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Shaygannejad A, Rafiei N, Vaheb S, Yazdan Panah M, Shaygannejad V, Mirmosayyeb O. The Role of Glial Fibrillary Acidic Protein as a Biomarker in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1050. [PMID: 39064479 PMCID: PMC11279275 DOI: 10.3390/medicina60071050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
There is debate on the role of glial fibrillary acidic protein (GFAP) as a reliable biomarker in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), and its potential to reflect disease progression. This review aimed to investigate the role of GFAP in MS and NMOSD. A systematic search of electronic databases, including PubMed, Embase, Scopus, and Web of Sciences, was conducted up to 20 December 2023 to identify studies that measured GFAP levels in people with MS (PwMS) and people with NMOSD (PwNMOSD). R software version 4.3.3. with the random-effect model was used to pool the effect size with its 95% confidence interval (CI). Of 4109 studies, 49 studies met our inclusion criteria encompassing 3491 PwMS, 849 PwNMOSD, and 1046 healthy controls (HCs). The analyses indicated that the cerebrospinal fluid level of GFAP (cGFAP) and serum level of GFAP (sGFAP) were significantly higher in PwMS than HCs (SMD = 0.7, 95% CI: 0.54 to 0.86, p < 0.001, I2 = 29%, and SMD = 0.54, 95% CI: 0.1 to 0.99, p = 0.02, I2 = 90%, respectively). The sGFAP was significantly higher in PwNMOSD than in HCs (SMD = 0.9, 95% CI: 0.73 to 1.07, p < 0.001, I2 = 10%). Among PwMS, the Expanded Disability Status Scale (EDSS) exhibited significant correlations with cGFAP (r = 0.43, 95% CI: 0.26 to 0.59, p < 0.001, I2 = 91%) and sGFAP (r = 0.36, 95% CI: 0.23 to 0.49, p < 0.001, I2 = 78%). Regarding that GFAP is increased in MS and NMOSD and has correlations with disease features, it can be a potential biomarker in MS and NMOSD and indicate the disease progression and disability in these disorders.
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Affiliation(s)
- Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
| | - Nazanin Rafiei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran;
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
| | - Mohammad Yazdan Panah
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord 88157-13471, Iran;
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.S.); (S.V.); (V.S.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
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Chatanaka MK, Avery LM, Pasic MD, Sithravadivel S, Rotstein D, Demos C, Cohen R, Gorham T, Wang M, Stengelin M, Mathew A, Sigal G, Wohlstadter J, Prassas I, Diamandis EP. The relationship between serum astroglial and neuronal markers and AQP4 and MOG autoantibodies. Clin Proteomics 2024; 21:28. [PMID: 38580905 PMCID: PMC10998414 DOI: 10.1186/s12014-024-09466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/14/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Certain demyelinating disorders, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) exhibit serum autoantibodies against aquaporin-4 (αAQP4) and myelin oligodendrocyte glycoprotein (αMOG). The variability of the autoantibody presentation warrants further research into subtyping each case. METHODS To elucidate the relationship between astroglial and neuronal protein concentrations in the peripheral circulation with occurrence of these autoantibodies, 86 serum samples were analyzed using immunoassays. The protein concentration of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL) and tau protein was measured in 3 groups of subcategories of suspected NMOSD: αAQP4 positive (n = 20), αMOG positive (n = 32) and αMOG/αAQP4 seronegative (n = 34). Kruskal-Wallis analysis, univariate predictor analysis, and multivariate logistic regression with ROC curves were performed. RESULTS GFAP and NFL concentrations were significantly elevated in the αAQP4 positive group (p = 0.003; p = 0.042, respectively), and tau was elevated in the αMOG/αAQP4 seronegative group (p < 0.001). A logistic regression model to classify serostatus was able to separate αAQP4 seropositivity using GFAP + tau, and αMOG seropositivity using tau. The areas under the ROC curves (AUCs) were 0.77 and 0.72, respectively. Finally, a combined seropositivity versus negative status logistic regression model was generated, with AUC = 0.80. CONCLUSION The 3 markers can univariately and multivariately classify with moderate accuracy the samples with seropositivity and seronegativity for αAQP4 and αMOG.
