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Garcia R, Jiménez-Valera M, Ruiz-Buck D, Sanchez C, Rojas A, Schütz MH, Rojas J, Hunfeld KP. Detection of intrathecal IgG antibody for varicella and measles diagnosis by evaluation and comparison of a commercial IgG chemiluminescent immunoassay with two ELISAs. Eur J Clin Microbiol Infect Dis 2024; 43:1139-1148. [PMID: 38613705 DOI: 10.1007/s10096-024-04822-x] [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: 12/27/2023] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Analyse alternative methods of intrathecal antibody detection by comparing chemiluminescent immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA) techniques to determine if CLIA can replace ELISA in the diagnosis of CNS infections. METHODS A panel of 280 paired samples-cerebrospinal fluid (CSF) and serum-with known antibody reactivities (Varicella, n = 60; Measles, n = 120) and negative samples (n = 100) were used to evaluate the performance of six serological test kits (Enzygnost, VirClia®, and Serion ELISA (Measles and Variella). RESULTS For Measles virus IgG, the VirClia® IgG monotest revealed 97% and 94% positive and negative agreement to the Enzygnost as reference test, respectively. In contrast, Serion ELISA kits yielded values of 18% and 90%. For the Varicella Zoster virus (VZV) IgG, the VirClia® IgG monotest showed 97% and 90% positive and negative agreement compared to Enzygnost. The Serion ELISA kits showed values of 55% and 86%, respectively. ROC analysis revealed that the areas under the curve for Measles and VZV IgGs were 0.7 and 0.852, respectively, using the Serion kit, and 0.963 and 0.955, for Vircell S.L CLIA technique. VirClia® monotest values were calculated using an antibody index cut-off of 1.3. CONCLUSION The findings indicate that CLIA testing can improve antibody detection in CSF samples, aiding the diagnosis of infectious neurological impairments.
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Affiliation(s)
- Rafael Garcia
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain.
| | - Maria Jiménez-Valera
- Department of Microbiology, Faculty of Pharmacy, University of Granada, Granada, Spain
| | - Daniel Ruiz-Buck
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Carlos Sanchez
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Almudena Rojas
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Malte Hendrik Schütz
- Institute for Laboratory Medicine, Medical Microbiology and Infection Control, Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Jose Rojas
- Vircell S.L., Parque Tecnológico de la Salud, C/ Avicena, 8, 18016, Granada, Spain
| | - Klaus- Peter Hunfeld
- Institute for Laboratory Medicine, Medical Microbiology and Infection Control, Northwest Medical Centre, Medical Faculty, Academic Teaching Hospital, Goethe-University, Frankfurt am Main, Germany
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Maaloul M, Mejdoub S, Sakka S, Hachicha H, Dammak M, Koubaa F, Mhiri C, Masmoudi H, Feki S. Infrequent patterns in cerebrospinal fluid isofocusing test: Clinical significance and contribution of IgG index and Reiber diagram to their interpretation. Mult Scler Relat Disord 2024; 84:105509. [PMID: 38422634 DOI: 10.1016/j.msard.2024.105509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
Cerebrospinal fluid (CSF) isoelectrofocusing (IEF) is considered as the gold standard for detecting an intrathecal synthesis of IgG, which is a hallmark of multiple sclerosis (MS). This corresponds to the presence of CSF-restricted IgG oligoclonal bands (OCB) (typically type 2 pattern). Moreover, this technique can also detect a systemic immune reaction with passive transfer of IgG (type 3 and 4 patterns) for which the clinical relevance is less understood. The aim of our study was to determine the frequency and disease associations of IEF type 3 and 4 patterns and to investigate the potential usefulness of including quantitative data (IgG index and Reiber Diagram) in interpreting such IEF profiles. Among 544 patients who underwent CSF IEF (Hydragel CSF isofocusing kit, Sebia®, France) in our Laboratory during a six-year-period, those who presented type 3 or 4 patterns were selected. Clinical data and results of other immunological tests were analyzed for 27 patients followed in the Neurological Department. Frequencies of type 3 and type 4 patterns were relatively low (2.3 % and 3.4 % respectively). Among patients with type 3 pattern included in our study (n = 10), 5 were diagnosed with MS. For the 5 other patients, the diagnosis was a clinically isolated syndrome (CIS) (2 cases), a probable auto-immune encephalitis (2 cases) and a possible genetic neurodegenerative disease (1 case). MS patients had an IgG index >0.7 and fell into area 4 of Reiber diagram while non-MS patients had an IgG index <0.7 and fell into area 1, except the last case. Regarding type 4 pattern (n = 17), the diagnoses were as follows: MS (3), CIS (4), Neuromyelitis optica spectrum disorders with positive anti-AQP4 antibodies (3) and anti-NMDAR autoimmune encephalitis (1). The remaining cases had central nervous system impairment related to vascular, metabolic or tumoral etiologies (3) or peripheral nervous system impairment (3). In this group (type 4 pattern), IgG index was <0.7 in 15/17 cases. Interpretation using Reiber diagram showed an abnormal blood-brain barrier for 8/17 patients. Type 3 and 4 IEF patterns are infrequently observed in routine neurology practice. It is important for the diagnostic laboratory professional as well as for the neurologist to understand their clinical relevance. Our findings highlight the contribution of quantitative evaluation of CSF (IgG index, Reiber diagram) for the interpretation of such situations. Despite the small size of our study population, our results emphasize the importance of reporting the exact type of IEF pattern and not only the positivity or not of OCB.
