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Yin HX, Wang YJ, Liu MG, Zhang DD, Ren HT, Mao ZF, Zhang Y, Peng B, Cui LY, Xu Y. Aquaporin-4 Antibody Dynamics and Relapse Risk in Seropositive Neuromyelitis Optica Spectrum Disorder Treated with Immunosuppressants. Ann Neurol 2023; 93:1069-1081. [PMID: 36843248 DOI: 10.1002/ana.26623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To investigate aquaporin-4 antibody (AQP4-IgG) dynamics and relapse risk in patients with seropositive neuromyelitis optica spectrum disorder treated with immunosuppressants. METHODS This observational cohort study with prospectively collected data included 400 neuromyelitis optica spectrum disorder patients seropositive for AQP4-IgG and treated with immunosuppressants. Serum AQP4-IgG was detected by fixed cell-based assay every 6 months. RESULTS After treatment with immunosuppressants, 128 patients became AQP4-IgG seronegative. The median time to become seronegative for 400 patients was 76.4 months (61.4 months, NA). Among those patients with negative change of AQP4-IgG, the mean annualized relapse rate significantly decreased after patients became seronegative (0.20 vs 0.77, p < 0.001), and a positive correlation was observed between time to become seronegative and relapse (OR 1.018, 95% CI 1.001-1.035, p < 0.05). Independent risk factors for AQP4-IgG becoming seronegative were older age at onset, initiation of immunosuppressants at onset, and shorter disease duration before maintenance therapy. Independent risk factors for relapse included younger age (≤46.4 years) at onset, poly-system involvement in the first attack, and unchanged or increased AQP4-IgG titer. The relapse risk was not associated with sex, combination with connective tissue disease, seropositivity for systemic autoimmune antibodies, or incomplete recovery from the first attack. INTERPRETATION Patients with younger age at onset, poly-system involvement in the first attack, and unchanged or increased titer of AQP4-IgG are most likely to experience relapse under treatment with immunosuppressants. Time to AQP4-IgG becoming seronegative and change of AQP4-IgG titer may become the surrogate efficacy biomarkers in clinical trials. ANN NEUROL 2023.
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Affiliation(s)
- He-Xiang Yin
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-Jie Wang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Man-Ge Liu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Ding-Ding Zhang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Hai-Tao Ren
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Feng Mao
- Neuroimmunology Group, KingMed Diagnostic Laboratory, Guangzhou, China.,Department of Clinical Medicine, Medical School, Xiangnan University, Chenzhou, China
| | - Yao Zhang
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Xu
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Capobianco M, Ringelstein M, Welsh C, Lobo P, deFiebre G, Lana-Peixoto M, Wang J, Min JH, Wingerchuk DM. Characterization of Disease Severity and Stability in NMOSD: A Global Clinical Record Review with Patient Interviews. Neurol Ther 2023; 12:635-650. [PMID: 36826457 PMCID: PMC10043113 DOI: 10.1007/s40120-022-00432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/01/2022] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION We sought insights into the classification of and factors associated with relapse severity and disease stability in neuromyelitis optica spectrum disorder (NMOSD) clinical practice worldwide. METHODS Neurologists recruited from six countries (the USA, Germany, Italy, Brazil, South Korea, and China) participated in a 30-60 minute online survey and submitted two to four clinical records for aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive adults with NMOSD, which included patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and severity. Separately, patients with NMOSD receiving maintenance therapy were interviewed over the telephone about their treatment journey, as well as perceptions of relapse severity and disease stability, and their potential influence on treatment decisions. RESULTS Clinical records for 1185 patients with AQP4-IgG-seropositive NMOSD were provided by 389 neurologists (July-August 2020); 33 patients were interviewed (October-November 2020). There was no clear consensus on how relapse severity was defined in clinical practice, with geographical variations in relapse classification also found. Neurologists tended to rely on clinical assessments when determining severity, viewing each relapse in isolation, whereas patients had a more subjective view based on the changes in their daily lives and comparisons with prior relapses. Similarly, there was a disconnect in the definition of disease stability: the complete absence of relapses was more important for patients than for neurologists. CONCLUSION A clear consensus on how to assess relapse severity and disease stability is needed to ensure that patients receive appropriate and timely treatment. In the future, clinical measures should be combined with patient-focused assessments.
