positive for anti-AQP4 antibodies. No cerebrospinal lesions were observed, and based on the diagnosis of neuromyelitis optica spectrum disorder (NMOSD), 5 mg/day oral prednisolone was continued for 2 years. Acute lower back pain and urinary retention appeared on day X. On day X + 1, consciousness disturbance (JCS level II) and paraplegia appeared, and she was transferred to our hospital. Neck stiffness, paraplegia, and urinary retention were present. A cerebrospinal fluid examination revealed mononucleosis-dominant pleocytosis (1,232 cells/μl). Brain magnetic resonance imaging (MRI) showed multiple lesions around the ventricles and corpus callosum, and spinal MRI revealed a longitudinally extensive transverse myelitis lesion (C2-Th5). A relapse of NMOSD was diagnosed and steroid pulse therapy was started, but the symptoms progressed and quadriplegia and coma occurred. Head MRI showed new deep white matter lesions around the ventricles. Plasma exchange was added after the second steroid pulse. The patient's consciousness gradually improved, and spontaneous movement of the left upper limb eventually appeared. We experienced a case of NMOSD that relapsed with multiple cerebrospinal lesions despite corticosteroid therapy, but plasmapheresis therapy was effective.
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Amaral JMSS, Talim N, Kleinpaul R, Lana-Peixoto MA. Optic neuritis at disease onset predicts poor visual outcome in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2020; 41:102045. [DOI: 10.1016/j.msard.2020.102045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022]
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Carnero Contentti E, Daccach Marques V, Soto de Castillo I, Tkachuk V, Ariel B, Castillo MC, Cristiano E, Diégues Serva GB, dos Santos AC, Finkelsteyn AM, López PA, Patrucco L, Molina O, Pettinicchi JP, Toneguzzo V, Caride A, Rojas JI. Clinical features and prognosis of late-onset neuromyelitis optica spectrum disorders in a Latin American cohort. J Neurol 2020; 267:1260-1268. [DOI: 10.1007/s00415-020-09699-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 01/04/2023]
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Singh N, Bhatia R, Bali P, Sreenivas V, Padma MV, Goyal V, Saxena R, Dash D, Garg A, Joseph SL. Clinical Features, Gender Differences, Disease Course, and Outcome in Neuromyelitis Optica Spectrum Disorder. Ann Indian Acad Neurol 2020; 24:186-191. [PMID: 34220061 PMCID: PMC8232474 DOI: 10.4103/aian.aian_334_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/03/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an astrocytopathy with a predilection for the optic nerve, spinal cord, and brainstem. In this ambispective study, we evaluate clinical characteristics, responses to therapy, and disability outcomes in patients with NMOSD. Methods: Patients diagnosed as NMOSD and following up for at least 1 year at a tertiary care center in India were recruited. Patient data were collected ambispectively from January 2012 until December 2018. Results: A total of 106 patients (29M/77F) with NMOSD were evaluated. The mean age of onset was 29 (±11.6) years. About 77 patients (72.64%) were positive for the AQP4 antibody. Age of onset was higher for those presenting with an opticospinal syndrome (34.2 years) as compared to either isolated longitudinally extensive transverse myelitis (LETM) (30 years) or optic neuritis (ON) (25.3 years). The most common syndrome at onset was LETM in 57 patients (53.77%) followed by ON in 31 patients (29.24%). Azathioprine was the most common immunotherapy (83.96%) prescribed followed by rituximab (7.54%) and mycophenolate mofetil (1.88%). There was a significant decrease in the number of relapses post-azathioprine (P < 0.001). Out of 67 patients with ON, 21 (31.34%) had complete recovery while 17 (25.37%) patients had a severe deficit at a 3-month follow-up. Out of 92 patients with a motor deficit, 49 (53.26%) patients had a partial motor deficit at a 6-month follow-up. The severe visual deficit at baseline and female gender predicted poor visual and motor recovery, respectively. Conclusion: This is the largest descriptive study on patients with NMOSD from India. Relapse rates were similar irrespective of the clinical presentation, age, gender, and disease course. Treatment with immunosuppressive treatment significantly affected the disease course.
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Affiliation(s)
- Nishita Singh
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - Prerna Bali
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - V Sreenivas
- Department of Biostatistics, All India institute of Medical Sciences, New Delhi, India
| | - M V Padma
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Department of Ophthalmology, All India institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India institute of Medical Sciences, New Delhi, India
| | - S Leve Joseph
- Department of Neuroimaging and Interventional Neuroradiology, All India institute of Medical Sciences, New Delhi, India
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He Q, Li L, Li Y, Lu Y, Wu K, Zhang R, Teng J, Zhao J, Jia Y. Free thyroxine level is associated with both relapse rate and poor neurofunction in first-attack Neuromyelitis Optica Spectrum Disorder (NMOSD) patients. BMC Neurol 2019; 19:329. [PMID: 31852443 PMCID: PMC6921452 DOI: 10.1186/s12883-019-1560-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022] Open
Abstract
Background To investigate whether the serum free thyroxine (FT4) level is a prognostic factor for the first-attack neuromyelitis optica spectrum disorders (NMOSD). Methods This retrospective study enrolled 109 patients with first-attack NMOSD. The Expanded Disability Status Scale (EDSS) and the relapse rate were used to evaluate the outcomes. The logistic regression model was used to analyze the independent effects of FT4 on relapse and final EDSS. Kaplan-Meier analysis, scatter plot smoothing method, and two-phase piecewise linear regression model were used to investigate the relationship between the FT4 level and the relapse rate. Results Multivariate analysis revealed that serum FT4 level might be a risk factor for both final EDSS (β = 0.17; 95% confidence interval: 0.03–0.32) and the relapse rate (HR = 1.18; 95% confidence interval: 1.05–1.32). Furthermore, 1400 days after the onset, nearly 100% of patients in the high-FT4 group relapsed, while only 40% of the patients in the low-FT4 group relapsed. Finally, we found that the relationship between the FT4 level and the NMOSD relapse rate was nonlinear. The risk of NMOSD relapse increased with the FT4 level up to the inflection point of 12.01 pmol/L (HR = 1.45; 95% confidence interval: 1.06–1.98). When the FT4 level was > 12.01 pmol/L, there was no correlation between the FT4 level and the risk of NMOSD relapse (HR = 1.05; 95% confidence interval: 0.78–1.41). Conclusion Serum FT4 level may be a prognostic indicator for the first-attack in patients with NMOSD. High FT4 levels are associated with poor neurofunctions and a high relapse rate in patients with the first-attack in patients with NMOSD.