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Affiliation(s)
- Mouna Maaloul
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Sabrina Mejdoub
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia.
| | - Salma Sakka
- Neurology Department, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Hend Hachicha
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Mariem Dammak
- Neurology Department, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Faten Koubaa
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Chokri Mhiri
- Neurology Department, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Hatem Masmoudi
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Sawsan Feki
- Immunology Laboratory, Habib Bourguiba University Hospital, University of Sfax, Tunisia
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Feki S, Naifar M, Dammak M, Majdoub S, Sakka S, Ben AY, Hachicha H, Mhiri C, Ayadi F, Masmoudi H. Vitamin D deficiency in relation with the systemic and central inflammation during multiple sclerosis. J Med Biochem 2023; 42:364-375. [PMID: 37814621 PMCID: PMC10560505 DOI: 10.5937/jomb0-37676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/23/2022] [Indexed: 10/11/2023] Open
Abstract
Background During the last decade, vitamin D (VitD) has become a topic of interest in immune regulation, especially in multiple sclerosis (MS) disease. Amongst the wide range of effects reported for this vitamin on the immune system, a regulatory role on cytokines production has been described. Our aim is to analyze the status of VitD and its correlation with the circulating inflammation and the intrathecal humoral response during MS. Methods We analyzed samples of 318 individuals: 108 MS patients and 210 controls. Determination of 25-(OH) VitD3 level in serum was made using electrochemiluminescence method. Circulating inflammatory cytokines (IL-6, IL-8, IL-10, TNF-a, IL12p70 and IL-1b) were investigated using Cytometer Bead Array Technology. The central humoral response was characterized using CSF isofocusing test and IgG Index calculation. Results As expected, mean value of VitD was significantly lower in MS group (26 nmol/L) than in control group (34.75 nmol/L) (p=0.002), with a severe deficiency in 67% of MS patients. Mean value of VitD was significantly lower in MS female patients. Regarding cytokines, mean value of TNFa was significantly higher in MS patients with oligoclonal bands of IgG in the CSF. IL6 was positively correlated with IgG level in serum of MS patients. Conclusions Our results support the association of VitD deficiency with MS, especially in female patients of our region. However, the vitamin level seems to not correlate with inflammatory cytokines nor with disability. Interestingly, TNFa and IL6 levels were correlated with the intrathecal synthesis of IgG and the circulating IgG level, respectively.
