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Zhang F, Zhou H, Yi Y, Li N, Liu M, Shen H, Guo Y, Wang J. Origin and significance of leucine-rich glioma-inactivated 1 antibodies in cerebrospinal fluid. Neurol Sci 2024; 45:4493-4500. [PMID: 38551680 DOI: 10.1007/s10072-024-07489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/19/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Whether antibodies against leucine-rich glioma-inactivated 1 (LGI1-Abs) in cerebrospinal fluid (CSF) are partially transferred from serum and the impact of CSF-LGI1-Ab positivity on clinical features and prognosis are unclear. Therefore, we aim to investigate the differences in serum titers, clinical features, and outcomes between LGI1-Ab CSF-positive and LGI1-Ab CSF-negative patients. METHODS Retrospective analysis of serum titers and clinical features according to CSF LGI1-Ab status. In addition, univariate and multivariate logistic regression were performed to identify predictors of worse outcomes. RESULTS A total of 60 patients with anti-LGI1 encephalitis and positive serum LGI1-Abs were identified, of whom 8 (13.3%) patients were excluded due to the absence of CSF LGI1-Ab testing. Among the remaining 52 patients, 33 (63.5%) were positive for LGI1-Abs in CSF. CSF-positive patients were more likely to have high serum titers (≥ 1:100) than CSF-negative patients (p = 0.003), and Spearman's correlation analysis showed a positive correlation between CSF and serum titers in CSF-positive patients (r2 = 0.405, p = 0.019). Psychiatric symptoms and hyponatremia were more frequent in CSF-positive patients (p < 0.05). Both univariate and multivariate logistic regression analyses showed that CSF LGI1-Ab positivity and delayed immunotherapy are independent risk factors for incomplete recovery (modified Rankin Scale (mRS) > 0 at last follow-up). CONCLUSIONS LGI1-Ab CSF-positive patients have higher serum titers, and their CSF titers are positively correlated with serum titers, indicating a possible peripheral origin of CSF LGI1-Abs. CSF-positive patients more often present with psychiatric symptoms, hyponatremia, and worse outcomes, suggesting more severe neuronal damage.
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Affiliation(s)
- Fang Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Hong Zhou
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yujie Yi
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Na Li
- Department of Neurology, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Miaomiao Liu
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Huijun Shen
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yingshi Guo
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Wang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
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2
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de Almeida GMR, de Araujo RS, Castrillo BB, Silva GD, Fortini I, Gonçalves MRR, Castro LHM, Tatsui NH, Adoni T, Sato DK, Apóstolos-Pereira SL, Callegaro D. Therapeutic plasma exchange for neuromyelitis optica attacks: Evidence and challenges from a real-world cohort from Brazil. J Neuroimmunol 2024; 388:578295. [PMID: 38280268 DOI: 10.1016/j.jneuroim.2024.578295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Therapeutic plasma exchange (TPE) can improve disability recovery after neuromyelitis optica spectrum disease (NMOSD) attacks, but its effectiveness and safety in Latin-American patients with access barriers and diverse ethnicity is underexplored. We carried out a retrospective cohort study with NMOSD patients that underwent TPE. 84 NMOSD attacks in 68 patients were evaluated. Despite a median 25-day delay from symptom onset to TPE, 65,5% of patients showed significant improvement. Adverse events occurred in 39% of patients, usually transitory and with no fatalities.
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Affiliation(s)
- Guilherme Mello Ramos de Almeida
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Cardio Pulmonar da Bahia, Salvador, Bahia, Brazil
| | - Roger Santana de Araujo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
| | - Bruno Batitucci Castrillo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Ida Fortini
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Henrique Martins Castro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Nelson Hidekazu Tatsui
- Hematology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Tarso Adoni
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas Kazutoshi Sato
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dagoberto Callegaro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
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3
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Aspden JW, Murphy MA, Kashlan RD, Xiong Y, Poznansky MC, Sîrbulescu RF. Intruders or protectors - the multifaceted role of B cells in CNS disorders. Front Cell Neurosci 2024; 17:1329823. [PMID: 38269112 PMCID: PMC10806081 DOI: 10.3389/fncel.2023.1329823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
B lymphocytes are immune cells studied predominantly in the context of peripheral humoral immune responses against pathogens. Evidence has been accumulating in recent years on the diversity of immunomodulatory functions that B cells undertake, with particular relevance for pathologies of the central nervous system (CNS). This review summarizes current knowledge on B cell populations, localization, infiltration mechanisms, and function in the CNS and associated tissues. Acute and chronic neurodegenerative pathologies are examined in order to explore the complex, and sometimes conflicting, effects that B cells can have in each context, with implications for disease progression and treatment outcomes. Additional factors such as aging modulate the proportions and function of B cell subpopulations over time and are also discussed in the context of neuroinflammatory response and disease susceptibility. A better understanding of the multifactorial role of B cell populations in the CNS may ultimately lead to innovative therapeutic strategies for a variety of neurological conditions.
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Affiliation(s)
- James W. Aspden
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Matthew A. Murphy
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Rommi D. Kashlan
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Yueyue Xiong
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mark C. Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ruxandra F. Sîrbulescu
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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4
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Majed M, Valencia Sanchez C, Bennett JL, Fryer J, Mulligan MD, Redenbaugh V, McKeon A, Mills JR, Wingerchuk DM, Lennon VA, Weinshenker B, Chen JJ, Flanagan EP, Pittock SJ, Kunchok A. Alterations in Aquaporin-4-IgG Serostatus in 986 Patients: A Laboratory-Based Longitudinal Analysis. Ann Neurol 2023; 94:727-735. [PMID: 37314750 DOI: 10.1002/ana.26722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was undertaken to investigate factors associated with aquaporin-4 (AQP4)-IgG serostatus change using a large serological database. METHODS This retrospective study utilizes Mayo Clinic Neuroimmunology Laboratory data from 2007 to 2021. We included all patients with ≥2 AQP4-IgG tests (by cell-based assay). The frequency and clinical factors associated with serostatus change were evaluated. Multivariable logistic regression analysis examined whether age, sex, or initial titer was associated with serostatus change. RESULTS There were 933 patients who had ≥2 AQP4-IgG tests with an initial positive result. Of those, 830 (89%) remained seropositive and 103 (11%) seroreverted to negative. Median interval to seroreversion was 1.2 years (interquartile range [IQR] = 0.4-3.5). Of those with sustained seropositivity, titers were stable in 92%. Seroreversion was associated with age ≤ 20 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.09-4.63; p = 0.028) and low initial titer of ≤1:100 (OR = 11.44, 95% CI = 3.17-41.26, p < 0.001), and 5 had clinical attacks despite seroreversion. Among 62 retested after seroreversion, 50% returned to seropositive (median = 224 days, IQR = 160-371). An initial negative AQP4-IgG test occurred in 9,308 patients. Of those, 99% remained seronegative and 53 (0.3%) seroconverted at a median interval of 0.76 years (IQR = 0.37-1.68). INTERPRETATION AQP4-IgG seropositivity usually persists over time with little change in titer. Seroreversion to negative is uncommon (11%) and associated with lower titers and younger age. Seroreversion was often transient, and attacks occasionally occurred despite prior seroreversion, suggesting it may not reliably reflect disease activity. Seroconversion to positive is rare (<1%), limiting the utility of repeat testing in seronegative patients unless clinical suspicion is high. ANN NEUROL 2023;94:727-735.