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Affiliation(s)
- Miyo K Chatanaka
- Department of Laboratory and Medicine Pathobiology, University of Toronto, 60 Murray St. Box 32, Floor 6, Rm L6-201, Toronto, ON, M5T 3L9, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Lisa M Avery
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Biostatistics, The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Maria D Pasic
- Department of Laboratory and Medicine Pathobiology, University of Toronto, 60 Murray St. Box 32, Floor 6, Rm L6-201, Toronto, ON, M5T 3L9, Canada
- Department of Laboratory Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada
| | - Shanthan Sithravadivel
- Department of Laboratory Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada
| | | | | | | | | | | | | | - Anu Mathew
- Meso Scale Diagnostics, LLC, Rockville, MD, USA
| | | | | | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Eleftherios P Diamandis
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
- Lunenfeld- Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
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Chatanaka MK, Avery LM, Pasic MD, Sithravadivel S, Rotstein D, Demos C, Cohen R, Gorham T, Wang M, Stengelin M, Mathew A, Wohlstadter J, Prassas I, Diamandis EP. The relationship between serum astroglial and neuronal markers and AQP4 and MOG autoantibodies. RESEARCH SQUARE 2023:rs.3.rs-3659922. [PMID: 38077014 PMCID: PMC10705596 DOI: 10.21203/rs.3.rs-3659922/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background Certain demyelinating disorders, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) exhibit serum autoantibodies against aquaporin-4 (αAQP4) and myelin oligodendrocyte glycoprotein (αMOG). The variability of the autoantibody presentation warrants further research into subtyping each case. Methods To elucidate the relationship between astroglial and neuronal protein concentrations in the peripheral circulation with occurrence of these autoantibodies, 86 serum samples were analyzed using immunoassays. The protein concentration of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL) and tau protein was measured in 3 groups of subcategories of suspected NMOSD: αAQP4 positive (n = 20), αMOG positive (n = 32) and αMOG/αAQP4 seronegative (n = 34). Kruskal-Wallis analysis, univariate predictor analysis, and multivariate logistic regression with ROC curves were performed. Results GFAP and NFL concentrations were significantly elevated in the αAQP4 positive group (p = 0.003; p = 0.042, respectively), and tau was elevated in the αMOG/αAQP4 seronegative group (p < 0.001). A logistic regression model to classify serostatus was able to separate αAQP4 seropositivity using GFAP + tau, and αMOG seropositivity using tau. The areas under the ROC curves (AUCs) were 0.77 and 0.72, respectively. Finally, a combined seropositivity versus negative status logistic regression model was generated, with AUC = 0.80. Conclusion The 3 markers can univariately and multivariately classify with moderate accuracy the samples with seropositivity and seronegativity for αAQP4 and αMOG.
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Maroto-García J, Martínez-Escribano A, Delgado-Gil V, Mañez M, Mugueta C, Varo N, García de la Torre Á, Ruiz-Galdón M. Biochemical biomarkers for multiple sclerosis. Clin Chim Acta 2023; 548:117471. [PMID: 37419300 DOI: 10.1016/j.cca.2023.117471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system. Although there is currently no definite cure for MS, new therapies have recently been developed based on a continuous search for new biomarkers. DEVELOPMENT MS diagnosis relies on the integration of clinical, imaging and laboratory findings as there is still no singlepathognomonicclinical feature or diagnostic laboratory biomarker. The most commonly laboratory test used is the presence of immunoglobulin G oligoclonal bands (OCB) in cerebrospinal fluid of MS patients. This test is now included in the 2017 McDonald criteria as a biomarker of dissemination in time. Nevertheless, there are other biomarkers currently in use such as kappa free light chain, which has shown higher sensitivity and specificity for MS diagnosis than OCB. In addition, other potential laboratory tests involved in neuronal damage, demyelination and/or inflammation could be used for detecting MS. CONCLUSIONS CSF and serum biomarkers have been reviewed for their use in MS diagnosis and prognosis to stablish an accurate and prompt MS diagnosis, crucial to implement an adequate treatment and to optimize clinical outcomes over time.