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Affiliation(s)
- Qianyi He
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Lifeng Li
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanfei Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yanhui Lu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Kaimin Wu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ruiyi Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Junfang Teng
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jie Zhao
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,National Telemedicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Internet Medical and System Applications of National Engineering Laboratory, Zhengzhou, Henan, China
| | - Yanjie Jia
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Çakar A, Ulusoy C, Gündüz T, Küçükali Cİ, Kürtüncü M. Clinical Features of the Patients with Neuromyelitis Optica Spectrum Disorder. ACTA ACUST UNITED AC 2019; 58:21-25. [PMID: 33795948 DOI: 10.29399/npa.23555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/01/2019] [Indexed: 01/01/2023]
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory, demyelinating syndrome of the central nervous system (CNS) that predominantly affects the spinal cord and optic nerves. Since it was first described, new information about the pathophysiology gained momentum with the discovery of an antibody against Aquaporin-4, a water channel protein that is predominantly found in the astrocytes. In our study, we evaluated the clinical features of NMOSD and clinically related CNS disorders. Method In our study, we recruited patients that were followed by Clinic for Multiple Sclerosis and Myelin Disorders at Istanbul University between 1979 and 2016. Results Thirty-five NMOSD, fifteen relapsing inflammatory optic neuropathy (RION) and ten opticospinal multiple sclerosis (OSMS) patients were recruited in our study. Forty-eight patients (%80) were female and twelve (%20) were male. Age, sex, follow-up period, annualized relapse rate, relapses in the first two years and progression index were similar between the groups. Cerebrospinal fluid (CSF) protein levels were higher in the NMOSD group. Concomitant autoimmune disorders were observed in six NMOSD patients and two OSMS patients. One patient with RION had nonspecific white matter lesions without gadolinium enhancement in the brain MRI. Conclusion Laboratory and imaging findings suggests that NMOSD is a distinct disorder than RION and OSMS. Further studies are needed to say specific comments about the existence of OSMS.
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Affiliation(s)
- Arman Çakar
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Canan Ulusoy
- Department of Neuroscience, Istanbul University Institute for Experimental Medical Research (DETAE), Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Istanbul University Institute for Experimental Medical Research (DETAE), Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Pan YL, Guo Y, Ma Y, Wang L, Zheng SY, Liu MM, Huang GC. Aquaporin-4 expression dynamically varies after acute spinal cord injury-induced disruption of blood spinal cord barrier in rats. Neuropathology 2019; 39:181-186. [PMID: 30919512 DOI: 10.1111/neup.12539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/25/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
The blood-spinal cord barrier (BSCB) changes badly after spinal cord injury (SCI), and it is an important pathophysiological basis of SCI secondary damage. Aquaporin-4 (AQP4), one of the transmembrane proteins in spinal cord, has been shown to be closely related to the development of the BSCB and edema. We established a SCI model in rats using a free-falling weight drop device to subsequently investigate AQP4 expression. AQP4 messenger RNA (mRNA) and protein expression and immunoreactivity were detected in spinal cord tissue using reverse transcription-real-time quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry and Western blot analysis. We found the water content and edema of the spinal cord were significantly higher than the control group after SCI, which was related to the growth of BSCB permeability; both reached their peak on the third day after injury. One, 3, 5, 7 days after injury, the immune response and protein expression in the model group increased from 1 to 3 days, with a plateau period from 3 to 5 days and a decline from 5 to 7 days, showing a significant difference compared with the sham group at each time point (P < 0.05), while the RT-qPCR results showed a decline of mRNA just after 3 days. In conclusion, after SCI, the water content of the spinal cord and the BSCB permeability increases, together with the excessive expression of AQP4, which reached a peak on the third day. AQP4 expression is closely relative to the permeability of BSCB and the water content of the spinal cord.
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Affiliation(s)
- Ya-Lan Pan
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yang Guo
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yong Ma
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lei Wang
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Su-Yang Zheng
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ming-Ming Liu
- Department of Traumatology & Orthopedics, Traditional Chinese Medicine Hospital of Xuzhou, Xuzhou, China
| | - Gui-Cheng Huang
- Institute of Traumatology & Orthopedics, Nanjing University of Chinese Medicine, Nanjing, China.,Laboratory of New Techniques of Restoration & Reconstruction of Orthopedics and Traumatology, Nanjing University of Chinese Medicine, Nanjing, China
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Ungureanu A, de Seze J, Ahle G, Sellal F. Myelin oligodendrocyte glycoprotein antibodies in neuromyelitis optica spectrum disorder. Rev Neurol (Paris) 2018; 174:675-679. [PMID: 30293882 DOI: 10.1016/j.neurol.2018.01.378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/17/2018] [Accepted: 01/26/2018] [Indexed: 01/09/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a severe inflammatory disease of the central nervous system characterized, in particular, by disabling episodes of optic neuritis and longitudinal extensive transverse myelitis. Its main pathogenic characteristic is the presence of anti-aquaporin-4 antibodies (AQP4-Abs) in the serum of affected patients. However, a proportion of patients with the typical NMOSD phenotype are, in fact, negative (seronegative) for AQP4-Abs and, within this category of patients, a proportion of them instead express antibodies to myelin oligodendrocyte glycoprotein (MOG-Abs). The presence of MOG-Abs in the sera of seronegative NMOSD patients is more frequently associated with monophasic disease and moderate symptom severity, and also appears to predict a better outcome. The present report is a review of the clinical and immunological features of MOG-Ab-positive NMOSD.
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Affiliation(s)
- A Ungureanu
- Department of Neurology, Louis-Pasteur Hospital, 39, avenue de la Liberté, 68024 Colmar, France.
| | - J de Seze
- Department of Neurology, Hautepierre University Hospital, 67200 Strasbourg, France
| | - G Ahle
- Department of Neurology, Louis-Pasteur Hospital, 39, avenue de la Liberté, 68024 Colmar, France
| | - F Sellal
- Department of Neurology, Louis-Pasteur Hospital, 39, avenue de la Liberté, 68024 Colmar, France
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Ömerhoca S, Akkaş SY, İçen NK. Multiple Sclerosis: Diagnosis and Differential Diagnosis. ACTA ACUST UNITED AC 2018; 55:S1-S9. [PMID: 30692847 DOI: 10.29399/npa.23418] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The diagnostic criteria for multiple sclerosis (MS) have been continuously evolved since 1950's, and gained speed parallel to the development of detailed laboratory methods. The common aim for all the defined criteria up to now, is to establish the dissemination in space and time of the clinical picture caused by the lesions in the central nervous system (CNS), and to rule out other diseases which might mimic MS. There is no definite measure or laboratory marker for the diagnosis of MS, yet. Both the clinical features of the disease, and laboratory investigations such as magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analyses are being used. Clinical and imaging findings that may be seen in MS, can also be mimicked by some infectious, neoplastic, genetic, metabolic, vascular and other idiopathic inflammatory demyelinating disorders (IIDD). In the earlier stages of the disease, especially IIDD's such as neuromyelitis optica spectrum disorders (NMOs) and acute disseminated encephalomyelitis (ADEM) can cause diagnostic difficulty, however, these disorders which have both distinct pathogeneses and clinical courses than MS, should also be treated differently. Therefore, to identify MS-related attacks and determine the final diagnosis is vital for the correct treatment choice and longterm disability prevention. In this manuscript the principal approach for the diagnosis and differential diagnosis of MS has been reviewed regarding the recent guidelines.