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Affiliation(s)
- Masoud Majed
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Martin D Mulligan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Vyankya Redenbaugh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Brian Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Amy Kunchok
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
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5
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Mousa WK, Chehadeh F, Husband S. Microbial dysbiosis in the gut drives systemic autoimmune diseases. Front Immunol 2022; 13:906258. [PMID: 36341463 PMCID: PMC9632986 DOI: 10.3389/fimmu.2022.906258] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/20/2022] [Indexed: 09/29/2023] Open
Abstract
Trillions of microbes survive and thrive inside the human body. These tiny creatures are crucial to the development and maturation of our immune system and to maintain gut immune homeostasis. Microbial dysbiosis is the main driver of local inflammatory and autoimmune diseases such as colitis and inflammatory bowel diseases. Dysbiosis in the gut can also drive systemic autoimmune diseases such as type 1 diabetes, rheumatic arthritis, and multiple sclerosis. Gut microbes directly interact with the immune system by multiple mechanisms including modulation of the host microRNAs affecting gene expression at the post-transcriptional level or production of microbial metabolites that interact with cellular receptors such as TLRs and GPCRs. This interaction modulates crucial immune functions such as differentiation of lymphocytes, production of interleukins, or controlling the leakage of inflammatory molecules from the gut to the systemic circulation. In this review, we compile and analyze data to gain insights into the underpinning mechanisms mediating systemic autoimmune diseases. Understanding how gut microbes can trigger or protect from systemic autoimmune diseases is crucial to (1) tackle these diseases through diet or lifestyle modification, (2) develop new microbiome-based therapeutics such as prebiotics or probiotics, (3) identify diagnostic biomarkers to predict disease risk, and (4) observe and intervene with microbial population change with the flare-up of autoimmune responses. Considering the microbiome signature as a crucial player in systemic autoimmune diseases might hold a promise to turn these untreatable diseases into manageable or preventable ones.
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Affiliation(s)
- Walaa K. Mousa
- Biology Department, Whitman College, Walla Walla, WA, United States
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- College of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Fadia Chehadeh
- Biology Department, Whitman College, Walla Walla, WA, United States
| | - Shannon Husband
- Biology Department, Whitman College, Walla Walla, WA, United States
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6
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Abstract
PURPOSE OF REVIEW Autoimmune encephalitis (AE) refers to immune-mediated neurological syndromes often characterised by the detection of pathogenic autoantibodies in serum and/or cerebrospinal fluid which target extracellular epitopes of neuroglial antigens. There is increasing evidence these autoantibodies directly modulate function of their antigens in vivo. Early treatment with immunotherapy improves outcomes. Yet, these patients commonly exhibit chronic disability. Importantly, optimal therapeutic strategies at onset and during escalation remain poorly understood. In this review of a rapidly emerging field, we evaluate recent studies on larger cohorts, registries, and meta-analyses to highlight existing evidence for contemporary therapeutic approaches in AE. RECENT FINDINGS We highlight acute and long-term treatments used in specific AE syndromes, exemplify how understanding disease pathogenesis can inform precision therapy and outline challenges of defining disability outcomes in AE. SUMMARY Early first-line immunotherapies, including corticosteroids and plasma exchange, improve outcomes, with emerging evidence showing second-line immunotherapies (especially rituximab) reduce relapse rates. Optimal timing of immunotherapy escalation remains unclear. Routine reporting of outcome measures which incorporate cognitive impairment, fatigue, pain, and mental health will permit more accurate quantification of residual disability and comprehensive comparisons between international multicentre cohorts, and enable future meta-analyses with the aim of developing evidence-based therapeutic guidelines.
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Affiliation(s)
- Benjamin P Trewin
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Isaak Freeman
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neurology, Concord Hospital, Sydney, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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7
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Dinoto A, Sechi E, Flanagan EP, Ferrari S, Solla P, Mariotto S, Chen JJ. Serum and Cerebrospinal Fluid Biomarkers in Neuromyelitis Optica Spectrum Disorder and Myelin Oligodendrocyte Glycoprotein Associated Disease. Front Neurol 2022; 13:866824. [PMID: 35401423 PMCID: PMC8983882 DOI: 10.3389/fneur.2022.866824] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
The term neuromyelitis optica spectrum disorder (NMOSD) describes a group of clinical-MRI syndromes characterized by longitudinally extensive transverse myelitis, optic neuritis, brainstem dysfunction and/or, less commonly, encephalopathy. About 80% of patients harbor antibodies directed against the water channel aquaporin-4 (AQP4-IgG), expressed on astrocytes, which was found to be both a biomarker and a pathogenic cause of NMOSD. More recently, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), have been found to be a biomarker of a different entity, termed MOG antibody-associated disease (MOGAD), which has overlapping, but different pathogenesis, clinical features, treatment response, and prognosis when compared to AQP4-IgG-positive NMOSD. Despite important refinements in the accuracy of AQP4-IgG and MOG-IgG testing assays, a small proportion of patients with NMOSD still remain negative for both antibodies and are called “seronegative” NMOSD. Whilst major advances have been made in the diagnosis and treatment of these conditions, biomarkers that could help predict the risk of relapses, disease activity, and prognosis are still lacking. In this context, a number of serum and/or cerebrospinal fluid biomarkers are emerging as potentially useful in clinical practice for diagnostic and treatment purposes. These include antibody titers, cytokine profiles, complement factors, and markers of neuronal (e.g., neurofilament light chain) or astroglial (e.g., glial fibrillary acidic protein) damage. The aim of this review is to summarize current evidence regarding the role of emerging diagnostic and prognostic biomarkers in patients with NMOSD and MOGAD.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Solla
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- *Correspondence: Sara Mariotto
| | - John J. Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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8
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Kim H, Lee EJ, Lim YM, Kim KK. Glial Fibrillary Acidic Protein in Blood as a Disease Biomarker of Neuromyelitis Optica Spectrum Disorders. Front Neurol 2022; 13:865730. [PMID: 35370870 PMCID: PMC8968934 DOI: 10.3389/fneur.2022.865730] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Glial fibrillary acidic protein (GFAP) is a type III intermediate filament protein found in astrocytes in the brain. Damaged astrocytes release GFAP into cerebrospinal fluid and blood. Thus, GFAP levels in these body fluids may reflect the disease state of neuromyelitis optica spectrum disorder (NMOSD), which includes astrocytopathy, characterized by pathogenic antibodies against aquaporin 4 located on astrocytes. Recently, single-molecule array technology that can detect these synaptic proteins in blood, even in the subfemtomolar range, has been developed. Emerging evidence suggests that GFAP protein is a strong biomarker candidate for NMOSD. This mini-review provides basic information about GFAP protein and innovative clinical data that show the potential clinical value of blood GFAP levels as a biomarker for NMOSD.
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Affiliation(s)
- Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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9
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Cousins O, Hodges A, Schubert J, Veronese M, Turkheimer F, Miyan J, Engelhardt B, Roncaroli F. The Blood‐CSF‐Brain Route of Neurological Disease: The Indirect Pathway into the Brain. Neuropathol Appl Neurobiol 2021; 48:e12789. [DOI: 10.1111/nan.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Oliver Cousins
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Angela Hodges
- Department of Old Age Psychiatry, IoPPN, King’s College London London United Kingdom
| | - Julia Schubert
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Mattia Veronese
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Federico Turkheimer
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Jaleel Miyan
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
- Geoffrey Jefferson Brain Research Centre; Manchester Academic Health Science Centre Manchester UK
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10
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Liu J, Tan G, Li B, Zhang J, Gao Y, Cao Y, Jia Z, Sugimoto K. Serum Aquaporin 4-Immunoglobulin G Titer and Neuromyelitis Optica Spectrum Disorder Activity and Severity: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:746959. [PMID: 34744983 PMCID: PMC8565925 DOI: 10.3389/fneur.2021.746959] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/15/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Aquaporin 4-immunoglobulin G (AQP4-IgG) plays a major role in the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD). Seropositive status for this antibody has become one of the required indicators for NMOSD diagnosis. Objective: Our goal was to systematically review and perform a meta-analysis of the current works of literature evaluating the clinical relevance of serum AQP4-IgG titer in patients with NMOSD. We sought to determine whether AQP4-IgG could indicate disease activity or severity, in addition to its diagnostic value in NMOSD. Methods: Electronic databases were searched for published literature, yielding 4,402 hits. Of the 124 full articles screened, 17 were included in the qualitative analysis and 14 in the meta-analysis. Results: There were no significant differences in serum AQP4-IgG titers between the relapse and remission phases in patients with NMOSD [standard mean difference (SMD): 0.32, 95% CI (-0.10, 0.74), p = 0.14]. Subgroup meta-analysis of AQP4-IgG detected by cell-based assays (CBA), an AQP4-IgG testing method recommended by the 2015 international consensus diagnostic criteria for NMOSD, confirmed the aforementioned result [SMD: 0.27, 95% CI (-0.01, 0.55), p = 0.06]. Moreover, the serum AQP4-IgG titer was positively correlated with the number of involved spinal cord segments [correlation coefficient (COR): 0.70, 95% CI (0.28-0.89), p = 0.003] and the Expanded Disability Status Scale (EDSS) score [COR: 0.54, 95% CI (0.06-0.82), p = 0.03] in the attack phase in patients with NMOSD. Conclusions: The present study systematically assessed the association between serum AQP4-IgG titer and NMOSD activity and severity. The results demonstrated that the serum AQP4-IgG titer was not associated with disease activity but indicated the disease severity in the attack phase in patients with NMOSD. A further meta-analysis with a larger number of studies that employed standardized AQP4-IgG assays and detected attack-remission paired samples from the same patients with detailed medication information will be required to confirm our findings and shed more light on optimizing clinical AQP4-IgG monitoring. Systematic Review Registration: [www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=208209], PROSPERO, identifier [CRD42020208209].