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Affiliation(s)
- Julia Maroto-García
- Biochemistry Department, Clínica Universidad de Navarra, Spain; Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Malaga, Spain.
| | - Ana Martínez-Escribano
- Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Malaga, Spain; Laboratory Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Virginia Delgado-Gil
- Neurology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Minerva Mañez
- Neurology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Carmen Mugueta
- Biochemistry Department, Clínica Universidad de Navarra, Spain
| | - Nerea Varo
- Biochemistry Department, Clínica Universidad de Navarra, Spain
| | - Ángela García de la Torre
- Clinical Analysis Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain; The Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Maximiliano Ruiz-Galdón
- Department of Biochemistry and Molecular Biology. Faculty of Medicine. University of Malaga, Spain; Clinical Analysis Service, Hospital Universitario Virgen de la Victoria, Malaga, Spain; The Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Kim HJ, Lee EJ, Kim SY, Kim H, Kim KW, Kim S, Kim H, Seo D, Lee BJ, Lim HT, Kim KK, Lim YM. Serum proteins for monitoring and predicting visual function in patients with recent optic neuritis. Sci Rep 2023; 13:5609. [PMID: 37019946 PMCID: PMC10076295 DOI: 10.1038/s41598-023-32748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
It is unclear whether serum proteins can serve as biomarkers to reflect pathological changes and predict recovery in inflammation of optic nerve. We evaluated whether serum proteins could monitor and prognosticate optic neuritis (ON). We prospectively recruited consecutive patients with recent ON, classified as ON with anti-aquaporin-4 antibody (AQP4-ON), ON with anti-myelin oligodendrocyte glycoprotein antibody (MOG-ON), and double-seronegative ON (DSN-ON). Using ultrasensitive single-molecule array assays, we measured serum neurofilament light chain and glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF). We analyzed the markers according to disease group, state, severity, and prognosis. We enrolled 60 patients with recent ON (15 AQP4-ON; 14 MOG-ON; 31 DSN-ON). At baseline, AQP4-ON group had significantly higher serum GFAP levels than did other groups. In AQP4-ON group, serum GFAP levels were significantly higher in the attack state than in the remission state and correlated with poor visual acuity. As a prognostic indicator, serum BDNF levels were positively correlated with follow-up visual function in the AQP4-ON group (r = 0.726, p = 0.027). Serum GFAP reflected disease status and severity, while serum BDNF was identified as a prognostic biomarker in AQP4-ON. Serum biomarkers are potentially helpful for patients with ON, particularly those with AQP4-ON.
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Affiliation(s)
- Hyo Jae 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, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Meidcal Center, Seoul, South Korea.
| | - Sang-Yeob Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seungmi Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunji Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, 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
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Fazeli B, Huss A, Gómez de San José N, Otto M, Tumani H, Halbgebauer S. Development of an ultrasensitive microfluidic assay for the analysis of Glial fibrillary acidic protein (GFAP) in blood. Front Mol Biosci 2023; 10:1175230. [PMID: 37168256 PMCID: PMC10164994 DOI: 10.3389/fmolb.2023.1175230] [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: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction: A rapid and reliable detection of glial fibrillary acidic protein (GFAP) in biological samples could assist in the diagnostic evaluation of neurodegenerative disorders. Sensitive assays applicable in the routine setting are needed to validate the existing GFAP tests. This study aimed to develop a highly sensitive and clinically applicable microfluidic immunoassay for the measurement of GFAP in blood. Methods: A microfluidic GFAP assay was developed and validated regarding its performance. Subsequently, serum and cerebrospinal fluid (CSF) of Alzheimer's disease (AD), Multiple Sclerosis (MS) and control patients were analyzed with the established assay, and levels were compared to the commercial GFAP Simoa discovery kit. Results: The developed GFAP assay showed a good performance with a recovery of 85% of spiked GFAP in serum and assay variations below 15%. The established assay was highly sensitive with a calculated lower limit of quantification and detection of 7.21 pg/mL and 2.37 pg/mL, respectively. GFAP levels were significantly increased in AD compared to control patients with advanced age (p = 0.002). However, GFAP levels revealed no significant increase in MS compared to control patients in the same age range (p = 0.140). Furthermore, serum GFAP levels evaluated with the novel microfluidic assay strongly correlated with Simoa concentrations (r = 0.88 (95% CI: 0.81-0.93), p < 0.0001). Conclusion: We successfully developed a sensitive and easy-to-use microfluidic assay to measure GFAP in blood. Furthermore, we could confirm previous findings of elevated GFAP levels in AD by applying the assay in a cohort of clinically characterized patients.