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Affiliation(s)
- Sawsan Feki
- University of Sfax, Habib Bourguiba Hospital, Immunology Laboratory, Sfax, Tunisia
| | - Manel Naifar
- University of Sfax, Habib Bourguiba Hospital, Biochemistry Laboratory, Sfax, Tunisia
| | - Mariem Dammak
- University of Sfax, Habib Bourguiba Hospital, Neurology Department, Sfax, Tunisia
| | - Sabrina Majdoub
- University of Sfax, Habib Bourguiba Hospital, Immunology Laboratory, Sfax, Tunisia
| | - Salma Sakka
- University of Sfax, Habib Bourguiba Hospital, Neurology Department, Sfax, Tunisia
| | - Ali Yesmine Ben
- University of Sfax, Habib Bourguiba Hospital, Immunology Laboratory, Sfax, Tunisia
| | - Hend Hachicha
- University of Sfax, Habib Bourguiba Hospital, Immunology Laboratory, Sfax, Tunisia
| | - Chokri Mhiri
- University of Sfax, Habib Bourguiba Hospital, Neurology Department, Sfax, Tunisia
| | - Fatma Ayadi
- University of Sfax, Habib Bourguiba Hospital, Biochemistry Laboratory, Sfax, Tunisia
| | - Hatem Masmoudi
- University of Sfax, Habib Bourguiba Hospital, Immunology Laboratory, Sfax, Tunisia
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Brauchle F, Rapp D, Senel M, Huss A, Dreyhaupt J, Klose V, Süße M, Stürner KH, Leypoldt F, Tumani H, Lewerenz J. Clinical associations and characteristics of the polyspecific intrathecal immune response in elderly patients with non-multiple sclerosis chronic autoimmune-inflammatory neurological diseases - a retrospective cross-sectional study. Front Neurol 2023; 14:1193015. [PMID: 37396770 PMCID: PMC10311206 DOI: 10.3389/fneur.2023.1193015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction The polyspecific intrathecal immune response (PSIIR), aka MRZ reaction (M = measles, R = rubella, Z = zoster, optionally Herpes simplex virus, HSV) is defined as intrathecal immunoglobulin synthesis (IIS) for two or more unrelated viruses. Although an established cerebrospinal fluid (CSF) biomarker for multiple sclerosis (MS), a chronic autoimmune-inflammatory neurological disease (CAIND) of the central nervous system (CNS) usually starting in young adulthood, the full spectrum of CAINDs with a positive PSIIR remains ill defined. Methods In this retrospective, cross-sectional study, patients with CSF-positive oligoclonal bands (OCB) and - to enrich for non-MS diagnoses - aged ≥50 years were enrolled. Results Of 415 with PSIIR testing results (MRZ, HSV optional), 76 were PSIIR-positive. Of these, 25 (33%) did not meet the diagnostic criteria for MS spectrum diseases (MS-S) comprising clinically or radiologically isolated syndrome (CIS/RIS) or MS. PSIIR-positive non-MS-S phenotypes were heterogenous with CNS, peripheral nerve and motor neuron involvement and often defied unequivocal diagnostic classification. A rating by neuroimmunology experts suggested non-MS CAINDs in 16/25 (64%). Long-term follow-up available in 13 always showed a chronically progressive course. Four of five responded to immunotherapy. Compared to MS-S patients, non-MS CAIND patients showed less frequent CNS regions with demyelination (25% vs. 75%) and quantitative IgG IIS (31% vs. 81%). MRZ-specific IIS did not differ between both groups, while additional HSV-specific IIS was characteristic for non-MS CAIND patients. Discussion In conclusion, PSIIR positivity occurs frequently in non-MS-S patients ≥50 years. Although sometimes apparently coincidental, the PSIIR seems to represent a suitable biomarker for previously unnoticed chronic neurologic autoimmunities, which require further characterization.
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Affiliation(s)
| | - Daniel Rapp
- Department of Neurology, Ulm University, Ulm, Germany
| | - Makbule Senel
- Department of Neurology, Ulm University, Ulm, Germany
| | - André Huss
- Department of Neurology, Ulm University, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Veronika Klose
- German Center for Neurodegenerative Diseases (DNZE), Campus Ulm, Ulm, Germany
| | - Marie Süße
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Klarissa Hanja Stürner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
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Polak J, Wagnerberger JH, Torsetnes SB, Lindeman I, Høglund RAA, Vartdal F, Sollid LM, Lossius A. Single-cell transcriptomics combined with proteomics of intrathecal IgG reveal transcriptional heterogeneity of oligoclonal IgG-secreting cells in multiple sclerosis. Front Cell Neurosci 2023; 17:1189709. [PMID: 37362001 PMCID: PMC10285169 DOI: 10.3389/fncel.2023.1189709] [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: 03/19/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023] Open
Abstract
The phenotypes of B lineage cells that produce oligoclonal IgG in multiple sclerosis have not been unequivocally determined. Here, we utilized single-cell RNA-seq data of intrathecal B lineage cells in combination with mass spectrometry of intrathecally synthesized IgG to identify its cellular source. We found that the intrathecally produced IgG matched a larger fraction of clonally expanded antibody-secreting cells compared to singletons. The IgG was traced back to two clonally related clusters of antibody-secreting cells, one comprising highly proliferating cells, and the other consisting of more differentiated cells expressing genes associated with immunoglobulin synthesis. These findings suggest some degree of heterogeneity among cells that produce oligoclonal IgG in multiple sclerosis.