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Affiliation(s)
- Jia Liu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Guojun Tan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jingze Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanbo Cao
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kazuo Sugimoto
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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Zou A, Ramanathan S, Dale RC, Brilot F. Single-cell approaches to investigate B cells and antibodies in autoimmune neurological disorders. Cell Mol Immunol 2021; 18:294-306. [PMID: 32728203 PMCID: PMC8027387 DOI: 10.1038/s41423-020-0510-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Autoimmune neurological disorders, including neuromyelitis optica spectrum disorder, anti-N-methyl-D-aspartate receptor encephalitis, anti-MOG antibody-associated disorders, and myasthenia gravis, are clearly defined by the presence of autoantibodies against neurological antigens. Although these autoantibodies have been heavily studied for their biological activities, given the heterogeneity of polyclonal patient samples, the characteristics of a single antibody cannot be definitively assigned. This review details the findings of polyclonal serum and CSF studies and then explores the advances made by single-cell technologies to the field of antibody-mediated neurological disorders. High-resolution single-cell methods have revealed abnormalities in the tolerance mechanisms of several disorders and provided further insight into the B cells responsible for autoantibody production. Ultimately, several factors, including epitope specificity and binding affinity, finely regulate the pathogenic potential of an autoantibody, and a deeper appreciation of these factors may progress the development of targeted immunotherapies for patients.
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Affiliation(s)
- Alicia Zou
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
- School of Medical Sciences, Discipline of Applied Medical Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Qin C, Tao R, Zhang SQ, Chen B, Chen M, Yu HH, Chu YH, Shang K, Wu LJ, Bu BT, Tian DS. Predictive Factors of Resistance to High-Dose Steroids Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorder. Front Neurol 2020; 11:585471. [PMID: 33281722 PMCID: PMC7688779 DOI: 10.3389/fneur.2020.585471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
High-dose steroids, the first-line therapy for acute attacks in neuromyelitis optica spectrum disorder (NMOSD), were ineffective in a proportion of NMOSD attacks. This study aimed to explore possible predictors of high-dose steroid resistance. Demographics and disease characteristics of acute attacks were compared between those who responded to high-dose intravenous methylprednisolone (IVMP) and those resistant to IVMP. In total, 197 attacks in 160 patients were identified in our NMOSD registry. Compared with responders, attacks resistant to high-dose steroids tended to have a higher proportion of previous history of immunosuppressive use (25.5 vs. 15.5%, p = 0.080). Significantly higher levels of proteins in the cerebrospinal fluid (CSF) were found in non-responders than in responders [485.5 (388–656) vs. 387 (291.5–532) mg/L, p = 0.006]. More active lesions were found in the brain stem of non-responders (8 attacks in 55, 14.5%), especially in the pons (7.3%) and medulla (14.5%), as opposed to responders (7 patients in 142, 4.9%). Multivariable logistic regression showed that resistance to high-dose steroid treatment was associated with previous immunosuppressant use [odds ratio (OR), 2.31; 95% confidence interval (CI) 1.002–5.34, p = 0.049], CSF protein level above 450 mg/L (OR 3.42, 95% CI 1.72–6.82, p < 0.001), and active lesions in the brainstem (OR 3.80, 95% CI 1.17–12.32, p = 0.026). In conclusion, NMOSD patients with previous use of immunosuppressants, higher levels of CSF protein, and active lesions in the brainstem are more likely to respond poorly to high-dose IVMP alone during an acute attack.
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Affiliation(s)
- Chuan Qin
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Tao
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo-Qi Zhang
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Man Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Han Yu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Shang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Bi-Tao Bu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Sun B, Ramberger M, O'Connor KC, Bashford-Rogers RJM, Irani SR. The B cell immunobiology that underlies CNS autoantibody-mediated diseases. Nat Rev Neurol 2020; 16:481-492. [PMID: 32724223 PMCID: PMC9364389 DOI: 10.1038/s41582-020-0381-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/17/2022]
Abstract
A rapidly expanding and clinically distinct group of CNS diseases are caused by pathogenic autoantibodies that target neuroglial surface proteins. Despite immunotherapy, patients with these neuroglial surface autoantibody (NSAb)-mediated diseases often experience clinical relapse, high rates of long-term morbidity and adverse effects from the available medications. Fundamentally, the autoantigen-specific B cell lineage leads to production of the pathogenic autoantibodies. These autoantigen-specific B cells have been consistently identified in the circulation of patients with NSAb-mediated diseases, accompanied by high serum levels of autoantigen-specific antibodies. Early evidence suggests that these cells evade well-characterized B cell tolerance checkpoints. Nearer to the site of pathology, cerebrospinal fluid from patients with NSAb-mediated diseases contains high levels of autoantigen-specific B cells that are likely to account for the intrathecal synthesis of these autoantibodies. The characteristics of their immunoglobulin genes offer insights into the underlying immunobiology. In this Review, we summarize the emerging knowledge of B cells across the NSAb-mediated diseases. We review the evidence for the relative contributions of germinal centres and long-lived plasma cells as sources of autoantibodies, discuss data that indicate migration of B cells into the CNS and summarize insights into the underlying B cell pathogenesis that are provided by therapeutic effects.
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Affiliation(s)
- Bo Sun
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Melanie Ramberger
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kevin C O'Connor
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, USA
| | | | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Jitprapaikulsan J, Fryer JP, Majed M, Smith CY, Jenkins SM, Cabre P, Hinson SR, Weinshenker BG, Mandrekar J, Chen JJ, Lucchinetti CF, Jiao Y, Segan J, Schmeling JE, Mills J, Flanagan EP, McKeon A, Pittock SJ. Clinical utility of AQP4-IgG titers and measures of complement-mediated cell killing in NMOSD. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/4/e727. [PMID: 35413004 PMCID: PMC7286655 DOI: 10.1212/nxi.0000000000000727] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/15/2020] [Indexed: 11/15/2022]
Abstract
ObjectiveTo investigate whether aquaporin-4–immunoglobulin G (AQP4-IgG) titers and measures of complement-mediated cell killing are clinically useful to predict the occurrence of relapse, relapse severity, and/or disability in neuromyelitis optica spectrum disorder (NMOSD).MethodsWe studied 336 serial serum specimens from 82 AQP4-lgG–seropositive patients. NMOSD activity at blood draw was defined as preattack (24 [7.1%], drawn within 30 days preceding an attack), attack (108 [32.1%], drawn on attack onset or within 30 days after), or remission (199 [59.2%], drawn >90 days after attack onset and >30 days preceding a relapse). For each specimen, we documented the attack type and severity and immunotherapy status. Complement-mediated cell killing was quantitated by flow cytometry using an M23-AQP4 cell-based assay.ResultsThe estimated logarithmic means of AQP4-IgG titers in preattack, attack, and remission samples were 3.302, 3.657, and 3.458, respectively, p = 0.21. Analyses of 81 attack/remission pairs in 42 patients showed no significant titer differences (3.736 vs 3.472, p = 0.15). Analyses of 13 preattack/attack pairs in 9 patients showed no significant titer differences (3.994 vs 3.889, p = 0.67). Of 5 patients who converted to seronegative status, 2 continued to have attacks. Titers for major and minor attacks (n = 70) were not significantly different (3.905 vs 3.676, p = 0.47). Similarly, measures (titers) of complement-mediated cell killing were not significantly associated with disease course, attack severity, or disability at 5 years.Conclusions and relevanceAQP4-IgG titer and complement-mediated cell killing lack significant prognostic or predictive utility in NMOSD. Although titers may drop in the setting of immunotherapy, seroconversion to negative status does not preclude ongoing clinical attacks.Classification of evidenceThis study provides Class II evidence that in patients with NMOSD, AQP4-IgG titers and measures of complement-mediated cell killing activity do not predict relapses, relapse severity, or disability.