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Affiliation(s)
- Badrieh Fazeli
- Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - André Huss
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
| | | | - Markus Otto
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
| | - Steffen Halbgebauer
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
- *Correspondence: Steffen Halbgebauer,
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Schindler P, Aktas O, Ringelstein M, Wildemann B, Jarius S, Paul F, Ruprecht K. Glial fibrillary acidic protein as a biomarker in neuromyelitis optica spectrum disorder: a current review. Expert Rev Clin Immunol 2023; 19:71-91. [PMID: 36378751 DOI: 10.1080/1744666x.2023.2148657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, often debilitating neuroinflammatory disease, whose predominant clinical manifestations are longitudinally extensive transverse myelitis and optic neuritis. About 80% of the patients with an NMOSD phenotype have pathogenic autoantibodies against the astrocyte water channel aquaporin-4 (AQP4-IgG). While therapeutic options for NMOSD have greatly expanded in recent years, well-established biomarkers for prognosis or treatment response are still lacking. Glial fibrillary acidic protein (GFAP) is mainly expressed in astrocytes and can be detected in cerebrospinal fluid (CSF) and blood of patients with NMOSD. AREAS COVERED Here, we comprehensively review the current knowledge on GFAP as a biomarker in NMOSD. EXPERT OPINION In patients with AQP4-IgG+ NMOSD, GFAP levels are elevated in CSF and serum during acute attacks and correlate with disability, consistent with the pathophysiology of this antibody-mediated astrocytopathy. Serum GFAP levels tend to be higher in AQP4-IgG+ NMOSD than in its differential diagnoses, multiple sclerosis, and myelin oligodendrocyte antibody-associated disease. Importantly, serum GFAP levels in AQP4-IgG+ NMOSD during remission may be predictive of future disease activity. Serial serum GFAP measurements are emerging as a biomarker to monitor disease activity in AQP4-IgG+ NMOSD and could have the potential for application in clinical practice.
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Affiliation(s)
- Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, Andris C, Asgari N, Barnett Y, Battistella R, Behbehani R, Berger T, Bikbov MM, Biotti D, Biousse V, Boschi A, Brazdil M, Brezhnev A, Calabresi PA, Cordonnier M, Costello F, Cruz FM, Cunha LP, Daoudi S, Deschamps R, de Seze J, Diem R, Etemadifar M, Flores-Rivera J, Fonseca P, Frederiksen J, Frohman E, Frohman T, Tilikete CF, Fujihara K, Gálvez A, Gouider R, Gracia F, Grigoriadis N, Guajardo JM, Habek M, Hawlina M, Martínez-Lapiscina EH, Hooker J, Hor JY, Howlett W, Huang-Link Y, Idrissova Z, Illes Z, Jancic J, Jindahra P, Karussis D, Kerty E, Kim HJ, Lagrèze W, Leocani L, Levin N, Liskova P, Liu Y, Maiga Y, Marignier R, McGuigan C, Meira D, Merle H, Monteiro MLR, Moodley A, Moura F, Muñoz S, Mustafa S, Nakashima I, Noval S, Oehninger C, Ogun O, Omoti A, Pandit L, Paul F, Rebolleda G, Reddel S, Rejdak K, Rejdak R, Rodriguez-Morales AJ, Rougier MB, Sa MJ, Sanchez-Dalmau B, Saylor D, Shatriah I, Siva A, Stiebel-Kalish H, Szatmary G, Ta L, Tenembaum S, Tran H, Trufanov Y, van Pesch V, Wang AG, Wattjes MP, Willoughby E, Zakaria M, Zvornicanin J, Balcer L, Plant GT. Diagnosis and classification of optic neuritis. Lancet Neurol 2022; 21:1120-1134. [PMID: 36179757 DOI: 10.1016/s1474-4422(22)00200-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.