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Affiliation(s)
- Sami Ömerhoca
- Department of Neurology, İstanbul Bağcılar Research and Training Hospital, İstanbul, Turkey
| | - Sinem Yazici Akkaş
- Department of Neurology, İstanbul Bağcılar Research and Training Hospital, İstanbul, Turkey
| | - Nilüfer Kale İçen
- Department of Neurology, İstanbul Bağcılar Research and Training Hospital, İstanbul, Turkey
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15
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Sun J, Sun X, Zhang N, Wang Q, Cai H, Qi Y, Li T, Qin W, Yu C. Analysis of brain and spinal cord lesions to occult brain damage in seropositive and seronegative neuromyelitis optica. Eur J Radiol 2017; 94:25-30. [PMID: 28941756 DOI: 10.1016/j.ejrad.2017.07.002] [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: 08/20/2016] [Revised: 04/29/2017] [Accepted: 07/07/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES According to aquaporin-4 antibody (AQP4-Ab), neuromyelitis optica (NMO) can be divided into seropositive and seronegative subgroups. The purpose of this study was to a) compare the distribution of spinal cord and brain magnetic resonance imaging (MRI) lesions between seropositive and seronegative NMO patients; b) explore occult brain damage in seropositive and seronegative NMO patients; and c) explore the contribution of visible lesions to occult grey and white matter damage in seropositive and seronegative NMO patients. MATERIALS AND METHODS Twenty-two AQP4-Ab seropositive and 14 seronegative NMO patients and 30 healthy controls were included in the study. Two neuroradiologists independently measured the brain lesion volume (BLV) and the length of spinal cord lesion (LSCL) and recorded the region of brain lesions. The normal-appearing grey matter volume (NAGM-GMV) and white matter fractional anisotropy (NAWM-FA) were calculated for each subject to evaluate occult brain damage. RESULTS The seropositive patients displayed more extensive damage in the spinal cord than the seronegative patients, and the seronegative group had a higher proportion of patients with brainstem lesions (28.57%) than the seropositive group (4.55%, P=0.064). Both NMO subgroups exhibited reduced NAGM-GMV and NAWM-FA compared with the healthy controls. NAGM-GMV was negatively correlated with LSCL in the seropositive group (rs=-0.444, P=0.044) and with BLV in the seronegative group (rs=-0.768, P=0.002). NAWM-FA was also negatively correlated with BLV in the seropositive group (rs=-0.682, P<0.001). CONCLUSION Our findings suggest that the occult brain damage in these two NMO subgroups may be due to different mechanisms, which need to be further clarified.
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Affiliation(s)
- Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xianting Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiuhui Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Huanhuan Cai
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yuan Qi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ting Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder of the central nervous system (CNS) with predilection for the optic nerves and spinal cord. Since its emergence in the medical literature in the late 1800's, the diagnostic criteria for NMO has slowly evolved from the simultaneous presentation of neurologic and ophthalmic signs to a relapsing or monophasic CNS disorder defined by clinical, neuroimaging, and laboratory criteria. Due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 (AQP4) in the vast majority of affected individuals, the clinical spectrum of NMO has greatly expanded necessitating the development of new international criteria for the diagnosis of NMO spectrum disorder (NMOSD). The routine application of new diagnostic criteria for NMOSD in clinical practice will be critical for future refinement and correlation with therapeutic outcomes.
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Mealy MA, Kim SH, Schmidt F, López R, Jimenez Arango JA, Paul F, Wingerchuk DM, Greenberg BM, Kim HJ, Levy M. Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders. Mult Scler 2017; 24:1737-1742. [PMID: 28857723 DOI: 10.1177/1352458517730131] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Debate exists about whether neuromyelitis optica spectrum disorder seronegative disease represents the same immune-mediated attack on astrocytic aquaporin-4 as in seropositive disease. OBJECTIVE We investigated whether response to common treatments for neuromyelitis optica spectrum disorder differed by serostatus, as assessed by change in annualized relapse rate. METHODS We performed a multicenter retrospective analysis of 245 patients with neuromyelitis optica spectrum disorder who were treated with either rituximab or mycophenolate mofetil as their first-line immunosuppressive treatment for disease prevention. Patients were followed for a minimum of 6 months following treatment initiation. RESULTS In those started on rituximab, the pre-treatment annualized relapse rates for seropositive and seronegative patients were 1.81 and 1.93, respectively. On-treatment annualized relapse rates significantly declined to 0.32 (seropositive; p < 0.0001) and 0.12 (seronegative; p = 0.0001). In those started on mycophenolate mofetil, the pre-treatment annualized relapse rates for seropositive and seronegative patients were 1.79 and 1.45, respectively. On-treatment annualized relapse rates declined to 0.29 (seropositive; p < 0.0001) and 0.30 (seronegative; p < 0.005). CONCLUSION In this international collaboration involving a large number of neuromyelitis optica spectrum disorder patients, treatment was effective regardless of serostatus. This suggests that treatment should not differ when considering these treatments.
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Affiliation(s)
- Maureen A Mealy
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Su-Hyun Kim
- Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Felix Schmidt
- Charité University Medicine and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | | | | | - Friedemann Paul
- Charité University Medicine and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | | | | | - Ho Jin Kim
- Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Michael Levy
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mori M, Uzawa A, Kuwabara S. Geographical differences in preventative therapies for neuromyelitis optica spectrum disorder. J Neurol Neurosurg Psychiatry 2017; 88:620. [PMID: 28607119 DOI: 10.1136/jnnp-2017-315769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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ZhangBao J, Zhou L, Li X, Cai T, Lu J, Lu C, Zhao C, Quan C. The clinical characteristics of AQP4 antibody positive NMO/SD in a large cohort of Chinese Han patients. J Neuroimmunol 2016; 302:49-55. [PMID: 27988051 DOI: 10.1016/j.jneuroim.2016.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
We aim to summarize the clinical features of AQP4-ab-positive NMO/SD in a large Chinese Han cohort. The clinical data of 145 AQP4-ab-seropositive patients was retrospectively reviewed. 55.9% (81/145) of the patients were defined as NMO while 39.3% (57/145) were defined as NMOSD according to the criteria established in 2006 and 2007. The mean onset age was 34.4years and the female to male ratio was 8.7:1. The median disease duration was 57months. The median of "time to second attack" and "time to develop NMO" was 7 and 13months respectively. Ratio of monophasic to relapsing was 1:7.1. Myelitis and optic neuritis (ON) were the most common manifestations at onset, followed by postrema syndrome. The median age of patients presenting with ON at disease onset was significantly younger than patients presenting with myelitis. Only 17.2% of the patients younger than 30years presented with longitudinally extensive transverse myelitis (LETM) at onset, while 55.6% of the patients over 30years presented with LETM at onset. The patients presenting with ON at disease onset all exhibited a relapsing course, had a higher probability of subsequent involvement of other CNS regions and developing into definite NMO over time compared with those with LETM as the first attack. AQP4-ab levels were higher in patients with circulating auto-antibodies such as ANA, SSA, anti-Ro-52, anti-dsDNA, anti-histone antibody, pANCA and SSB, and positively correlated with CSF protein concentrations.