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Affiliation(s)
- Jiraporn Jitprapaikulsan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - James P Fryer
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Masoud Majed
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Philippe Cabre
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Shannon R Hinson
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Brian G Weinshenker
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Jay Mandrekar
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Yujuan Jiao
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Jessica Segan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John E Schmeling
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - John Mills
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Departments of Neurology (J.J., M.M., B.G.W., C.F.L., Y.J., E.P.F., A.M., S.J.P.), Laboratory Medicine and Pathology (J.J., J.P.F., S.R.H., J.E.S., J. Mills, A.M., S.J.P.), Health Sciences Research (C.Y.S., S.M.J., J. Mandrekar), Mayo Clinic, Rochester, MN; Department of Neurology (P.C.), Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Martinique; Center for MS and Autoimmune Neurology (B.G.W., J.J.C., C.F.L., J. S., J. Mills, E.P.F., A.M., S.J.P.), and Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN.
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Cameron S, Gillio-Meina C, Ranger A, Choong K, Fraser DD. Collection and Analyses of Cerebrospinal Fluid for Pediatric Translational Research. Pediatr Neurol 2019; 98:3-17. [PMID: 31280949 DOI: 10.1016/j.pediatrneurol.2019.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 12/18/2022]
Abstract
Cerebrospinal fluid sample collection and analysis is imperative to better elucidate central nervous system injury and disease in children. Sample collection methods are varied and carry with them certain ethical and biologic considerations, complications, and contraindications. Establishing best practices for sample collection, processing, storage, and transport will ensure optimal sample quality. Cerebrospinal fluid samples can be affected by a number of factors including subject age, sampling method, sampling location, volume extracted, fraction, blood contamination, storage methods, and freeze-thaw cycles. Indicators of sample quality can be assessed by matrix-associated laser desorption/ionization time-of-flight mass spectrometry and include cystatin C fragments, oxidized proteins, prostaglandin D synthase, and evidence of blood contamination. Precise documentation of sample collection processes and the establishment of meticulous handling procedures are essential for the creation of clinically relevant biospecimen repositories. In this review we discuss the ethical considerations and best practices for cerebrospinal fluid collection, as well as the influence of preanalytical factors on cerebrospinal fluid analyses. Cerebrospinal fluid biomarkers in highly researched pediatric diseases or disorders are discussed.
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Affiliation(s)
| | | | - Adrianna Ranger
- Pediatrics, Western University, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Karen Choong
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Douglas D Fraser
- Pediatrics, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada; Physiology and Pharmacology, Western University, London, Ontario, Canada; Translational Research Centre, London, Ontario, Canada.
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Alves Do Rego C, Collongues N. Neuromyelitis optica spectrum disorders: Features of aquaporin-4, myelin oligodendrocyte glycoprotein and double-seronegative-mediated subtypes. Rev Neurol (Paris) 2018; 174:458-470. [PMID: 29685427 DOI: 10.1016/j.neurol.2018.02.084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 01/27/2023]
Abstract
The new diagnostic classification of neuromyelitis optica spectrum disorder (NMOSD) in 2015 highlights the central role of biomarkers, such as antibodies against aquaporin-4 (AQP4-Ab), in diagnosis. Also, in approximately 20-25% of patients without AQP4-Ab (NMOSDAQP4-) the presence of an antibody directed against myelin oligodendrocyte glycoprotein (MOG) characterizes a specific population of NMOSD patients (NMOSDMOG+), according to their demographic and clinical data and prognoses. While double-seronegative cases (NMOSDNEG) have not been fully described, they may correspond to the very first patients with opticospinal demyelination reported by Devic and Gault in 1894. The present report reviews the current knowledge of the pathophysiology and clinical features of NMOSDAQP4+, NMOSDMOG+ and NMOSDNEG patients, and also discusses the relationship between the extended spectrum of MOG disease and NMOSDMOG+. Finally, the current treatments for acute relapses and relapse prevention are described, with a focus on serological-based therapeutic responses and the promising new therapeutic targets.
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Affiliation(s)
- C Alves Do Rego
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - N Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France; Clinical Investigation Center, INSERM U1434, University Hospital of Strasbourg, Strasbourg, France; Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, University Hospital of Strasbourg, Strasbourg, France.
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17
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Wang X, Jiao W, Lin M, Lu C, Liu C, Wang Y, Ma D, Wang X, Yin P, Feng J, Zhu J, Zhu M. Resolution of inflammation in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2018; 27:34-41. [PMID: 30300851 DOI: 10.1016/j.msard.2018.09.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/06/2018] [Accepted: 09/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of neuroinflammatory disorders associated with autoimmune antibodies against aquaporin-4 (AQP4). Accumulating evidence suggests that inflammation is involved in NMOSD pathogenesis. Resolution of inflammation, which is a highly regulated process mediated by specialized pro-resolving lipid mediators (SPMs) is important to prevent over-responsive inflammation. Deficiency in resolution of inflammation may lead to or accelerates inflammatory diseases. However, whether resolution of inflammation is impaired in NMOSD is not known. The objective of this study was to analyze the levels of SPMs in the serum and cerebrospinal fluid (CSF) of NMOSD patients, and to explore the roles of SPMs in clinical features of NMOSD. METHODS Thirty-five patients with NMOSD, 34 patients with multiple sclerosis, and 36 patients with non-inflammatory neurological diseases were enrolled in this study. Pro-resolving mediators including Annexin A1 (ANXA1) and resolvin D1 (RvD1), as well as pro-inflammatory lipid mediator leukotriene B4 (LTB4) levels were analyzed by enzyme-linked immunosorbent assay. Pro- and anti-inflammatory cytokines as well as chemokine levels were analyzed using cytometric beads array (CBA). RESULTS Our results showed RvD1 levels were significantly decreased, whereas LTB4 levels were significantly increased in the CSF of NMOSD patients. AQP4-IgG titer was negatively correlated with RvD1 levels in the CSF of NMOSD patients. CONCLUSIONS Decreased RvD1 levels indicate impaired resolution of inflammation in NMOSD patients. AQP4-IgG may contribute to increased inflammation and lead to unresolved inflammation in NMOSD.
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Affiliation(s)
- Xu Wang
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Wenyu Jiao
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Meng Lin
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Chao Lu
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Caiyun Liu
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Ying Wang
- Department of Neurobiology, Care Sciences & Society, Section of Neurodegeneration, Karolinska Institute, Center for Alzheimer Research, Blickagången 6, SE-141 57 Huddinge, Sweden
| | - Di Ma
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Xiuzhe Wang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ping Yin
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Jiachun Feng
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China
| | - Jie Zhu
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China; Department of Neurobiology, Care Sciences & Society, Section of Neurodegeneration, Karolinska Institute, Center for Alzheimer Research, Blickagången 6, SE-141 57 Huddinge, Sweden
| | - Mingqin Zhu
- Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China.