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Affiliation(s)
- Justyna Polak
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Johanna H. Wagnerberger
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Ida Lindeman
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
| | - Rune A. Aa. Høglund
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Frode Vartdal
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
| | - Ludvig M. Sollid
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Lossius
- K.G. Jebsen Coeliac Disease Research Centre, University of Oslo, Oslo, Norway
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
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6
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Gåsland H, Trier NH, Kyllesbech C, Draborg AH, Slibinskas R, Ciplys E, Frederiksen JL, Houen G. Antibodies to expanded virus antigen panels show elevated diagnostic sensitivities in multiple sclerosis and optic neuritis. Immunol Lett 2023; 254:54-64. [PMID: 36764611 DOI: 10.1016/j.imlet.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
An antigen panel consisting of Epstein-Barr, measles, mumps, varicella zoster and rubella viruses (EMMRZ) was recently presented, which may aid in the diagnosis of multiple sclerosis (MS). The aim of this study was to validate and extend the EMMRZ panel. Various candidates, such as Cytomegalovirus and John Cunningham virus were analysed in relapsing-remitting MS (RRMS) and optic neuritis (ON) samples by enzyme-linked immunosorbent assay. IgG levels were elevated in RRMS samples and correlations were found between serum and cerebrospinal fluid levels. Cohort-dependent optimized panels were obtained for RRMS and ON, which obtained the highest sensitivity when combined with the status of oligoclonal bands.
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Affiliation(s)
- Helena Gåsland
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Nicole H Trier
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Cecilie Kyllesbech
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Anette H Draborg
- Department of Autoimmunology, Statens Serum Institut, Ørestads boulevard 5, 2300 Copenhagen S, Denmark
| | - Rimantas Slibinskas
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, 10257 Vilnius, Lithuania
| | - Evaldas Ciplys
- Institute of Biotechnology, University of Vilnius, Saulėtekio al. 7, 10257 Vilnius, Lithuania
| | - Jette L Frederiksen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark
| | - Gunnar Houen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens vej 13, 2600 Glostrup, Denmark; Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Autoimmunology, Statens Serum Institut, Ørestads boulevard 5, 2300 Copenhagen S, Denmark.
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Intrathecal B cell-related markers for an optimized biological investigation of multiple sclerosis patients. Sci Rep 2022; 12:16425. [PMID: 36180495 PMCID: PMC9525661 DOI: 10.1038/s41598-022-19811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
In multiple sclerosis (MS) disease, the importance of the intrathecal B cell response classically revealed as IgG oligoclonal bands (OCB) in cerebrospinal fluid (CSF) was reaffirmed again in the recently revised diagnostic criteria. We aimed to optimize Laboratory investigation by testing the performance of new B cell-related molecules in CSF (Ig free light chains (FLCκ and λ) and CXCL13 (B-Cell Attracting chemokine1)) for MS diagnosis. 320 paired (CSF-serum) samples were collected from 160 patients with MS (n = 82) and non-MS diseases (n = 78). All patients benefited from IgG index determination, OCB detection, CSF CXCL13 and FLC (κ and λ) measurement in CSF and serum for metrics calculation (κ/λ ratio, FLC-related indexes, and κFLC-intrathecal fraction (IF)). CXCL13 and FLC metrics in CSF were higher in patients with MS and positive OCB. As expected, κFLC metrics—in particular, κFLC index and κFLC IF—had the highest accuracy for MS diagnosis. κ index showed the best performance (sensitivity 83% and specificity 91.7%) at a cut-off of 14.9. Most of the FLC-related parameters were positively correlated with IgG index and the level of CXCL13. In conclusion, the quantitative, standardizable, and technically simple CSF FLCκ metrics seem to be reliable for MS diagnosis, but could not replace OCB detection. CXCL13 appears to be an effective parameter reflecting the intrathecal B cell response. An optimized way for CSF testing combining the conventional and the new B cell-related parameters is proposed in this study.