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Serum glial fibrillary acidic protein is a body fluid biomarker: A valuable prognostic for neurological disease – A systematic review. Int Immunopharmacol 2022; 107:108624. [DOI: 10.1016/j.intimp.2022.108624] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/14/2022]
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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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Blood GFAP as an emerging biomarker in brain and spinal cord disorders. Nat Rev Neurol 2022; 18:158-172. [PMID: 35115728 DOI: 10.1038/s41582-021-00616-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
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Neuroinflammation Is Associated with GFAP and sTREM2 Levels in Multiple Sclerosis. Biomolecules 2022; 12:biom12020222. [PMID: 35204724 PMCID: PMC8961656 DOI: 10.3390/biom12020222] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Astrocytes and microglia play an important role in the inflammatory process of multiple sclerosis (MS). We investigated the associations between the cerebrospinal fluid (CSF) levels of glial fibrillary acid protein (GFAP) and soluble triggering receptors expressed on myeloid cells-2 (sTREM-2), inflammatory molecules, and clinical characteristics in a group of patients with relapsing-remitting MS (RRMS). Methods: Fifty-one RRMS patients participated in the study. Clinical evaluation and CSF collection were performed at the time of diagnosis. The CSF levels of GFAP, sTREM-2, and of a large set of inflammatory and anti-inflammatory molecules were determined. MRI structural measures (cortical thickness, T2 lesion load, cerebellar volume) were examined. Results: The CSF levels of GFAP and sTREM-2 showed significant correlations with inflammatory cytokines IL-8, G-CSF, and IL-5. Both GFAP and sTREM-2 CSF levels positively correlated with age at diagnosis. GFAP was also higher in male MS patients, and was associated with an increased risk of MS progression, as evidenced by higher BREMS at the onset. Finally, a negative association was found between GFAP CSF levels and cerebellar volume in RRMS at diagnosis. Conclusions: GFAP and sTREM-2 represent suitable biomarkers of central inflammation in MS. Our results suggest that enhanced CSF expression of GFAP may characterize patients with a higher risk of progression.
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Sun M, Liu N, Xie Q, Li X, Sun J, Wang H, Wang M. A candidate biomarker of glial fibrillary acidic protein in CSF and blood in differentiating multiple sclerosis and its subtypes: A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 51:102870. [PMID: 33819724 DOI: 10.1016/j.msard.2021.102870] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/20/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) is an inflammatory demyelinating autoimmune disease of the central nervous system. Glial fibrillary acidic protein (GFAP) is a monomeric intermediate filament protein. A systematic review and meta-analysis was performed regarding a candidate biomarker for astrocytic damage of cerebrospinal fluid (CSF) and blood GFAP levels in differentiating multiple sclerosis and its subtypes. METHODS Relevant studies published prior to October 2020 were retrieved from the PubMed, Web of Science, Cochrane Library and clinicaltrials.gov databases using the following keywords: 'Multiple sclerosis' or 'MS' and 'Glial Fibrillary Acidic Protein' or 'GFAP'. Two authors independently selected the articles and extracted the data. Of the 31 full articles screened, 11 were included in the qualitative analysis and meta-analysis. Differences in the mean CSF and blood GFAP levels were used as the main efficacy measures, and the meta-analysis was performed using Review Manager version 5.3 software. RESULTS Eleven clinical trials comprising 960 patients were selected. CSF GFAP levels were higher in 503 MS patients than in 252 (healthy and disease) controls, with a moderate effect size of 0.72 (p < 0.00001). Mean CSF GFAP levels were significantly higher in 325 MS patients with relapsing disease than in 140 MS patients with progressive disease (SMD=-0.47; 95% CI=-0.80 to -0.15; P = 0.005). CSF GFAP levels in 161 MS patients in relapse (irrespective of MS subtype) were significantly higher than those in 180 MS patients in remission (MD=103.83; 95% CI=68.09 to139.57; P<0.001). The performances of GFAP in blood for differentiating patients with MS from controls were also significant. Blood GFAP was higher in 245 MS patients than in 53 (healthy and disease) controls, with a moderate effect size of 37.25 (p < 0.00001). CONCLUSION The level of CSF-GFAP is correlated with MS and its different subtypes, reflecting the different degrees of damage to astrocytes in different subtypes of MS. In addition, progressive MS is more closely related to the increase in cerebrospinal fluid GFAP level than relapsing-remitting MS, and GFAP may be a useful marker of disease progression. Moreover, the GFAP level in the blood of MS patients is higher than that in the control group, and the sample size needs to be further expanded for verification in the future..
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Affiliation(s)
- MengJiao Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China.
| | - Ning Liu
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - QinFang Xie
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Xiaoling Li
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Jing Sun
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - Hongxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China
| | - ManXia Wang
- Department of Neurology, Lanzhou University Second Hospital, Cuiyingmen 82, Chengguan District, Lanzhou 730030, Gansu, China.