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18
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Abstract
RATIONALE An acute presentation with diffuse magnetic resonance imaging lesions can have a broad differential. Demyelination and malignancy are important considerations. Therefore, sometimes it is hard to differentiate glioma from some demyelinating diseases solely on imaging because of the similar clinical presentation and imaging features. Detection of highly specific serum autoantibody marker aquaporin-4 (AQP4)-IgG positivity has helped to define a category of neuromyelitis optica spectrum disorders (NMOSD), but the test of AQP4 antibody has not been reported in patients with glioma. PATIENTS CONCERNS AND DIAGNOSES We report a case of a 56-year-old woman with cerebrospinal fluid (CSF) positive aquaporin-4 antibodies with initial response to immune therapy and secondary deterioration. A surgical biopsy revealed an anaplastic astrocytoma. INTERVENTIONS AND OUTCOMES After the admission the patient was treated with a short course of intravenous steroid agents. After anaplastic astrocytoma was diagnosed, she began to receive a radiation treatment and soon later experienced a clinical deterioration with frequent epilepsy seizure and disturbance of consciousness within a few months. LESSON This case indicates that tumors could lead to polyclonal antibody responses as in this case with aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies. The absence of a typical clinical phenotype and lack of sustained response to immunotherapy should alert the clinical suspicion of an alternative diagnosis. When AQP4 antibody was detected positive in CSF of a patient but negative in serum, differential diagnosis should especially be considered.
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Affiliation(s)
- Yuanyuan Liu
- Department of Neurology, Peking University First Hospital, Beijing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Feng Gao
- Department of Neurology, Peking University First Hospital, Beijing
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing
| | - Weiping Sun
- Department of Neurology, Peking University First Hospital, Beijing
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing
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19
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Mader S, Brimberg L, Diamond B. The Role of Brain-Reactive Autoantibodies in Brain Pathology and Cognitive Impairment. Front Immunol 2017; 8:1101. [PMID: 28955334 PMCID: PMC5601985 DOI: 10.3389/fimmu.2017.01101] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022] Open
Abstract
Antibodies to different brain proteins have been recently found to be associated with an increasing number of different autoimmune diseases. They need to penetrate the blood–brain barrier (BBB) in order to bind antigens within the central nervous system (CNS). They can target either neuronal or non-neuronal antigen and result in damage either by themselves or in synergy with other inflammatory mediators. Antibodies can lead to acute brain pathology, which may be reversible; alternatively, they may trigger irreversible damage that persists even though the antibodies are no longer present. In this review, we will describe two different autoimmune conditions and the role of their antibodies in causing brain pathology. In systemic lupus erythematosus (SLE), patients can have double stranded DNA antibodies that cross react with the neuronal N-methyl-d-aspartate receptor (NMDAR), which have been recently linked to neurocognitive dysfunction. In neuromyelitis optica (NMO), antibodies to astrocytic aquaporin-4 (AQP4) are diagnostic of disease. There is emerging evidence that pathogenic T cells also play an important role for the disease pathogenesis in NMO since they infiltrate in the CNS. In order to enable appropriate and less invasive treatment for antibody-mediated diseases, we need to understand the mechanisms of antibody-mediated pathology, the acute and chronic effects of antibody exposure, if the antibodies are produced intrathecally or systemically, their target antigen, and what triggers their production. Emerging data also show that in utero exposure to some brain-reactive antibodies, such as those found in SLE, can cause neurodevelopmental impairment since they can penetrate the embryonic BBB. If the antibody exposure occurs at a critical time of development, this can result in irreversible damage of the offspring that persists throughout adulthood.
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Affiliation(s)
- Simone Mader
- The Feinstein Institute for Medical Research, The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Northwell Health System, Manhasset, NY, United States
| | - Lior Brimberg
- The Feinstein Institute for Medical Research, The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Northwell Health System, Manhasset, NY, United States
| | - Betty Diamond
- The Feinstein Institute for Medical Research, The Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, Northwell Health System, Manhasset, NY, United States
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20
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Guo Y, Weigand SD, Popescu BF, Lennon VA, Parisi JE, Pittock SJ, Parks NE, Clardy SL, Howe CL, Lucchinetti CF. Pathogenic implications of cerebrospinal fluid barrier pathology in neuromyelitis optica. Acta Neuropathol 2017; 133:597-612. [PMID: 28184993 PMCID: PMC5348570 DOI: 10.1007/s00401-017-1682-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/12/2017] [Accepted: 01/25/2017] [Indexed: 02/06/2023]
Abstract
Pathogenic autoantibodies associated with neuromyelitis optica (NMO) induce disease by targeting aquaporin-4 (AQP4) water channels enriched on astrocytic endfeet at blood–brain interfaces. AQP4 is also expressed at cerebrospinal fluid (CSF)–brain interfaces, such as the pial glia limitans and the ependyma and at the choroid plexus blood–CSF barrier. However, little is known regarding pathology at these sites in NMO. Therefore, we evaluated AQP4 expression, microglial reactivity, and complement deposition at pial and ependymal surfaces and in the fourth ventricle choroid plexus in 23 autopsy cases with clinically and/or pathologically confirmed NMO or NMO spectrum disorder. These findings were compared to five cases with multiple sclerosis, five cases of choroid plexus papilloma, and five control cases without central nervous system disease. In the NMO cases, AQP4 immunoreactivity was reduced relative to control levels in the pia (91%; 21/23), ependyma (56%; 9/16), and choroid plexus epithelium (100%; 12/12). AQP4 immunoreactivity was normal in MS cases in these regions. Compared to MS, NMO cases also showed a focal pattern of pial and ependymal complement deposition and more pronounced microglial reactivity. In addition, AQP4 loss, microglial reactivity, and complement deposition colocalized along the pia and ependyma only in NMO cases. Within the choroid plexus, AQP4 loss was coincident with C9neo immunoreactivity on epithelial cell membranes only in NMO cases. These observations demonstrate that NMO immunopathology extends beyond perivascular astrocytic foot processes to include the pia, ependyma, and choroid plexus, suggesting that NMO IgG-induced pathological alterations at CSF–brain and blood–CSF interfaces may contribute to the occurrence of ventriculitis, leptomeningitis, and hydrocephalus observed among NMO patients. Moreover, disruption of the blood–CSF barrier induced by binding of NMO IgG to AQP4 on the basolateral surface of choroid plexus epithelial cells may provide a unique portal for entry of the pathogenic antibody into the central nervous system.
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Affiliation(s)
- Yong Guo
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Bogdan F Popescu
- Department of Anatomy and Cell Biology, Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Natalie E Parks
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stacey L Clardy
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Charles L Howe
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Neuroscience, Mayo Clinic, Rochester, MN, USA.
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
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21
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Tuller F, Holzer H, Schanda K, Aboulenein-Djamshidian F, Höftberger R, Khalil M, Seifert-Held T, Leutmezer F, Berger T, Reindl M. Characterization of the binding pattern of human aquaporin-4 autoantibodies in patients with neuromyelitis optica spectrum disorders. J Neuroinflammation 2016; 13:176. [PMID: 27371173 PMCID: PMC4930584 DOI: 10.1186/s12974-016-0642-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/24/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The discovery of a highly specific antibody against the aquaporin-4 (AQP4) water channel (AQP4-IgG) unified the spectrum of neuromyelitis optica spectrum disorders (NMOSD), which are considered to be antibody-mediated autoimmune diseases. The AQP4 water channel is located on astrocytic end-feet processes and consists of six transmembrane helical domains forming three extracellular loops A, C, and E in which defined amino acids were already proven to be critical for AQP4-IgG binding. However, the clinical relevance of these findings is unclear. Therefore, we have characterized the epitope specificity of AQP4-IgG-positive NMOSD patients. METHODS We established a cell-based flow cytometry assay for the quantitative detection of AQP4-IgG-positive serum samples. Human embryonic kidney (HEK) cells were transiently transfected with an EmGFP-tagged AQP4-M23, AQP4-M1, or six AQP4-M23 extracellular loop mutants including two mutations in loop A (serial AA substitution, insertion of a myc-tag), two in loop C (N153Q, insertion of a myc-tag), and two in loop E (H230G, insertion of a myc-tag). Fourty-seven baseline and 49 follow-up serum samples and six paired cerebrospinal fluid (CSF) baseline samples of 47 AQP4-IgG-positive Austrian NMOSD patients were then tested for their binding capability to AQP4-M1 and AQP4-M23 isoforms and these six extracellular loop mutants. RESULTS Overall, we could identify two broad patterns of antibody recognition based on differential sensitivity to mutations in extracellular loop A. Pattern A was characterized by reduced binding to the two mutations in loop A, whereas pattern B had only partial or no reduced binding to these mutations. These two patterns were not associated with significant differences in demographic and clinical parameters or serum titers in this retrospective study. Interestingly, we found a change of AQP4-IgG epitope recognition pattern in seven of 20 NMOSD patients with available follow-up samples. Moreover, we found different binding patterns in five of six paired CSF versus serum samples, with a predominance of pattern A in CSF. CONCLUSIONS Our study demonstrates that AQP4-IgG in sera of NMOSD patients show distinct patterns of antibody recognition. The clinical and diagnostic relevance of these findings have to be addressed in prospective studies.