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8
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Mejdoub S, Feki S, Farhat N, Dammak M, Hachicha H, Sakka S, Ayedi A, Ayedi F, Mhiri C, Masmoudi H. Antinuclear antibodies positivity is not rare during multiple sclerosis and is associated with relapsing status and IgG oligoclonal bands positivity. Rev Neurol (Paris) 2022; 178:812-816. [DOI: 10.1016/j.neurol.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
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Kyllesbech C, Trier N, Slibinskas R, Ciplys E, Tsakiri A, Frederiksen J, Houen G. Virus-specific antibody indices may supplement the total IgG index in diagnostics of multiple sclerosis. J Neuroimmunol 2022; 367:577868. [DOI: 10.1016/j.jneuroim.2022.577868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 12/01/2022]
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Geographic heterogeneity in the association of varicella-zoster virus seropositivity and multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 53:103024. [PMID: 34148006 DOI: 10.1016/j.msard.2021.103024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/09/2021] [Accepted: 05/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although there has long been a suspected association between varicella-zoster virus (VZV) and multiple sclerosis (MS), the connection has remained unclear. In this study, we performed a meta-analysis in an attempt to assess the association between VZV IgG serostatus and MS. METHODS A literature search was performed using three databases: MEDLINE, EMBASE, and Cochrane. Eligible results included observational studies investigating the seroprevalence of VZV immunoglobulin G (IgG) in adults with MS versus non-MS controls. Two authors performed a screen of the search results, evaluating them for quality and relevant outcomes. Using a random-effect model, we estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS The literature search yielded 1,268 articles, 8 of which (2,266 MS patients and 1,818 controls) were eligible for inclusion in the meta-analysis. Evaluation of all included studies together showed no significant association between VZV IgG seropositivity and MS (OR 1.439; 95%CI, 0.503-4.118; p 0.497). However, when analyzed in subgroups based on geographical area, studies performed in Asian countries showed VZV IgG seropositivity was more common in MS patients than in controls (OR 4.470; 95%CI 1.959-10.203; p < 0.001). No significant association was found in European countries. CONCLUSIONS This study found evidence of an association between VZV IgG seropositivity and MS in Asian countries. Additional studies are warranted to ascertain factors impacting this association.
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Current Immunological and Clinical Perspective on Vaccinations in Multiple Sclerosis Patients: Are They Safe after All? Int J Mol Sci 2021; 22:ijms22083859. [PMID: 33917860 PMCID: PMC8068297 DOI: 10.3390/ijms22083859] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
Vaccines work by stimulating the immune system, and their immunogenicity is key in achieving protection against specific pathogens. Questions have been raised whether in Multiple Sclerosis (MS) patients they could induce disease exacerbation and whether vaccines could possibly act as a trigger in the onset of MS in susceptible populations. So far, no correlation has been found between the vaccinations against influenza, hepatitis B, tetanus, human papillomavirus, measles, mumps, rubella, varicella zoster, tuberculosis, yellow fever, or typhoid fever and the risk of MS. Further research is needed for the potential protective implications of the tetanus and Bacillus Calmette-Guerin vaccines in MS patients. Nowadays with the emerging coronavirus disease 2019 (COVID-19) and recent vaccinations approval and arrival, the risk-benefit in MS patients with regards to safety and efficacy of COVID-19 vaccination in those treated with immunosuppressive therapies is of paramount importance. In this manuscript, we demonstrate how different vaccine types could be related to the immunopathogenesis of MS and discuss the risks and benefits of different vaccinations in MS patients.