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Affiliation(s)
- Marco Capobianco
- Neurology Department, "S. Croce e Carle" Hospital, Cuneo, Italy.
| | - 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
| | | | | | | | - Marco Lana-Peixoto
- Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Jiawei Wang
- Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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A novel aquaporin-4-associated optic neuritis rat model with severe pathological and functional manifestations. J Neuroinflammation 2022; 19:263. [PMID: 36303157 PMCID: PMC9615200 DOI: 10.1186/s12974-022-02623-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Optic neuritis (ON) is a common manifestation of aquaporin-4 (AQP4) antibody seropositive neuromyelitis optica (NMO). The extent of tissue damage is frequently severe, often leading to loss of visual function, and there is no curative treatment for this condition. To develop a novel therapeutic strategy, elucidating the underlying pathological mechanism using a clinically relevant experimental ON model is necessary. However, previous ON animal models have only resulted in mild lesions with limited functional impairment. In the present study, we attempted to establish a feasible ON model with severe pathological and functional manifestations using a high-affinity anti-AQP4 antibody. Subsequently, we aimed to address whether our model is suitable for potential drug evaluation by testing the effect of minocycline, a well-known microglia/macrophage inhibitor. Methods AQP4-immunoglobulin G (IgG)-related ON in rats was induced by direct injection of a high-affinity anti-AQP4 monoclonal antibody, E5415A. Thereafter, the pathological and functional characterizations were performed, and the therapeutic potential of minocycline was investigated. Results We established an experimental ON model that reproduces the histological characteristics of ON in seropositive NMO, such as loss of AQP4/glial fibrillary acidic protein immunoreactivity, immune cell infiltration, and extensive axonal damage. We also observed that our rat model exhibited severe visual dysfunction. The histological analysis showed prominent accumulation of macrophages/activated microglia in the lesion site in the acute phase. Thus, we investigated the possible effect of the pharmacological inhibition of macrophages/microglia activation by minocycline and revealed that it effectively ameliorated axonal damage and functional outcome. Conclusions We established an AQP4-IgG-induced ON rat model with severe functional impairments that reproduce the histological characteristics of patients with NMO. Using this model, we revealed that minocycline treatment ameliorates functional and pathological outcomes, highlighting the usefulness of our model for evaluating potential therapeutic drugs for ON in NMO. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02623-7.
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Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis. Int J Mol Sci 2022; 23:ijms23179769. [PMID: 36077167 PMCID: PMC9456305 DOI: 10.3390/ijms23179769] [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: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Optic neuritis (ON) is an inflammatory condition involving the optic nerve. Several important typical and atypical ON variants are now recognized. Typical ON has a more favorable prognosis; it can be idiopathic or represent an early manifestation of demyelinating diseases, mostly multiple sclerosis (MS). The atypical spectrum includes entities such as antibody-driven ON associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), chronic/relapsing inflammatory optic neuropathy (CRION), and sarcoidosis-associated ON. Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. This review paper aims at presenting the currently available state-of-the-art treatment strategies for typical and atypical ON, both in the acute phase and in the long-term. Moreover, emerging therapeutic approaches and novel steps in the direction of achieving remyelination are discussed.
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Long-term safety of satralizumab in neuromyelitis optica spectrum disorder (NMOSD) from SAkuraSky and SAkuraStar. Mult Scler Relat Disord 2022; 66:104025. [DOI: 10.1016/j.msard.2022.104025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 07/03/2022] [Indexed: 12/27/2022]
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Lopez JA, Houston SD, Tea F, Merheb V, Lee FXZ, Smith S, McDonald D, Zou A, Liyanage G, Pilli D, Denkova M, Lechner-Scott J, van der Walt A, Barnett MH, Reddel SW, Broadley S, Ramanathan S, Dale RC, Brown DA, Brilot F. Validation of a Flow Cytometry Live Cell-Based Assay to Detect Myelin Oligodendrocyte Glycoprotein Antibodies for Clinical Diagnostics. J Appl Lab Med 2021; 7:12-25. [PMID: 34718586 DOI: 10.1093/jalm/jfab101] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibodies (MOG Ab) are essential in the diagnosis of MOG Ab-associated disease (MOGAD). Live cell-based assays (CBAs) are the gold standard for MOG Ab detection with improved sensitivity and specificity over fixed CBAs. A number of testing centers have used flow cytometry for its high throughput and quantitative utility. Presently, there is increasing demand to translate these research-based methods into an accredited routine diagnostic setting. METHODS A flow cytometry live CBA was used to detect MOG Ab in patients with demyelination. Serostatuses were compared between a research-based assay and a streamlined diagnostic assay. Inter-laboratory validation of the streamlined assay was performed in an accredited diagnostic laboratory. Further streamlining was performed by introducing a borderline serostatus range and reducing the number of controls used to determine the positivity threshold. RESULTS High serostatus agreement (98%-100%) was observed between streamlined and research-based assays. Intra- and inter-assay imprecision was improved in the streamlined assay (mean intra- and inter-assay CV = 7.3% and 27.8%, respectively) compared to the research-based assay (mean intra- and inter-assay CV = 11.8% and 33.6%, respectively). Borderline positive and clear positive serostatuses were associated with confirmed phenotypes typical of MOGAD. Compared to using 24 controls, robust serostatus classification was observed when using 13 controls without compromising analytical performance (93%-98.5% agreement). CONCLUSIONS Flow cytometry live CBAs show robust utility in determining MOG Ab serostatus. Streamlining and standardizing use of this assay for diagnostics would improve the accuracy and reliability of routine testing to aid diagnosis and treatment of patients with demyelination.