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Sharquie IK, Gawwam GA, Abdullah SF. Serum Glial Fibrillary Acidic Protein: A Surrogate Marker of the Activity of Multiple Sclerosis. Medeni Med J 2020; 35:212-218. [PMID: 33110673 PMCID: PMC7584269 DOI: 10.5222/mmj.2020.48265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/12/2020] [Indexed: 11/08/2022] Open
Abstract
Objective Multiple sclerosis (MS) is a neurodegenerative disorder with various clinical types. Glial fibrillary acidic protein (GFAP) is significantly elevated in the cerebrospinal fluid (CSF) of MS patients compared with that of healthy controls. The aim of this study is to evaluate serum levels of GFAP in relation to disease activity in relapsing-remitting MS patients and to compare them with those of healthy controls. Method This study involved 58 MS patients of relapsing-remitting MS (RRMS) type, 22 in an active stage of the disease and 36 in remission, and 50 healthy individuals as age- and sex-matched controls. Blood samples were taken from the patients at the MS Clinic of the Baghdad Teaching Hospital, and the serum levels of GFAP were determined using the enzyme-linked immunosorbent assay (ELISA) technique. Results Mean GFAP serum levels in 22 patients presenting in the active state of the disease (6.47±3.39 ng/ml) and 36 cases in remission were (5.33±2.82 ng/ml) (p=0.074) were determined as indicated. When RRMS patients (n=58) were compared with the healthy controls (n=50, 1.89±1.21), the difference in serum levels of GFAP was statistically significant (p<0.001). The area under the curve of the serum measures of GFAP obtained through the receiver operating characteristics was 0.903, which was also statistically significant (p<0.001). Conclusion GFAP biomarker is an indicator of disease activity in RRMS patients, and its serum level may correlate with the state of remission or exacerbation.
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Affiliation(s)
- Inas K Sharquie
- University of Baghdad, College of Medicine, Department of Microbiology & Immunology, Baghdad, Iraq
| | - Gheyath Al Gawwam
- University of Baghdad, College of Medicine, Baghdad Teaching Hospital, Department of Neurology, Baghdad, Iraq
| | - Shatha F Abdullah
- University of Baghdad, College of Medicine, Department of Microbiology & Immunology, Baghdad, Iraq
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Thoman ME, McKarns SC. Metabolomic Profiling in Neuromyelitis Optica Spectrum Disorder Biomarker Discovery. Metabolites 2020; 10:metabo10090374. [PMID: 32961928 PMCID: PMC7570337 DOI: 10.3390/metabo10090374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/21/2022] Open
Abstract
There is no specific test for diagnosing neuromyelitis optica spectrum disorder (NMOSD), a disabling autoimmune disease of the central nervous system. Instead, diagnosis relies on ruling out other related disorders with overlapping clinical symptoms. An urgency for NMOSD biomarker discovery is underscored by adverse responses to treatment following misdiagnosis and poor prognosis following the delayed onset of treatment. Pathogenic autoantibiotics that target the water channel aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) contribute to NMOSD pathology. The importance of early diagnosis between AQP4-Ab+ NMOSD, MOG-Ab+ NMOSD, AQP4-Ab− MOG-Ab− NMOSD, and related disorders cannot be overemphasized. Here, we provide a comprehensive data collection and analysis of the currently known metabolomic perturbations and related proteomic outcomes of NMOSD. We highlight short chain fatty acids, lipoproteins, amino acids, and lactate as candidate diagnostic biomarkers. Although the application of metabolomic profiling to individual NMOSD patient care shows promise, more research is needed.