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12
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The role of antibody indexes in clinical virology. Clin Microbiol Infect 2021; 27:1207-1211. [PMID: 33813108 DOI: 10.1016/j.cmi.2021.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serological techniques are an essential part of the diagnostic tools used in clinical virology. Among these techniques, antibody indexes are not novel, but do require specific expertise. Their niche has expanded substantially in recent years due to increasing evidence of their performance to diagnose viral infections. OBJECTIVES This narrative review describes the background and clinical applications of antibody indexes. The first objective is to provide an overview of the theoretical background, insights for implementation, limitations and pitfalls. The second objective is to review the available evidence for the diagnostic performance, with a specific focus on viral encephalitis and uveitis. SOURCES A comprehensive literature search was performed in PubMed, including original studies and reviews, with no time limit on the studies included. The following search terms were used: antibody index, Goldmann-Witmer coefficient, Reibergram, viral encephalitis, viral uveitis, herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein-Barr virus, rubella virus, measles virus, enterovirus, influenza virus, flaviviruses. CONTENT Antibody indexes can support the diagnosis of a spectrum of viral infections in immune privileged sites such as the central nervous system and the eye, through the demonstration of virus-specific intrathecal or intraocular antibody production. This is especially useful in situations where PCR has a lower positivity rate: infections with rapid viral clearance due to natural immunity or treatment and chronic stages of viral infections. IMPLICATIONS Antibody indexes expand the clinical microbiologist's diagnostic toolbox. Careful interpretation of the results of these assays is crucial and further standardization of methods is required to improve interchangeability of results between laboratories.
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13
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Houen G, Trier NH, Frederiksen JL. Epstein-Barr Virus and Multiple Sclerosis. Front Immunol 2020; 11:587078. [PMID: 33391262 PMCID: PMC7773893 DOI: 10.3389/fimmu.2020.587078] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is a neurologic disease affecting myelinated nerves in the central nervous system (CNS). The disease often debuts as a clinically isolated syndrome, e.g., optic neuritis (ON), which later develops into relapsing-remitting (RR) MS, with temporal attacks or primary progressive (PP) MS. Characteristic features of MS are inflammatory foci in the CNS and intrathecal synthesis of immunoglobulins (Igs), measured as an IgG index, oligoclonal bands (OCBs), or specific antibody indexes. Major predisposing factors for MS are certain tissue types (e.g., HLA DRB1*15:01), vitamin D deficiency, smoking, obesity, and infection with Epstein-Barr virus (EBV). Many of the clinical signs of MS described above can be explained by chronic/recurrent EBV infection and current models of EBV involvement suggest that RRMS may be caused by repeated entry of EBV-transformed B cells to the CNS in connection with attacks, while PPMS may be caused by more chronic activity of EBV-transformed B cells in the CNS. In line with the model of EBV's role in MS, new treatments based on monoclonal antibodies (MAbs) targeting B cells have shown good efficacy in clinical trials both for RRMS and PPMS, while MAbs inhibiting B cell mobilization and entry to the CNS have shown efficacy in RRMS. Thus, these agents, which are now first line therapy in many patients, may be hypothesized to function by counteracting a chronic EBV infection.
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Affiliation(s)
- Gunnar Houen
- Institute of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | | | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Robinson T, Abdelhak A, Bose T, Meinl E, Otto M, Zettl UK, Dersch R, Tumani H, Rauer S, Huss A. Cerebrospinal Fluid Biomarkers in Relation to MRZ Reaction Status in Primary Progressive Multiple Sclerosis. Cells 2020; 9:cells9122543. [PMID: 33255854 PMCID: PMC7761295 DOI: 10.3390/cells9122543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
The MRZ reaction (MRZR) comprises the three antibody indices (AIs) against measles, rubella, and varicella zoster virus, reflecting an intrathecal polyspecific B cell response highly specific for multiple sclerosis (MS). Thus, MRZR can be used to confirm a diagnosis of primary progressive MS (PPMS) but its pathophysiological and wider clinical relevance is unclear. This study aimed to investigate whether PPMS patients with a positive MRZR (MRZR+) differ from those with a negative MRZR (MRZR-) according to cerebrospinal fluid (CSF) biomarkers of B cell activity, neuroaxonal damage or glial activity, and clinical features. (1) Methods: In a multicenter PPMS cohort (n = 81) with known MRZR status, we measured B cell-activating factor (BAFF), chemokine CXC ligand 13 (CXCL-13), soluble B cell maturation antigen (sBCMA), soluble transmembrane activator and CAML interactor (sTACI), and chitinase-3-like protein 1 (CHI3L1) in the CSF with enzyme-linked immunosorbent assays (ELISAs). Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) were detected in serum and CSF using single molecule array (SIMOA) technology. (2) Results: MRZR+ patients (45.7% of all PPMS patients) revealed higher levels of NfL in CSF compared to MRZR- patients (54.3%). There were positive correlations between each of sBCMA, sTACI, and intrathecal immunoglobin G (IgG) synthesis. Additionally, NfL concentrations in serum positively correlated with those in CSF and those of GFAP in serum. However, MRZR+ and MRZR- patients did not differ concerning clinical features (e.g., age, disease duration, Expanded Disability Status Scale (EDSS) at diagnosis and follow-up); CSF routine parameters; CSF concentrations of BAFF, CXCL-13, sBCMA, sTACI, CHI3L1, and GFAP; or serum concentrations of GFAP and NfL. (3) Conclusions: In PPMS patients, MRZR positivity might indicate a more pronounced axonal damage. Higher levels of the soluble B cell receptors BCMA and transmembrane activator and CAML interactor (TACI) in CSF are associated with a stronger intrathecal IgG synthesis in PPMS.