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Affiliation(s)
- Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Xiaoyang Li
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Tongjia Cai
- Department of Neurology, Jing'an District Centre Hospital of Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China; Department of Neurology, Jing'an District Centre Hospital of Shanghai, China.
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China.
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Borisow N, Kleiter I, Gahlen A, Fischer K, Wernecke KD, Pache F, Ruprecht K, Havla J, Krumbholz M, Kümpfel T, Aktas O, Ringelstein M, Geis C, Kleinschnitz C, Berthele A, Hemmer B, Angstwurm K, Weissert R, Stellmann JP, Schuster S, Stangel M, Lauda F, Tumani H, Mayer C, Zeltner L, Ziemann U, Linker RA, Schwab M, Marziniak M, Then Bergh F, Hofstadt-van Oy U, Neuhaus O, Winkelmann A, Marouf W, Rückriem L, Faiss J, Wildemann B, Paul F, Jarius S, Trebst C, Hellwig K. Influence of female sex and fertile age on neuromyelitis optica spectrum disorders. Mult Scler 2016; 23:1092-1103. [PMID: 27758954 DOI: 10.1177/1352458516671203] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gender and age at onset are important epidemiological factors influencing prevalence, clinical presentation, and treatment response in autoimmune diseases. OBJECTIVE To evaluate the impact of female sex and fertile age on aquaporin-4-antibody (AQP4-ab) status, attack localization, and response to attack treatment in patients with neuromyelitis optica (NMO) and its spectrum disorders (neuromyelitis optica spectrum disorder (NMOSD)). METHODS Female-to-male ratios, diagnosis at last visit (NMO vs NMOSD), attack localization, attack treatment, and outcome were compared according to sex and age at disease or attack onset. RESULTS A total of 186 NMO/SD patients (82% female) were included. In AQP4-ab-positive patients, female predominance was most pronounced during fertile age (female-to-male ratio 23:1). Female patients were more likely to be positive for AQP4-abs (92% vs 55%; p < 0.001). Interval between onset and diagnosis of NMO/SD was longer in women than in men (mean 54 vs 27 months; p = 0.023). In women, attacks occurring ⩽40 years of age were more likely to show complete remission ( p = 0.003) and better response to high-dose intravenous steroids ( p = 0.005) compared to woman at >40 years. CONCLUSION Our data suggest an influence of sex and age on susceptibility to AQP4-ab-positive NMO/SD. Genetic and hormonal factors might contribute to pathophysiology of NMO/SD.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anna Gahlen
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Katrin Fischer
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | | | - Florence Pache
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Markus Krumbholz
- Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Geis
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany/Hans-Berger Department of Neurology and Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | | | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Technische Universität München, Munich, Germany
| | - Klemens Angstwurm
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Robert Weissert
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany/Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Schuster
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangel
- Department of Clinical Neuroimmunology and Neurochemistry and Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Florian Lauda
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology at RKU and Specialty Clinic of Neurology Dietenbronn, University of Ulm, Ulm, Germany
| | - Christoph Mayer
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Lena Zeltner
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ralf A Linker
- Department of Neurology, Friedrich-Alexander University Erlangen-Nüremberg, Erlangen, Germany
| | - Matthias Schwab
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Martin Marziniak
- Department of Neurology, University of Münster, Münster, Germany/Department of Neurology and Neurological Intensive Care, Isar-Amper-Clinic, Munich-East, Haar, Germany
| | | | - Ulrich Hofstadt-van Oy
- Department of Neurology, Klinikum Bayreuth, Bayreuth, Germany/Department of Neurology, Klinikum Westfalen, Dortmund, Germany
| | - Oliver Neuhaus
- Department of Neurology, SRH Krankenhaus Sigmaringen, Sigmaringen, Germany
| | | | - Wael Marouf
- Department of Neurology, HELIOS Hanseklinikum Stralsund, Stralsund, Germany
| | - Lioba Rückriem
- Department of Neurology, MediClin Hedon Klinik, Lingen, Germany
| | - Jürgen Faiss
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | | | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité University Medicine Berlin, Berlin, Germany
| | - Sven Jarius
- Department of Neurology, Heidelberg University, Heidelberg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Abstract
PURPOSE To evaluate the prevalence of aquaporin 4 antibody (AQP4-Ab) in new-onset optic neuritis patients and investigate the characteristics of seropositive patients. METHODS Thirty-six women and six men with new-onset isolated optic neuritis were included in this study between January 2013 and December 2014. AQP4-Ab was detected and all blood samples were obtained prior to treatment and within one week from attack. The patients were sub-grouped into either a seropositive group or a seronegative group according to AQP4-Ab. Differences in age, gender, initial visual acuity, and final visual acuity between groups were analyzed. RESULTS Six (14.3%) of these patients (five women and one man) exhibited AQP4-Ab. There was no significant difference in mean age between study groups (positive group: 38.7 ± 11.5 years, negative group: 42.3 ± 14.7 years, P=0.548). Bilateral simultaneous involvement was more common in seropositive patients than in seronegative patients (occurred in two out of six seropositive patients and in one out of 36 seronegative patients, P = 0.007). With regards to poor visual outcome (worse than 1.0 LogMAR), seropositive patients exhibited more severe visual loss than seronegative patients. None of the seropositive patients exhibited myelitis symptoms during the follow-up period (mean follow-up period: 8-32 months). CONCLUSION The prevalence of AQP4 antibody was often detected in new-onset optic neuritis patients. In patients with bilateral involvement or poor initial visual acuity, the AQP4 antibody test should be considered.
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Affiliation(s)
- Kyung Min Kim
- a Department of Ophthalmology , Kim's Eye Hospital , Seoul , Korea
| | - Ungsoo Samuel Kim
- a Department of Ophthalmology , Kim's Eye Hospital , Seoul , Korea.,b Department of Ophthalmology , Konyang University College of Medicine , Daejeon , Korea
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Badri N, Teleb M, Syed S, Wardi M, Porres-Aguilar M, Cruz-Flores S. Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male. Case Rep Neurol 2016; 8:102-7. [PMID: 27403130 PMCID: PMC4924463 DOI: 10.1159/000446105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.
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Affiliation(s)
- Nabeel Badri
- Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
| | - Mohamed Teleb
- Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
| | - Saad Syed
- Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
| | - Miraie Wardi
- Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
| | - Mateo Porres-Aguilar
- Departments of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
| | - Salvador Cruz-Flores
- Departments of Neurology, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, Tex., USA
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The Efficacy and Tolerability of Mycophenolate Mofetil in Treating Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder in Western China. Clin Neuropharmacol 2016; 39:81-7. [DOI: 10.1097/wnf.0000000000000131] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder Patients in Turkish Cohort. Neurologist 2015; 20:61-6. [DOI: 10.1097/nrl.0000000000000057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weinfurtner K, Graves J, Ness J, Krupp L, Milazzo M, Waubant E. Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment. J Child Neurol 2015; 30:1366-70. [PMID: 25387545 DOI: 10.1177/0883073814553974] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022]
Abstract
Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.