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Affiliation(s)
- Maxton E. Thoman
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Laboratory of TGF-β Biology, Epigenetics, and Cytokine Regulation, Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Susan C. McKarns
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Laboratory of TGF-β Biology, Epigenetics, and Cytokine Regulation, Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Department of Microbiology and Immunology, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Correspondence:
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Watanabe M, Nakamura Y, Michalak Z, Isobe N, Barro C, Leppert D, Matsushita T, Hayashi F, Yamasaki R, Kuhle J, Kira JI. Serum GFAP and neurofilament light as biomarkers of disease activity and disability in NMOSD. Neurology 2019; 93:e1299-e1311. [DOI: 10.1212/wnl.0000000000008160] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/02/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo test the hypothesis that serum levels of glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL), which are an intermediate astrocyte and neuron filaments, respectively, are clinically useful biomarkers of disease activity and disability in neuromyelitis optica spectrum disorders (NMOSD).MethodsLevels of GFAP and NfL in serum (sGFAP and sNfL, respectively) and in CSF samples were measured in healthy controls (HCs) (n = 49; 49 serum samples), patients with NMOSD (n = 33; 42 CSF and 102 serum samples), and patients with multiple sclerosis (MS) (n = 49; 53 CSF and 91 serum samples) by ultrasensitive single-molecule array assays. Association of sGFAP and sNfL levels with clinical parameters was determined.ResultsFor both GFAP and NfL, CSF and serum levels were strongly correlated. Both were higher in the serum of patients with NMOSD than in HCs (both p < 0.001). Moreover, sGFAP was higher in NMOSD than in MS (median 207.7 vs 121.1 pg/mL, p < 0.001). In NMOSD, sGFAP concentration increased after recent relapse (540.9 vs 152.9 pg/mL, p < 0.001). Multivariate analyses indicated that sGFAP and sNfL were associated with Expanded Disability Status Scale score in NMOSD (p = 0.026 and p < 0.001, respectively). Higher sGFAP/sNfL quotient at relapse differentiated NMOSD from MS with a sensitivity of 73.0% and a specificity of 75.8%.ConclusionssGFAP and sNfL are likely to be good biomarkers of disease activity and disability, and the sGFAP/sNfL quotient at relapse is a potential diagnostic marker for NMOSD.
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Barro C, Leocani L, Leppert D, Comi G, Kappos L, Kuhle J. Fluid biomarker and electrophysiological outcome measures for progressive MS trials. Mult Scler 2017; 23:1600-1613. [DOI: 10.1177/1352458517732844] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Progressive multiple sclerosis (MS) is characterized by insidious clinical worsening that is difficult to accurately quantify and predict. Biofluid markers and electrophysiological measures are potential candidate outcome measures in clinical trials, allowing the quantification of nervous damage occurring in the disease. Neurofilaments are highly specific neuronal proteins. They may have come closest to such applications by their higher concentrations repeatedly demonstrated in cerebrospinal fluid (CSF) in all stages of MS, during relapses, their responsiveness to disease-modifying treatments in relapsing and progressive MS and their associations with measures of inflammatory and degenerative magnetic resonance imaging (MRI) outcomes. Digital single-molecule array (Simoa) technology improves accuracy of bioassays in the quantification of neurofilament light chain (NfL) in serum and plasma. NfL seems to mark a common final path of neuroaxonal injury independent of specific causal pathways. CSF and blood levels of NfL are highly correlated across various diseases including MS, suggesting that blood measurements may be useful in assessing response to treatment and predicting future disease activity. Other biomarkers like matrix metalloproteinases, chemokines, or neurotrophic factors have not been studied to a similar extent. Such measures, especially in blood, need further validation to enter the trial arena or clinical practice. The broadening armamentarium of highly sensitive assay technologies in the future may shed even more light on patient heterogeneity and mechanisms leading to disability in MS. Evoked potentials (EPs) are used in clinical practice to measure central conduction of central sensorimotor pathways. They correlate with and predict the severity of clinical involvement of their corresponding function. Their validation for use in multicenter studies is still lacking, with the exception of visual EPs. If further validated, EPs and fluid biomarkers would represent useful outcome measures for clinical trials, being related to specific mechanisms of the ongoing pathologic changes.
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Affiliation(s)
- Christian Barro
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Letizia Leocani
- Department of Neurology and Institute of Experimental Neurology (INSPE), San Raffaele Hospital, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - David Leppert
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland/Novartis Pharma AG, Basel, Switzerland
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology (INSPE), San Raffaele Hospital, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland
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Kassubek R, Gorges M, Schocke M, Hagenston VAM, Huss A, Ludolph AC, Kassubek J, Tumani H. GFAP in early multiple sclerosis: A biomarker for inflammation. Neurosci Lett 2017; 657:166-170. [PMID: 28802830 DOI: 10.1016/j.neulet.2017.07.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/17/2017] [Accepted: 07/27/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The role of Glial Fibrillic Acidic Protein (GFAP) as a potential biomarker for relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS) has been controversially discussed. The aim was to characterize the added value of GFAP levels in the CSF of RRMS and CIS patients in correlation with MRI lesion load. MATERIALS & METHODS GFAP levels in the CSF from 18 patients with RRMS, 8 patients with CIS and 35 controls were analyzed together with MRI data for acute and chronic inflammatory lesion load. RESULTS GFAP levels of patients vs. controls were higher (p=0.005), while there was no difference between GFAP levels in RRMS and CIS. There was no correlation between the number of supra- or infratentorial gadolinium enhancing lesions and GFAP levels, while there was a correlation between GFAP levels with infratentorial chronic inflammatory lesion load (p=0.0035). Most importantly, a highly significant correlation could be observed between GFAP levels and the intensity of gadolinium-enhancement as a parameter for the acute activity of inflammatory processes (p=0.0002). CONCLUSIONS GFAP seems to be a useful biomarker for highly active acute inflammation in patients with RRMS as well as with CIS.