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Affiliation(s)
- Tilman Robinson
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - Ahmed Abdelhak
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
| | - Tanima Bose
- Biomedical Center and Klinikum Grosshadern, Institute of Clinical Neuroimmunology, Ludwig Maximilian University, 81377 Munich, Germany; (T.B.); (E.M.)
| | - Edgar Meinl
- Biomedical Center and Klinikum Grosshadern, Institute of Clinical Neuroimmunology, Ludwig Maximilian University, 81377 Munich, Germany; (T.B.); (E.M.)
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
| | - Uwe K. Zettl
- Neuroimmunological Section, Department of Neurology, Medical Center of the University of Rostock, 18051 Rostock, Germany;
| | - Rick Dersch
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - Hayrettin Tumani
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
- Specialty Hospital Dietenbronn, 88477 Schwendi, Germany
- Correspondence:
| | - Sebastian Rauer
- Clinic of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79085 Freiburg, Germany; (T.R.); (R.D.); (S.R.)
| | - André Huss
- Department of Neurology, University Hospital Ulm, 89081 Ulm, Germany; (A.A.); (M.O.); (A.H.)
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15
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Mejdoub S, Feki S, Dammak M, Farhat N, Hdiji O, Boukthir S, Hachicha H, Mhiri C, Masmoudi H. Neuromyelitis optica spectrum disorders in South of Tunisia: A rare entity with low seroprevalence of anti-aquaporin 4 autoantibodies. Rev Neurol (Paris) 2020; 176:261-267. [DOI: 10.1016/j.neurol.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022]
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16
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Huss A, Mojib-Yezdani F, Bachhuber F, Fangerau T, Lewerenz J, Otto M, Tumani H, Senel M. Association of cerebrospinal fluid kappa free light chains with the intrathecal polyspecific antiviral immune response in multiple sclerosis. Clin Chim Acta 2019; 498:148-153. [PMID: 31437445 DOI: 10.1016/j.cca.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/20/2022]
Abstract
The polyspecific B-lymphocyte response to neurotropic viruses such as measles (M), rubella (R) and varicella zoster (Z), known as MRZ reaction, is to-date the most specific neurochemical marker for multiple sclerosis (MS). The aim of this study was to investigate a possible association of immunoglobulin (Ig) kappa (κ-) and lambda (λ-) free light chains (FLC) with the presence of the MRZ reaction in multiple sclerosis. Immunoglobulin κ- and λ-FLC, MRZ reaction, oligoclonal IgG bands (OCB), and cerebrospinal fluid (CSF) routine parameters were measured in 65 MS patients. OCB were detected in 97% of MS patients, intrathecal IgG synthesis according to Reiber was detectable in 57%, an elevated IgG index (>0.7) in 66% and the MRZR was positive in 45%. All investigated κ-values (CSF κFLC, CSF-serum ratio of κFLCs (QκFLC), and κFLC index (κFLC/QAlbumin)) were significantly higher in patients with positive MRZ reaction as compared to MRZ negative MS patients. In contrast, λ-values showed no significant differences. Additionally to the putative diagnostic sensitivity and prognostic value of κFLC, the association of κFLC with a highly specific neurochemical marker for MS - the MRZ reaction, especially the determination of κFLCs is an informative tool to assess the B-cell response and determine its extent in MS patients.
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Affiliation(s)
- André Huss
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Tanja Fangerau
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany; Specialty Hospital of Neurology Dietenbronn, Schwendi, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany.