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Affiliation(s)
| | - Jennifer Graves
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Jayne Ness
- Department of Neurology, University of Alabama, AL, USA
| | - Lauren Krupp
- Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University, NY, USA
| | - Maria Milazzo
- Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University, NY, USA School of Nursing, State University of New York, Stony Brook, NY, USA
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, CA, USA Department of Pediatrics, University of California, San Francisco, CA, USA
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Features of anti-aquaporin 4 antibody-seropositive Chinese patients with neuromyelitis optica spectrum optic neuritis. J Neurol 2015; 262:2293-304. [DOI: 10.1007/s00415-015-7844-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/04/2023]
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Specificity and sensitivity of aquaporin 4 antibody detection tests in patients with neuromyelitis optica: A meta-analysis. Mult Scler Relat Disord 2015. [DOI: 10.1016/j.msard.2015.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Pereira WLDCJ, Reiche EMV, Kallaur AP, Kaimen-Maciel DR. Epidemiological, clinical, and immunological characteristics of neuromyelitis optica: A review. J Neurol Sci 2015; 355:7-17. [PMID: 26050520 DOI: 10.1016/j.jns.2015.05.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/16/2023]
Abstract
The aim of this study was to review the epidemiological and clinical characteristics of neuromyelitis optica (NMO) and the immunopathological mechanisms involved in the neuronal damage. NMO is an inflammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. NMO is thought to be more prevalent among non-Caucasians and where multiple sclerosis (MS) prevalence is low. NMO follows a relapsing course in more than 80-90% of cases, which is more commonly in women. It is a complex disease with an interaction between host genetic and environmental factors and the main immunological feature is the presence of anti-aquaporin 4 (AQP4) antibodies in a subset of patients. NMO is frequently associated with multiple other autoantibodies and there is a strong association between NMO with other systemic autoimmune diseases. AQP4-IgG can cause antibody-dependent cellular cytotoxicity (ADCC) when effector cells are present and complement-dependent cytotoxicity (CDC) when complement is present. Acute therapies, including corticosteroids and plasma exchange, are designed to minimize injury and accelerate recovery. Several aspects of NMO pathogenesis remain unclear. More advances in the understanding of NMO disease mechanisms are needed in order to identify more specific biomarkers to NMO diagnosis.
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Affiliation(s)
- Wildéa Lice de Carvalho Jennings Pereira
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil; Outpatient Clinic for Demyelinating Diseases, University Hospital, State University of Londrina, Londrina, Paraná 86061-335, Brazil.
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
| | - Ana Paula Kallaur
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
| | - Damacio Ramón Kaimen-Maciel
- Outpatient Clinic for Demyelinating Diseases, University Hospital, State University of Londrina, Londrina, Paraná 86061-335, Brazil; Department of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
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Bernard-Valnet R, Liblau RS, Vukusic S, Marignier R. Neuromyelitis optica: a positive appraisal of seronegative cases. Eur J Neurol 2015; 22:1511-8, e82-3. [DOI: 10.1111/ene.12679] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/22/2014] [Indexed: 01/10/2023]
Affiliation(s)
- R. Bernard-Valnet
- INSERM U1043; CNRS; UMR 5282; Centre de Physiopathologie de Toulouse Purpan; Toulouse France
| | - R. S. Liblau
- INSERM U1043; CNRS; UMR 5282; Centre de Physiopathologie de Toulouse Purpan; Toulouse France
| | - S. Vukusic
- Service de Neurologie A; Observatoire Français de la Sclérose en Plaques; EDMUS Coordinating Center and Eugène Devic EDMUS Foundation against Multiple Sclerosis; Hôpital Neurologique Pierre Wertheimer; Hospices Civils de Lyon; Bron France
| | - R. Marignier
- Service de Neurologie A; Observatoire Français de la Sclérose en Plaques; EDMUS Coordinating Center and Eugène Devic EDMUS Foundation against Multiple Sclerosis; Hôpital Neurologique Pierre Wertheimer; Hospices Civils de Lyon; Bron France
- Team ONCOFLAM; INSERM U1028; CNRS; UMR 5292; Center for Research in Neuroscience of Lyon; Lyon France
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Tüzün E, Tzartos J, Ekizoğlu E, Stergiou C, Zisimopoulou P, Coban A, Shugaiv E, Türkoğlu R, Kürtüncü M, Baykan B, Tzartos S. Aquaporin-1 antibody in neuromyelitis optical patients. Eur Neurol 2014; 72:271-2. [PMID: 25277962 DOI: 10.1159/000364904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/METHODS To find out the prevalence of aquaporin-antibody (Aqp-Ab) and characterize Aqp-Ab associated clinical features in NMO, Aqp-1 and Aqp-4-Abs were examined using radioimmunoprecipitation and cell-based assays, respectively. RESULTS Aqp-4 and Aqp-1-Abs were detected in 20/30 and 8/30 NMO patients, respectively. One patient was Aqp-1-Ab single-positive, 13 patients were Aqp-4-Ab single-positive, 7 patients were Aqp-4/Aqp-1-Ab double-positive and 9 patients were seronegative. All double-positive patients had optic neuritis during the first attack. Only 2/29 MS patients and none of the control idiopathic intracranial hypertension patients were Aqp-1-Ab positive. CONCLUSION Aqp-1-Ab is usually detected in Aqp-4-Ab positive NMO patients and might be involved in optic neuritis pathogenesis.