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Affiliation(s)
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Michael Schocke
- Department of Radiology and Neuroradiology, University and Rehabilitation Hospital Ulm, Ulm, Germany
| | | | - André Huss
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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What's new in neuromyelitis optica? A short review for the clinical neurologist. J Neurol 2017; 264:2330-2344. [PMID: 28289845 DOI: 10.1007/s00415-017-8445-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/27/2017] [Indexed: 02/06/2023]
Abstract
The evolution of neuromyelitis optica spectrum disorder (NMOSD) from a rare, incurable and misunderstood disease with almost universally poor outcomes to its present state in just over a decade is unprecedented in neurology and possibly in medicine. Our knowledge of NMOSD biology has led to the recognition of wider phenotypes, new disease mechanisms, and thus clinical trials of new and effective treatments. This article aims to update readers on the recent developments in NMOSD with particular emphasis on clinical advances, the 2015 diagnostic criteria, biomarkers, imaging, and therapeutic interventions.
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20
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Petzold A. Glial fibrillary acidic protein is a body fluid biomarker for glial pathology in human disease. Brain Res 2015; 1600:17-31. [DOI: 10.1016/j.brainres.2014.12.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022]
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21
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Petzold A, Plant GT. Diagnosis and classification of autoimmune optic neuropathy. Autoimmun Rev 2014; 13:539-45. [DOI: 10.1016/j.autrev.2014.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
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Sato DK, Lana-Peixoto MA, Fujihara K, de Seze J. Clinical Spectrum and Treatment of Neuromyelitis Optica Spectrum Disorders: Evolution and Current Status. Brain Pathol 2013; 23:647-60. [DOI: 10.1111/bpa.12087] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Jerome de Seze
- Department of Neurology; Strasbourg University and Clinical Investigation Center; Strasbourg Hospital; Strasbourg; France
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Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported. J Neurol 2013; 261:17-26. [PMID: 23700317 DOI: 10.1007/s00415-013-6957-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/03/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
Chronic relapsing inflammatory optic neuropathy (CRION) is an entity that was described in 2003. Early recognition of patients suffering from CRION is relevant because of the associated risk for blindness if treated inappropriately. It seems timely to have a clinical review on this recently defined entity. A systematic literature review, irrespective of language, retrieved 22 case series and single reports describing 122 patients with CRION between 2003 and 2013. We review the epidemiology, diagnostic workup, differential diagnosis, and treatment (acute, intermediate, and long term) in view of the collective data. These data suggest that CRION is a distinct nosological entity, which is seronegative for anti-aquaporin four auto-antibodies and recognized by and managed through its dependency on immuno-suppression. Revised diagnostic criteria are proposed in light of the data compromising a critical discussion of relevant limitations.
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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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Fujihara K, Misu T, Nakashima I, Takahashi T, Bradl M, Lassmann H, Takano R, Nishiyama S, Takai Y, Suzuki C, Sato D, Kuroda H, Nakamura M, Fujimori J, Narikawa K, Sato S, Itoyama Y, Aoki M. Neuromyelitis optica should be classified as an astrocytopathic disease rather than a demyelinating disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1759-1961.2012.00030.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Ichiro Nakashima
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | | | - Monika Bradl
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Hans Lassmann
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Rina Takano
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Shuhei Nishiyama
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Yoshiki Takai
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Chihiro Suzuki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Douglas Sato
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Hiroshi Kuroda
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Masashi Nakamura
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Juichi Fujimori
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Koichi Narikawa
- Department of Neurology; National Hospital Organization Sendai Medical Center; Sendai; Japan
| | - Shigeru Sato
- Department of Neurology; Kohnan Hospital; Sendai; Japan
| | - Yasuto Itoyama
- National Center Hosptial; National Center of Neurology and Psychiatry; Tokyo; Japan
| | - Masashi Aoki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
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