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Affiliation(s)
- Friederike Tuller
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hannah Holzer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fahmy Aboulenein-Djamshidian
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Sozialmedizinisches Zentrum Ost Donauspital, Vienna, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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22
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Marignier R, Ruiz A, Cavagna S, Nicole A, Watrin C, Touret M, Parrot S, Malleret G, Peyron C, Benetollo C, Auvergnon N, Vukusic S, Giraudon P. Neuromyelitis optica study model based on chronic infusion of autoantibodies in rat cerebrospinal fluid. J Neuroinflammation 2016; 13:111. [PMID: 27193196 PMCID: PMC4872335 DOI: 10.1186/s12974-016-0577-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/10/2016] [Indexed: 11/19/2022] Open
Abstract
Background Devic’s neuromyelitis optica (NMO) is an autoimmune astrocytopathy, associated with central nervous system inflammation, demyelination, and neuronal injury. Several studies confirmed that autoantibodies directed against aquaporin-4 (AQP4-IgG) are relevant in the pathogenesis of NMO, mainly through complement-dependent toxicity leading to astrocyte death. However, the effect of the autoantibody per se and the exact role of intrathecal AQP4-IgG are still controversial. Methods To explore the intrinsic effect of intrathecal AQP4-IgG, independent from additional inflammatory effector mechanisms, and to evaluate its clinical impact, we developed a new animal model, based on a prolonged infusion of purified immunoglobulins from NMO patient (IgGAQP4+, NMO-rat) and healthy individual as control (Control-rat) in the cerebrospinal fluid (CSF) of live rats. Results We showed that CSF infusion of purified immunoglobulins led to diffusion in the brain, spinal cord, and optic nerves, the targeted structures in NMO. This was associated with astrocyte alteration in NMO-rats characterized by loss of aquaporin-4 expression in the spinal cord and the optic nerves compared to the Control-rats (p = 0.001 and p = 0.02, respectively). In addition, glutamate uptake tested on vigil rats was dramatically reduced in NMO-rats (p = 0.001) suggesting that astrocytopathy occurred in response to AQP4-IgG diffusion. In parallel, myelin was altered, as shown by the decrease of myelin basic protein staining by up to 46 and 22 % in the gray and white matter of the NMO-rats spinal cord, respectively (p = 0.03). Loss of neurofilament positive axons in NMO-rats (p = 0.003) revealed alteration of axonal integrity. Then, we investigated the clinical consequences of such alterations on the motor behavior of the NMO-rats. In a rotarod test, NMO-rats performance was lower compared to the controls (p = 0.0182). AQP4 expression, and myelin and axonal integrity were preserved in AQP4-IgG-depleted condition. We did not find a major immune cell infiltration and microglial activation nor complement deposition in the central nervous system, in our model. Conclusions We establish a link between motor-deficit, NMO-like lesions and astrocytopathy mediated by intrathecal AQP4-IgG. Our study validates the concept of the intrinsic effect of autoantibody against surface antigens and offers a model for testing antibody and astrocyte-targeted therapies in NMO. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0577-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Marignier
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France. .,Université Lyon 1, Université de Lyon, Lyon, France. .,Service de Neurologie A, Eugène Devic EDMUS Foundation Against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon-Bron cedex, France.
| | - A Ruiz
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - S Cavagna
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - A Nicole
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France
| | - C Watrin
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - M Touret
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - S Parrot
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - G Malleret
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - C Peyron
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - C Benetollo
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - N Auvergnon
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
| | - S Vukusic
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France.,Service de Neurologie A, Eugène Devic EDMUS Foundation Against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 Boulevard Pinel, 69677, Lyon-Bron cedex, France
| | - P Giraudon
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience of Lyon, Lyon, France.,Université Lyon 1, Université de Lyon, Lyon, France
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Majed M, Fryer JP, McKeon A, Lennon VA, Pittock SJ. Clinical utility of testing AQP4-IgG in CSF: Guidance for physicians. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e231. [PMID: 27144221 PMCID: PMC4841640 DOI: 10.1212/nxi.0000000000000231] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/15/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To define, using assays of optimized sensitivity and specificity, the most informative specimen type for aquaporin-4 immunoglobulin G (AQP4-IgG) detection. METHODS Results were reviewed from longitudinal service testing for AQP4-IgG among specimens submitted to the Mayo Clinic Neuroimmunology Laboratory from 101,065 individual patients. Paired samples of serum/CSF were tested from 616 patients, using M1-AQP4-transfected cell-based assays (both fixed AQP4-CBA Euroimmun kit [commercial CBA] and live in-house flow cytometry [FACS]). Sensitivities were compared for 58 time-matched paired specimens (drawn ≤30 days apart) from patients with neuromyelitis optica (NMO) or high-risk patients. RESULTS The frequency of CSF submission as sole initial specimen was 1 in 50 in 2007 and 1 in 5 in 2015. In no case among 616 paired specimens was CSF positive and serum negative. In 58 time-matched paired specimens, AQP4-IgG was detected by FACS or by commercial CBA more sensitively in serum than in CSF (respectively, p = 0.06 and p < 0.001). A serum titer >1:100 predicted CSF positivity (p < 0.001). The probability of CSF positivity was greater around attack time (p = 0.03). No control specimen from 128 neurologic patients was positive by either assay. CONCLUSIONS FACS and commercial CBA detection of AQP4-IgG is less sensitive in CSF than in serum. The data suggest that most AQP4-IgG is produced in peripheral lymphoid tissues and that a critical serum/CSF gradient is required for IgG to penetrate the CNS in pathogenic quantity. Serum is the optimal and most cost-effective specimen for AQP4-IgG testing. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with NMO or NMOSD, CSF is less sensitive than serum for detection of AQP4-IgG.
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Affiliation(s)
- Masoud Majed
- Departments of Laboratory Medicine and Pathology (M.M., J.P.F., A.M., V.A.L., S.J.P.), Neurology (A.M., V.A.L., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - James P Fryer
- Departments of Laboratory Medicine and Pathology (M.M., J.P.F., A.M., V.A.L., S.J.P.), Neurology (A.M., V.A.L., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Departments of Laboratory Medicine and Pathology (M.M., J.P.F., A.M., V.A.L., S.J.P.), Neurology (A.M., V.A.L., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- Departments of Laboratory Medicine and Pathology (M.M., J.P.F., A.M., V.A.L., S.J.P.), Neurology (A.M., V.A.L., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Departments of Laboratory Medicine and Pathology (M.M., J.P.F., A.M., V.A.L., S.J.P.), Neurology (A.M., V.A.L., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
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24
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Detection of Antibodies against Human and Plant Aquaporins in Patients with Multiple Sclerosis. Autoimmune Dis 2015; 2015:905208. [PMID: 26290755 PMCID: PMC4529886 DOI: 10.1155/2015/905208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease that affects the body's central nervous system. Around 90% of MS sufferers are diagnosed with relapsing-remitting MS (RRMS). We used ELISA to measure IgG, IgA, and IgM antibodies against linear epitopes of human and plant aquaporins (AQP4) as well as neural antigens in RRMS patients and controls to determine whether patients suffering from RRMS have simultaneous elevations in antibodies against these peptides and antigens. In comparison to controls, significant elevations in isotype-specific antibodies against human and plant AQP4 and neural antigens such as MBP, MOG, and S100B were detected in RRMS patients, indicating a high correlation in antibody reaction between plant aquaporins and brain antigens. This correlation between the reactivities of RRMS patients with various tested antigens was the most significant for the IgM isotype. We conclude that a subclass of patients with RRMS reacts to both plant and human AQP4 peptides. This immune reaction against different plant aquaporins may help in the development of dietary modifications for patients with MS and other neuroimmune disorders.