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Affiliation(s)
- Erdem Tüzün
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Jarius S, Paul F, Fechner K, Ruprecht K, Kleiter I, Franciotta D, Ringelstein M, Pache F, Aktas O, Wildemann B. Aquaporin-4 antibody testing: direct comparison of M1-AQP4-DNA-transfected cells with leaky scanning versus M23-AQP4-DNA-transfected cells as antigenic substrate. J Neuroinflammation 2014; 11:129. [PMID: 25074611 PMCID: PMC4128531 DOI: 10.1186/1742-2094-11-129] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/08/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO, Devic syndrome) is associated with antibodies to aquaporin-4 (NMO-IgG/AQP4-Ab) in the majority of cases. NMO-IgG/AQP4-Ab seropositivity in patients with NMO and its spectrum disorders has important differential diagnostic, prognostic and therapeutic implications. So-called cell-based assays (CBA) are thought to provide the best AQP4-Ab detection rates. OBJECTIVE To compare directly the AQP4-IgG detection rates of the currently most widely used commercial CBA, which employs cells transfected with a full-length (M1)-human AQP4 DNA in a fashion that allows leaky scanning (LS) and thus expression of M23-AQP4 in addition to M1-AQP, to that of a newly developed CBA from the same manufacturer employing cells transfected with human M23-AQP4-DNA. METHODS Results from 368 serum samples that had been referred for routine AQP4-IgG determination and had been tested in parallel in the two assays were compared. RESULTS Seventy-seven out of 368 samples (20.9%) were positive for NMO-IgG/AQP4-Ab in at least one assay. Of these, 73 (94.8%) were positive in both assays. A single sample (1.3%) was exclusively positive in the novel assay; three samples (3.9%) were unequivocally positive only in the 'classic' assay due to high background intensity in the novel assay. Both median fluorescence intensity and background intensity were higher in the new assay. CONCLUSIONS This large study did not reveal significant differences in AQP4-IgG detection rates between the 'classic' CBA and a new M23-DNA-based CBA. Importantly, our results largely re-affirm the validity of previous studies that had used the 'classic' AQP4-CBA to establish NMO-IgG/AQP4-Ab seropositivity rates in NMO and in a variety of NMO spectrum disorders.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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Jarius S, Wildemann B, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014; 176:149-64. [PMID: 24666204 DOI: 10.1111/cei.12271] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 12/11/2022] Open
Abstract
The term 'neuromyelitis optica' ('Devic's syndrome', NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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The retinal nerve fiber layer of patients with neuromyelitis optica and chronic relapsing optic neuritis is more severely damaged than patients with multiple sclerosis. J Neuroophthalmol 2014; 33:220-4. [PMID: 23917443 DOI: 10.1097/wno.0b013e31829f39f1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare the retinal nerve fiber layer (RNFL) in eyes of patients with relapsing remitting multiple sclerosis (RRMS), neuromyelitis optica (NMO) and chronic relapsing inflammatory optic neuritis (CRION). METHODS Evaluation of 62 patients with RRMS, NMO, and CRION in a cross-sectional study with spectral domain optical coherence tomography. RESULTS A total of 124 eyes were evaluated (96 RRMS, 18 NMO, and 10 CRION). Frequency of optic neuritis for each disease was: 34% for RRMS, 84% for NMO, and 100% for CRION. Visual acuity and RNFL thickness were significantly worse in NMO and CRION eyes than in RRMS, but there were no differences between NMO and CRION eyes. A RNFL of 41 μm was 100% specific for optic neuritis associated with NMO and CRION when compared to RRMS. CONCLUSION This study established RNFL values to differentiate optic neuritis of RRMS from NMO and CRION. Although similarities observed between NMO and CRION eyes might suggest that they are within the same disease spectrum, it is still recommended that these 2 conditions be differentiated on clinical grounds. Optical coherence tomography serves as an additional diagnostic tool and can be used to monitor disease progression.
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Levy M, Wildemann B, Jarius S, Orellano B, Sasidharan S, Weber MS, Stuve O. Immunopathogenesis of neuromyelitis optica. Adv Immunol 2014; 121:213-42. [PMID: 24388217 DOI: 10.1016/b978-0-12-800100-4.00006-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica (NMO, Devic's syndrome) is a clinical syndrome characterized by optic neuritis and (mostly longitudinally extensive) myelitis. If untreated, NMO usually takes a relapsing course and often results in blindness and tetra- or paraparesis. The discovery of autoantibodies to aquaporin-4, the most abundant water channel in the CNS, in 70-80% of patients with NMO (termed NMO-IgG or AQP4-Ab) and subsequent investigations into the pathogenic impact of this new reactivity have led to the recognition of NMO as an autoimmune condition and as a disease entity in its own right, distinct from classic multiple sclerosis. Here, we comprehensively review the current knowledge on the role of NMO-IgG/AQP4-Ab, B cells, T cells, and the innate immune system in the pathogenesis of NMO.
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Affiliation(s)
- Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Benjamine Orellano
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Saranya Sasidharan
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin S Weber
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany; Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Olaf Stuve
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA; Neurology Section, VA North Texas Health Care System, Medical Service, Dallas, Texas, USA; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, München, Germany; Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Matas SLDA, Glehn FV, Fernandes GBP, Soares CAS. Cerebrospinal fluid analysis in the context of CNS demyelinating diseases. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:685-8. [PMID: 24141505 DOI: 10.1590/0004-282x20130151] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The central nervous system demyelinating diseases are a group of disorders with different etiologies, characterized by inflammatory lesions that are associated with loss of myelin and eventually axonal damage. In this group the most studied ones are multiple sclerosis (MS), neuromyelitis optic (NMO) and acute disseminated encephalomyelitis (ADEM). The cerebrospinal fluid is essential to differentiate between these different syndromes and to define multiple sclerosis, helping to assess the probability of Clinical Isolated Syndrome turn into multiple sclerosis.
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36
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Drori T, Chapman J. Diagnosis and classification of neuromyelitis optica (Devic's Syndrome). Autoimmun Rev 2014; 13:531-3. [DOI: 10.1016/j.autrev.2014.01.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 11/26/2022]
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Saadoun S, Waters P, Owens GP, Bennett JL, Vincent A, Papadopoulos MC. Neuromyelitis optica MOG-IgG causes reversible lesions in mouse brain. Acta Neuropathol Commun 2014; 2:35. [PMID: 24685353 PMCID: PMC3977893 DOI: 10.1186/2051-5960-2-35] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/09/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) are present in some neuromyelitis optica patients who lack antibodies against aquaporin-4 (AQP4-IgG). The effects of neuromyelitis optica MOG-IgG in the central nervous system have not been investigated in vivo. We microinjected MOG-IgG, obtained from patients with neuromyelitis optica, into mouse brains and compared the results with AQP4-IgG. Results MOG-IgG caused myelin changes and altered the expression of axonal proteins that are essential for action potential firing, but did not produce inflammation, axonal loss, neuronal or astrocyte death. These changes were independent of complement and recovered within two weeks. By contrast, AQP4-IgG produced complement-mediated myelin loss, neuronal and astrocyte death with limited recovery at two weeks. Conclusions These differences mirror the better outcomes for MOG-IgG compared with AQP4-IgG patients and raise the possibility that MOG-IgG contributes to pathology in some neuromyelitis optica patients.
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Abstract
Acute optic neuritis is the most common optic neuropathy affecting young adults. Exciting developments have occurred over the past decade in understanding of optic neuritis pathophysiology, and these developments have been translated into treatment trials. In its typical form, optic neuritis presents as an inflammatory demyelinating disorder of the optic nerve, which can be associated with multiple sclerosis. Atypical forms of optic neuritis can occur, either in association with other inflammatory disorders or in isolation. Differential diagnosis includes various optic nerve and retinal disorders. Diagnostic investigations include MRI, visual evoked potentials, and CSF examination. Optical coherence tomography can show retinal axonal loss, which correlates with measures of persistent visual dysfunction. Treatment of typical forms with high-dose corticosteroids shortens the period of acute visual dysfunction but does not affect the final visual outcome. Atypical forms can necessitate prolonged immunosuppressive regimens. Optical coherence tomography and visual evoked potential measures are suitable for detection of neuroaxonal loss and myelin repair after optic neuritis. Clinical trials are underway to identify potential neuroprotective or remyelinating treatments for acutely symptomatic inflammatory demyelinating CNS lesions.
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Affiliation(s)
- Ahmed T Toosy
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK; Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK.
| | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David H Miller
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, London, UK; Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK; New Zealand Brain Research Institute, University of Otago, Christchurch, New Zealand
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von Glehn F, Jarius S, Cavalcanti Lira RP, Alves Ferreira MC, von Glehn FHR, Costa E Castro SM, Beltramini GC, Bergo FP, Farias AS, Brandão CO, Wildemann B, Damasceno BP, Cendes F, Santos LMB, Yasuda CL. Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders. Mult Scler 2014; 20:1189-97. [PMID: 24477120 DOI: 10.1177/1352458513519838] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO. OBJECTIVE This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness. METHODS Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed. RESULTS We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease. CONCLUSIONS Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.