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17
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Venhoff N, Thiel J, Rizzi M, Venhoff A, Rauer S, Endres D, Hentze C, Staniek J, Huzly D, Voll RE, Salzer U, Hottenrott T. The MRZ-Reaction and Specific Autoantibody Detection for Differentiation of ANA-Positive Multiple Sclerosis From Rheumatic Diseases With Cerebral Involvement. Front Immunol 2019; 10:514. [PMID: 30941143 PMCID: PMC6433788 DOI: 10.3389/fimmu.2019.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Rheumatic diseases with involvement of the central nervous system (RDwCNS) may mimic multiple sclerosis (MS). Inversely, up to 60% of MS-patients have antinuclear autoantibodies (ANAs) and may be misdiagnosed as RDwCNS. The detection of antibodies against extractable nuclear antigens (ENA) and oligoclonal bands (OCB) are established valuable diagnostic tools in the differential diagnosis of RDwCNS and MS. The MRZ-reaction (MRZR) is defined by three antibody indices (AIs) against neurotropic viruses and is frequently positive in MS. To investigate the added value of MRZR combined with testing for antibodies against ENAs and OCB detection to distinguish RDwCNS from ANA positive MS. Methods: MRZR was evaluated in RDwCNS (n = 40) and 68 ANA positive MS-patients. Two stringency levels, MRZR-1 and MRZR-2 (at least one respectively two of three AIs positive) were applied. Autoantibody testing included ANA plus ENA and anti-dsDNA antibodies, antiphospholipid antibodies, and anti-neutrophil cytoplasmic antibodies. Results: Most of the RDwCNS patients (n = 32; 80%) suffered from systemic lupus erythematosus. Within the RDwCNS group 20% had a positive MRZR-1 and 8.5% a positive MRZR-2 compared to 80.9 and 60%, respectively within the MS-group (p < 0.0001 for both comparisons). Oligoclonal bands were found in 28.6% of the RDwCNS patients and 94.3% of the MS-patients (p < 0.0001). Conversely, autoantibodies to specific nuclear antigens or phospholipids were found more frequently in RDwCNS. A positive MRZR in conjunction with the absence of ENA autoantibodies distinguished MS from RDwCNS with high specificity (97.5%). Conclusions: We suggest combining MRZR, OCBs, and specific autoantibody diagnostics to differentiate RDwCNS from MS.
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Affiliation(s)
- Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ana Venhoff
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Rauer
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Carolin Hentze
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Julian Staniek
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniela Huzly
- Faculty of Medicine, Institute of Virology, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Tilman Hottenrott
- Department of Neurology and Neurophysiology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
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18
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Tomescu-Baciu A, Vartdal F, Holmøy T, Vedeler CA, Lossius A. G1m1 predominance of intrathecal virus-specific antibodies in multiple sclerosis. Ann Clin Transl Neurol 2018; 5:1303-1309. [PMID: 30349866 PMCID: PMC6186941 DOI: 10.1002/acn3.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 12/05/2022] Open
Abstract
We have previously shown that plasmablasts of the G1m1 allotype of IgG1 are selectively enriched in the cerebrospinal fluid of G1m1/G1m3 heterozygous patients with multiple sclerosis, whereas both allotypes are equally used in neuroborreliosis. Here, we demonstrate a strong preference for the G1m1 allotype in the intrathecal humoral immune responses against measles, rubella, and varicella zoster virus in G1m1/G1m3 heterozygous multiple sclerosis patients. Conversely, intrathecally synthesized varicella zoster virus‐specific IgG1 in varicella zoster virus meningoencephalitis comprised both allotypes. This implies that G1m1 B cells are selected to the central nervous system of multiple sclerosis patients regardless of specificity and suggests that an antigen‐independent mechanism could drive the intrathecal humoral immune response.
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Affiliation(s)
- Alina Tomescu-Baciu
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway
| | - Frode Vartdal
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway.,Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Christian A Vedeler
- Department of Clinical Medicine University of Bergen Bergen Norway.,Department of Neurology Haukeland University Hospital Bergen Norway
| | - Andreas Lossius
- Department of Immunology and Transfusion Medicine Faculty of Medicine University of Oslo Oslo University Hospital Rikshospitalet Oslo Norway.,Department of Neurology Akershus University Hospital Lørenskog Norway
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