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Kowarik MC, Dzieciatkowska M, Wemlinger S, Ritchie AM, Hemmer B, Owens GP, Bennett JL. The cerebrospinal fluid immunoglobulin transcriptome and proteome in neuromyelitis optica reveals central nervous system-specific B cell populations. J Neuroinflammation 2015; 12:19. [PMID: 25626447 PMCID: PMC4323273 DOI: 10.1186/s12974-015-0240-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 01/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is a severe demyelinating disorder of the central nervous system (CNS) associated with the presence of an autoimmune antibody response (AQP4-IgG) against the water channel aquaporin-4 (AQP4). It remains unclear whether pathologic AQP4-IgG in the CNS is produced entirely by peripheral plasma cells or is generated in part by infiltrating B cells. To determine the overlap of AQP4-IgG idiotypes between the CNS and periphery, we compared the immunoglobulin G (IgG) transcriptome of cerebrospinal fluid (CSF) plasmablasts with the CSF and serum IgG proteomes in 7 AQP4-seropositive NMO patients following exacerbation. Methods CSF variable region Ig heavy- (VH) and light-chain (VL) transcriptome libraries were generated for each patient from CSF plasmablasts by single cell sorting, reverse transcriptase polymerase chain reaction (RT-PCR), and DNA sequencing. Recombinant antibodies were generated from clonally expanded, paired VH and VL sequences and tested for AQP4-reactivity by cell-binding assay. CSF and serum IgG fractions were searched for sequences that matched their respective CSF IgG transcriptome. Matching peptides within the same patient’s CSF and serum IgG proteomes were also identified. Results In each NMO patient, we recovered CSF IgG VH and VL sequences that matched germline-mutated IgG protein sequences from the patient’s CSF and serum IgG proteomes. Although a modest variation was observed between patients, the overlap between the transcriptome and proteome sequences was found primarily, but not exclusively, within the CSF. More than 50% of the CSF IgG transcriptome sequences were exclusively found in the CSF IgG proteome, whereas 28% were found in both the CSF and blood IgG proteome, and 18% were found exclusively in the blood proteome. A comparable distribution was noted when only AQP4-specific IgG clones were considered. Similarly, on average, only 50% of the CSF IgG proteome matched corresponding peptide sequences in the serum. Conclusions During NMO exacerbations, a substantial fraction of the intrathecal Ig proteome is generated by an intrathecal B cell population composed of both novel and peripherally-derived clones. Intrathecal CSF B cell clones may contribute to NMO disease exacerbation and lesion formation and may be an important target for preventative therapies.
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Affiliation(s)
- Markus C Kowarik
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | | | - Scott Wemlinger
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Alanna M Ritchie
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Bernhard Hemmer
- Department of Neurology, TU-München, Klinikum Rechts der Isar, Munich, Germany. .,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Gregory P Owens
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Jeffrey L Bennett
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA. .,Department of Ophthalmology, Neuroscience Program, Denver, CO, USA.
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Biomarkers for neuromyelitis optica. Clin Chim Acta 2014; 440:64-71. [PMID: 25444748 DOI: 10.1016/j.cca.2014.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 02/06/2023]
Abstract
Neuromyelitis optica (NMO) is an acquired, heterogeneous inflammatory disorder, which is characterized by recurrent optic neuritis and longitudinally extensive spinal cord lesions. The discovery of the serum autoantibody marker, anti-aquaporin 4 (anti-AQP4) antibody, revolutionizes our understanding of pathogenesis of NMO. In addition to anti-AQP4 antibody, other biomarkers for NMO are also reported. These candidate biomarkers are particularly involved in T helper (Th)17 and astrocytic damages, which play a critical role in the development of NMO lesions. Among them, IL-6 in the peripheral blood is associated with anti-AQP4 antibody production. Glial fibrillary acidic protein (GFAP) in CSF demonstrates good correlations with clinical severity of NMO relapses. Detecting these useful biomarkers may be useful in the diagnosis and evaluation of disease activity of NMO. Development of compounds targeting these biomarkers may provide novel therapeutic strategies for NMO. This article will review the related biomarker studies in NMO and discuss the potential therapeutics targeting these biomarkers.
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Malaspina A, Puentes F, Amor S. Disease origin and progression in amyotrophic lateral sclerosis: an immunology perspective. Int Immunol 2014; 27:117-29. [DOI: 10.1093/intimm/dxu099] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Abstract
Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system directed against astrocytes. Initially diagnosed in individuals with monophasic or relapsing optic neuritis and transverse myelitis, NMO is now recognized as a demyelinating disorder with pleiotropic presentations due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 in the majority of individuals. As visual impairment and neurologic dysfunction in NMO are commonly severe, aggressive treatment of relapses and prophylactic immunomodulatory therapy are the focus of treatment. Although there are no approved treatments for NMO, medications and therapeutic interventions for acute and chronic treatment have been the subject of retrospective study and case reports. The goal of this review is to familiarize the reader with biologic and clinical data supporting current treatments in NMO and highlight future strategies based on advancements in our understanding of NMO pathogenesis.
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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: 237] [Impact Index Per Article: 23.7] [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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Probst C, Saschenbrecker S, Stoecker W, Komorowski L. Anti-neuronal autoantibodies: Current diagnostic challenges. Mult Scler Relat Disord 2014; 3:303-20. [DOI: 10.1016/j.msard.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/01/2013] [Accepted: 12/03/2013] [Indexed: 01/17/2023]
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Vaishnav RA, Liu R, Chapman J, Roberts AM, Ye H, Rebolledo-Mendez JD, Tabira T, Fitzpatrick AH, Achiron A, Running MP, Friedland RP. Aquaporin 4 molecular mimicry and implications for neuromyelitis optica. J Neuroimmunol 2013; 260:92-8. [PMID: 23664693 PMCID: PMC3682654 DOI: 10.1016/j.jneuroim.2013.04.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 12/31/2022]
Abstract
Neuromyelitis optica (NMO) is associated with antibodies to aquaporin 4 (AQP4). We hypothesized that antibodies to AQP4 can be triggered by exposure to environmental proteins. We compared human AQP4 to plant and bacterial proteins to investigate the occurrence of significantly similar structures and sequences. High similarity to a known epitope for NMO-IgG, AQP4(207-232), was observed for corn ZmTIP4-1. NMO and non-NMO sera were assessed for reactivity to AQP4(207-232) and the corn peptide. NMO patient serum showed reactivity to both peptides as well as to plant tissue. These findings warrant further investigation into the role of the environment in NMO etiology.
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Affiliation(s)
- Radhika A. Vaishnav
- Department of Neurology, University of Louisville, KY, USA
- Department of Physiology and Biophysics, University of Louisville, KY, USA
| | - Ruolan Liu
- Department of Neurology, University of Louisville, KY, USA
| | - Joab Chapman
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Andrew M. Roberts
- Department of Physiology and Biophysics, University of Louisville, KY, USA
| | - Hong Ye
- Department of Pharmacology, University of Louisville, KY, USA
| | | | - Takeshi Tabira
- Department of Diagnosis, Prevention, and Treatment of Dementia, Graduate School of Juntendo University, Tokyo, Japan
| | | | - Anat Achiron
- Department of Neurology, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Robert P. Friedland
- Department of Neurology, University of Louisville, KY, USA
- Department of Biochemistry, University of Louisville, KY, USA
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Abstract
Autoimmune diseases currently affect 5-7% of the world's population; in most diseases there are circulating autoantibodies. Brain-reactive antibodies are present in approximately 2-3% of the general population but do not usually contribute to brain pathology. These antibodies penetrate brain tissue only early in development or under pathologic conditions. This restriction on their pathogenicity and the lack of correlation between serum titers and brain pathology have, no doubt, contributed to a delayed appreciation of the contribution of autoantibodies in diseases of the central nervous system. Nonetheless, it is increasingly clear that antibodies can cause damage in the brain and likely initiate or aggravate multiple neurologic conditions; brain-reactive antibodies contribute to symptomatology in autoimmune disease, infectious disease, and malignancy.