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Affiliation(s)
- Felipe von Glehn
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany
| | | | | | | | | | - Guilherme Coco Beltramini
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil Institute of Physics "Gleb Wataghin", University of Campinas, Brazil
| | - Felipe Pg Bergo
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Alessandro S Farias
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil
| | - Carlos Otávio Brandão
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany
| | - Benito P Damasceno
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Fernando Cendes
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
| | - Leonilda M B Santos
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil
| | - Clarissa Lin Yasuda
- Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil
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Jarius S, Wildemann B. 'Spinal amaurosis' (1841). On the early contribution of Edward Hocken to the concept of neuromyelitis optica. J Neurol 2013; 261:400-4. [PMID: 24366649 DOI: 10.1007/s00415-013-7210-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
While the history of classical multiple sclerosis has been extensively studied, only little is known about the early history of neuromyelitis optica (Devic's syndrome). Here we discuss a forgotten report by Edward Octavius Hocken (1820-1845) published in The Lancet in 1841. Hocken's report is important from a historic point of view for two reasons. Firstly, apart from a French language report by Antoine Portal, no earlier case of spinal cord inflammation and amaurosis is known. Secondly and much more importantly, Hocken, who upon his untimely death at the age of just 25 years was honoured by his contemporaries as a "precocious talent" of "very early reputation", in that article propagated the novel concept of 'spinal amaurosis', i.e. the concept of acute amaurosis and spinal cord disease being pathogenetically connected. Hocken's ideas predate Devic and Gault's seminal works on 'neuromyelitis optica' by more than 50 years.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany,
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Collongues N, Marignier R, Jacob A, Leite MI, Siva A, Paul F, Zephir H, Akman-Demir G, Elsone L, Jarius S, Papeix C, Mutch K, Saip S, Wildemann B, Kitley J, Karabudak R, Aktas O, Kuscu D, Altintas A, Palace J, Confavreux C, De Seze J. Characterization of neuromyelitis optica and neuromyelitis optica spectrum disorder patients with a late onset. Mult Scler 2013; 20:1086-94. [PMID: 24323817 DOI: 10.1177/1352458513515085] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few data are available for patients with a late onset (≥ 50 years) of neuromyelitis optica (LONMO) or neuromyelitis optica spectrum disease (LONMOSD), defined by an optic neuritis/longitudinally extensive transverse myelitis with aquaporin-4 antibodies (AQP4-Ab). OBJECTIVE To characterize LONMO and LONMOSD, and to analyze their predictive factors of disability and death. METHODS We identified 430 patients from four cohorts of NMO/NMOSD in France, Germany, Turkey and UK. We extracted the late onset patients and analyzed them for predictive factors of disability and death, using the Cox proportional model. RESULTS We followed up on 63 patients with LONMO and 45 with LONMOSD during a mean of 4.6 years. This LONMO/LONMOSD cohort was mainly of Caucasian origin (93%), women (80%), seropositive for AQP4-Ab (85%) and from 50 to 82.5 years of age at onset. No progressive course was noted. At last follow-up, the median Expanded Disability Status Scale (EDSS) scores were 5.5 and 6 in the LONMO and LONMOSD groups, respectively. Outcome was mainly characterized by motor disability and relatively good visual function. At last follow-up, 14 patients had died, including seven (50%) due to acute myelitis and six (43%) because of opportunistic infections. The EDSS 4 score was independently predicted by an older age at onset, as a continuous variable after 50 years of age. Death was predicted by two independent factors: an older age at onset and a high annualized relapse rate. CONCLUSION LONMO/LONMOSD is particularly severe, with a high rate of motor impairment and death.
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Affiliation(s)
- N Collongues
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
| | - R Marignier
- Department of Neurology, Pierre Wertheimer Hospital, University of Lyon, France
| | - A Jacob
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - M I Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - F Paul
- Neurocure, Charité University Medicine Berlin, Germany
| | - H Zephir
- Department of Neurology, Robert Salengro Hospital, University of Lille Nord de France, France
| | - G Akman-Demir
- Department of Neurology, Istanbul University, Turkey
| | - L Elsone
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Jarius
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - C Papeix
- Department of Neurology, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - K Mutch
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - B Wildemann
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - J Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - R Karabudak
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - O Aktas
- Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany
| | - D Kuscu
- Department of Neurology, Bakýrkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | | | - J De Seze
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
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Woodhall M, Çoban A, Waters P, Ekizoğlu E, Kürtüncü M, Shugaiv E, Türkoğlu R, Akman-Demir G, Eraksoy M, Vincent A, Tüzün E. Glycine receptor and myelin oligodendrocyte glycoprotein antibodies in Turkish patients with neuromyelitis optica. J Neurol Sci 2013; 335:221-3. [DOI: 10.1016/j.jns.2013.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Lin A, Zhu J, Yao X, Lin S, Murong S, Li Z. Clinical Manifestations and Spinal Cord Magnetic Resonance Imaging Findings in Chinese Neuromyelitis Optica Patients. Eur Neurol 2013; 71:35-41. [DOI: 10.1159/000353983] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Jarius S, Wildemann B. Aquaporin-4 antibodies, CNS acidosis and neuromyelitis optica: a potential link. Med Hypotheses 2013; 81:1090-5. [PMID: 24182872 DOI: 10.1016/j.mehy.2013.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/17/2013] [Accepted: 10/09/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO, Devic's syndrome) is a severely disabling disorder of the central nervous system characterized by optic neuritis and longitudinally extensive myelitis. In around 80% of cases, NMO is caused by autoantibodies to astrocytic aquaporin-4 (AQP4), the most abundant water channel in the CNS. Acute NMO attacks are frequently accompanied by elevated levels of lactate in the cerebrospinal fluid (CSF). As a strongly dissociated anion (pK'=3.7) directly changing the strong ion difference, lactate causes a reduction in the dependent anion [HCO3-] and a rise in [H+], resulting in "metabolic" acidosis in the CSF. CSF acidosis also develops during respiratory failure due to brainstem or high cervical spinal cord lesions, the most common cause of death in NMO. However, lactic acid and more generally, a decrease in pH, has been shown to increase the membrane expression of AQP4 in astrocytes. An increase in AQP4 membrane expression during acute NMO attacks could potentially enhance the complement-mediated humoral immune reaction against AQP4-expressing astrocytes characteristic for NMO and, thus, result in more severe astrocytic damage. Moreover, lactate and acidosis have been shown to cause astrocytic swelling and to affect astrocytic viability, potentially rendering astrocytes more susceptible to AQP4-Ab-mediated damage. Finally, increased AQP4 expression could be an independent risk factor in NMO and other forms of CNS inflammation, as indicated by the finding of grossly attenuated experimental autoimmune encephalomyelitis in AQP4-null mice. Therefore, we hypothesize that CSF acidosis might play a role in the pathophysiology of AQP4-Ab-positive NMO and that alterations in CSF pH might possibly influence the outcome of acute attacks in this condition. In addition, we discuss potential clinical implications and make proposals on how to test the hypothesis. Finally, other factors that influence astrocytic AQP4 membrane expression and might play a role in NMO are discussed.
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Affiliation(s)
- S Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany.
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Jiao Y, Fryer JP, Lennon VA, Jenkins SM, Quek AML, Smith CY, McKeon A, Costanzi C, Iorio R, Weinshenker BG, Wingerchuk DM, Shuster EA, Lucchinetti CF, Pittock SJ. Updated estimate of AQP4-IgG serostatus and disability outcome in neuromyelitis optica. Neurology 2013; 81:1197-204. [PMID: 23997151 DOI: 10.1212/wnl.0b013e3182a6cb5c] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To 1) determine, using contemporary recombinant antigen-based assays, the aquaporin-4 (AQP4)-immunoglobulin G (IgG) detection rate in sequential sera of patients assigned a clinical diagnosis of neuromyelitis optica (NMO) but initially scored negative by tissue-based indirect immunofluorescence (IIF) assay; and 2) evaluate the impact of serostatus on phenotype and outcome. METHODS From Mayo Clinic records (2005-2011), we identified 163 patients with NMO; 110 (67%) were seropositive by IIF and 53 (33%) were scored seronegative. Available stored sera from 49 "seronegative" patients were tested by ELISA, AQP4-transfected cell-based assay, and in-house fluorescence-activated cell sorting assay. Clinical characteristics were compared based on final serostatus. RESULTS Thirty of the 49 IIF-negative patients (61%) were reclassified as seropositive, yielding an overall AQP4-IgG seropositivity rate of 88% (i.e., 12% seronegative). The fluorescence-activated cell sorting assay improved the detection rate to 87%, cell-based assay to 84%, and ELISA to 79%. The sex ratio (female to male) was 1:1 for seronegatives and 9:1 for seropositives (p < 0.0001). Simultaneous optic neuritis and transverse myelitis as onset attack type (i.e., within 30 days of each other) occurred in 32% of seronegatives and in 3.6% of seropositives (p < 0.0001). Relapse rate, disability outcome, and other clinical characteristics did not differ significantly. CONCLUSIONS Serological tests using recombinant AQP4 antigen are significantly more sensitive than tissue-based IIF for detecting AQP4-IgG. Testing should precede immunotherapy; if negative, later-drawn specimens should be tested. AQP4-IgG-seronegative NMO is less frequent than previously reported and is clinically similar to AQP4-IgG-seropositive NMO.
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Affiliation(s)
- Yujuan Jiao
- From the Departments of Laboratory Medicine and Pathology (Y.J., J.P.F., V.A.L., A.M.L.Q., A.M., R.I., S.J.P.), Neurology (V.A.L., A.M., C.C., B.G.W., C.F.L., S.J.P.), Immunology (V.A.L.), and Health Sciences Research (S.M.J., C.Y.S.), College of Medicine, Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), College of Medicine, Mayo Clinic, Scottsdale, AZ; and Department of Neurology (E.A.S.), College of Medicine, Mayo Clinic, Jacksonville, FL
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Evaluation of clinical interest of anti-aquaporin-4 autoantibody followup in neuromyelitis optica. Clin Dev Immunol 2013; 2013:146219. [PMID: 23710199 PMCID: PMC3655457 DOI: 10.1155/2013/146219] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/02/2013] [Indexed: 11/18/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune disease in which a specific biomarker named NMO-IgG and directed against aquaporin-4 (AQP4) has been found. A correlation between disease activity and anti-AQP4 antibody (Ab) serum concentration or complement-mediated cytotoxicity has been reported, but the usefulness of longitudinal evaluation of these parameters remains to be evaluated in actual clinical practice. Thirty serum samples from 10 NMO patients positive for NMO-IgG were collected from 2006 to 2011. Anti-AQP4 Ab serum concentration and complement-mediated cytotoxicity were measured by flow cytometry using two quantitative cell-based assays (CBA) and compared with clinical parameters. We found a strong correlation between serum anti-AQP4 Ab concentration and complement-mediated cytotoxicity (P < 0.0001). Nevertheless, neither relapse nor worsening of impairment level was closely associated with a significant increase in serum Ab concentration or cytotoxicity. These results suggest that complement-mediated serum cytotoxicity assessment does not provide extra insight compared to anti-AQP4 Ab serum concentration. Furthermore, none of these parameters appears closely related to disease activity and/or severity. Therefore, in clinical practice, serum anti-AQP4 reactivity seems not helpful as a predictive biomarker in the followup of NMO patients as a means of predicting the onset of a relapse and adapting the treatment accordingly.
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Jarius S, Wildemann B. The history of neuromyelitis optica. J Neuroinflammation 2013; 10:8. [PMID: 23320783 PMCID: PMC3599417 DOI: 10.1186/1742-2094-10-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/07/2012] [Indexed: 11/25/2022] Open
Abstract
The discovery of a novel serum autoantibody (termed NMO-IgG or AQP4-Ab) in a subset of patients in 2004 has revived interest in neuromyelitis optica (NMO). While the history of classical multiple sclerosis has been extensively studied, only little is known about the history of NMO. In the present article, we provide a comprehensive review of the early history of this rare but intriguing syndrome. We trace the origins of the concept of NMO in the 19th century medical literature and follow its evolution throughout the 20th and into the 21st century. Finally, we discuss recent proposals to revise the concept of NMO and explain why there is indeed a need for a more systematic and descriptive nomenclature.
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Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 450, 69120, Heidelberg, Germany.
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González C, González-Buitrago JM, Izquierdo G. Aquaporins, anti-aquaporin-4 autoantibodies and neuromyelitis optica. Clin Chim Acta 2013; 415:350-60. [DOI: 10.1016/j.cca.2012.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/25/2012] [Accepted: 04/27/2012] [Indexed: 12/24/2022]
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Kıyat-Atamer A, Ekizoğlu E, Tüzün E, Kürtüncü M, Shugaiv E, Akman-Demir G, Eraksoy M. Long-term MRI findings in neuromyelitis optica: seropositive versus seronegative patients. Eur J Neurol 2012; 20:781-7. [DOI: 10.1111/ene.12058] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A. Kıyat-Atamer
- Department of Neurology; TC Bilim University; Istanbul; Turkey
| | - E. Ekizoğlu
- Department of Neurology; Istanbul Faculty of Medicine; Istanbul University; Istanbul; Turkey
| | - E. Tüzün
- Department of Neuroscience; Institute of Experimental Medicine; Istanbul University; Istanbul; Turkey
| | - M. Kürtüncü
- Department of Neurology; Acibadem University; Istanbul; Turkey
| | - E. Shugaiv
- Department of Neurology; Istanbul Faculty of Medicine; Istanbul University; Istanbul; Turkey
| | - G. Akman-Demir
- Department of Neurology; TC Bilim University; Istanbul; Turkey
| | - M. Eraksoy
- Department of Neurology; Istanbul Faculty of Medicine; Istanbul University; Istanbul; Turkey
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