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Affiliation(s)
- B Diamond
- Feinstein Institute for Medical Research, Manhasset, New York 11030, USA.
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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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Chanson JB, de Seze J, Eliaou JF, Vincent T. Immunological follow-up of patients with neuromyelitis optica: Is there a good biomarker? Lupus 2012; 22:229-32. [DOI: 10.1177/0961203312467669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A serial assessment of biomarkers related to disease activity could be clinically useful in some autoimmune diseases. Neuromyelitis optica (NMO) is a severe inflammatory disease of the optic nerves and spinal cord that can be associated with lupus erythematosus, Sjögren syndrome or myasthenia gravis. In this review, we discuss the existing data on the use of biomarkers of disease activity in NMO. A specific and pathogenic antibody (Ab) directed against aquaporin 4 (AQP4) was recently discovered in this disease. The relapses were frequently accompanied by a rise and immunosuppressive therapy by a decrease in serum anti-AQP4 Ab concentrations. However, this association is not strong enough to justify treatment changes based only on anti-AQP4 Ab level variations. This parameter might be helpful as a longitudinal biomarker but only if a threshold inducing a relapse and justifying a switch in therapy can be established. A link between disease severity and serum cytotoxicity against AQP4-expressing cells was proposed but has not yet been confirmed. Finally, the assessment of T cell immunity against AQP4 and specific cytokines could be future directions for research.
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Affiliation(s)
- J-B Chanson
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, France
- Laboratoire d’Imagerie et de Neurosciences Cognitives (LINC), Université de Strasbourg-CNRS, France
| | - J de Seze
- Département de Neurologie, Hôpitaux Universitaires de Strasbourg, France
- Laboratoire d’Imagerie et de Neurosciences Cognitives (LINC), Université de Strasbourg-CNRS, France
| | - J-F Eliaou
- Département d’Immunologie, Hôpital Saint-Eloi, Centre Hospitalier Universitaire de Montpellier, France
| | - T Vincent
- Département d’Immunologie, Hôpital Saint-Eloi, Centre Hospitalier Universitaire de Montpellier, France
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Where Do AQP4 Antibodies Fit in the Pathogenesis of NMO? Mult Scler Int 2012; 2012:862169. [PMID: 22530129 PMCID: PMC3316941 DOI: 10.1155/2012/862169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/28/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022] Open
Abstract
Recent advances in the field of neuromyelitis optica (NMO) research provided convincing evidence that anti-AQP4 antibody (AQP4-Ab) not only serves as a highly specific disease marker, but also plays an essential role in the pathogenesis of the disease. Although it is now widely recognized that AQP4-Ab induces astrocytic necrosis in a complement-dependent manner, additional triggers are also suspected as a prerequisite for the development of the disease. Unraveling these unresolved aspects of the disease will provide substantial insight into still controversial issues in the pathogenesis of NMO.
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Ekizoglu E, Içoz S, Tuzun E, Birisik O, Kocasoy-Orhan E, Akman-Demir G, Baykan B. Aquaporin-4 antibodies are not present in patients with idiopathic intracranial hypertension. Cephalalgia 2012; 32:198-202. [PMID: 22238356 DOI: 10.1177/0333102411434167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to investigate anti-aquaporin-4 (AQP-4) water channel antibodies, affecting cerebrospinal fluid (CSF) secretion and absorption, in idiopathic intracranial hypertension (IIH) patients. METHODS Patients fulfilling the modified Dandy's diagnostic criteria for IIH were included and their clinical features and CSF findings were reviewed. Their serum samples and control groups were investigated by immunofluorescence and a cell-based assay for anti-AQP-4 antibodies and by immunohistochemistry for IgG binding patterns. RESULTS Twenty-nine patients diagnosed with IIH were investigated. We could not detect any anti-AQP-4 antibodies in our series. However, we identified different serum IgG binding patterns in 11 IIH patients. CONCLUSION There is only one report investigating the anti-AQP4 antibodies in IIH. Our study with a larger sample confirmed the results of this report and indicated that AQP4 antibodies did not have a primary role in IIH pathogenesis, but provided some support for the contribution of inflammatory mechanisms in IIH.
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Affiliation(s)
- Esme Ekizoglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
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Mader S, Gredler V, Schanda K, Rostasy K, Dujmovic I, Pfaller K, Lutterotti A, Jarius S, Di Pauli F, Kuenz B, Ehling R, Hegen H, Deisenhammer F, Aboul-Enein F, Storch MK, Koson P, Drulovic J, Kristoferitsch W, Berger T, Reindl M. Complement activating antibodies to myelin oligodendrocyte glycoprotein in neuromyelitis optica and related disorders. J Neuroinflammation 2011; 8:184. [PMID: 22204662 PMCID: PMC3278385 DOI: 10.1186/1742-2094-8-184] [Citation(s) in RCA: 339] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 12/28/2011] [Indexed: 01/21/2023] Open
Abstract
Background Serum autoantibodies against the water channel aquaporin-4 (AQP4) are important diagnostic biomarkers and pathogenic factors for neuromyelitis optica (NMO). However, AQP4-IgG are absent in 5-40% of all NMO patients and the target of the autoimmune response in these patients is unknown. Since recent studies indicate that autoimmune responses to myelin oligodendrocyte glycoprotein (MOG) can induce an NMO-like disease in experimental animal models, we speculate that MOG might be an autoantigen in AQP4-IgG seronegative NMO. Although high-titer autoantibodies to human native MOG were mainly detected in a subgroup of pediatric acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) patients, their role in NMO and High-risk NMO (HR-NMO; recurrent optic neuritis-rON or longitudinally extensive transverse myelitis-LETM) remains unresolved. Results We analyzed patients with definite NMO (n = 45), HR-NMO (n = 53), ADEM (n = 33), clinically isolated syndromes presenting with myelitis or optic neuritis (CIS, n = 32), MS (n = 71) and controls (n = 101; 24 other neurological diseases-OND, 27 systemic lupus erythematosus-SLE and 50 healthy subjects) for serum IgG to MOG and AQP4. Furthermore, we investigated whether these antibodies can mediate complement dependent cytotoxicity (CDC). AQP4-IgG was found in patients with NMO (n = 43, 96%), HR-NMO (n = 32, 60%) and in one CIS patient (3%), but was absent in ADEM, MS and controls. High-titer MOG-IgG was found in patients with ADEM (n = 14, 42%), NMO (n = 3, 7%), HR-NMO (n = 7, 13%, 5 rON and 2 LETM), CIS (n = 2, 6%), MS (n = 2, 3%) and controls (n = 3, 3%, two SLE and one OND). Two of the three MOG-IgG positive NMO patients and all seven MOG-IgG positive HR-NMO patients were negative for AQP4-IgG. Thus, MOG-IgG were found in both AQP4-IgG seronegative NMO patients and seven of 21 (33%) AQP4-IgG negative HR-NMO patients. Antibodies to MOG and AQP4 were predominantly of the IgG1 subtype, and were able to mediate CDC at high-titer levels. Conclusions We could show for the first time that a subset of AQP4-IgG seronegative patients with NMO and HR-NMO exhibit a MOG-IgG mediated immune response, whereas MOG is not a target antigen in cases with an AQP4-directed humoral immune response.
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Affiliation(s)
- Simone Mader
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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