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Affiliation(s)
- Joseph A Lopez
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Samuel D Houston
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,School of Biomedical Engineering, The University of Sydney, Sydney, Australia
| | - Fiona Tea
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Vera Merheb
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia
| | - Fiona X Z Lee
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia
| | - Sandy Smith
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | - David McDonald
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | - Alicia Zou
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ganesha Liyanage
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Deepti Pilli
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martina Denkova
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, Faculty of Medicine and Public Health, The University of Newcastle, Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - Anneke van der Walt
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Simon Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University Southport, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - David A Brown
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Westmead Institute for Medical Research, Sydney, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia.,Specialty of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, Australia
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7
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Royston M, Kielhorn A, Weycker D, Shaff M, Houde L, Tanvir I, Bhattacharyya S, Levy M. Neuromyelitis Optica Spectrum Disorder: Clinical Burden and Cost of Relapses and Disease-Related Care in US Clinical Practice. Neurol Ther 2021; 10:767-783. [PMID: 34046846 PMCID: PMC8571448 DOI: 10.1007/s40120-021-00253-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition characterized by unpredictable relapses that affect the optic nerves and spinal cord, which can lead to blindness, paralysis, and increased mortality rates. Evidence on the clinical and economic burden of NMOSD in the USA is currently lacking. Methods A retrospective, observational cohort study was conducted using data from the IQVIA PharMetrics Plus Healthcare Claims Database between January 1, 2012 and March 31, 2019. Adults (aged 18 years or more) with evidence of NMOSD and a matched group of comparison patients were identified. Outcomes, including NMOSD relapses, healthcare utilization, and healthcare expenditure (reported in 2018 US dollars), were evaluated during the follow-up period (maximum 6 years). Healthcare utilization and expenditure were assessed overall (all-cause) and during NMOSD relapses. Results The study included 1363 patients with NMOSD; the mean age was 44.9 years, and 75.3% were female. During the follow-up period (median 2.0 years), 47.7% of patients with NMOSD had one or more relapses, corresponding to an annualized relapse rate of 0.8 (95% confidence interval [CI] 0.7–0.9). When analyzing healthcare expenditure per patient, the mean annualized all-cause healthcare expenditure among patients with NMOSD was $60,599 (95% CI $52,112–66,716) compared with $8912 (95% CI $7084–10,727) among comparison patients, representing a difference of $51,687 (95% CI $43,820–58,664) attributable to NMOSD. The mean annualized total expenditure for NMOSD relapses was $10,070 (95% CI $7726–12,660) per patient, with hospital/inpatient care requiring more expenditure than ambulatory/outpatient care. Conclusion Findings of this large, retrospective, observational study indicate that relapses among patients with NMOSD are common in US clinical practice, leading to substantial healthcare utilization and expenditure. Therapies with the highest relapse risk reduction could lead to markedly lower relapse-associated healthcare utilization and clinical burden in patients with NMOSD. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00253-4. Neuromyelitis optica spectrum disorder (NMOSD) is a severely debilitating neurological disease that affects the nerves in the brain and spinal cord. People who have NMOSD may experience recurrent attacks, or relapses, that can cause blindness and disability. These relapses may lead to hospitalizations, doctor’s office visits, and pharmacy costs that are paid by health insurance plans. Overall, the cost of treating relapses in patients with NMOSD is substantial. Our study analyzed healthcare claims data from the USA. During a median follow-up time of 2.0 years, our study showed that 47.7% of patients with NMOSD experienced one or more relapses, resulting in hospital/inpatient admissions and ambulatory/outpatient treatments. In addition, the average healthcare cost among patients with NMOSD was $60,599 per year compared with $8912 per year for patients without NMOSD. This represents a difference of $51,687 per year, which can be attributed to NMOSD. Among patients with three or more relapses during the follow-up period, the average total healthcare cost was more than $83,000 per patient. Therefore, medicines that prevent relapses could lead to fewer relapse-associated hospitalizations and outpatient treatments for patients with NMOSD.
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Affiliation(s)
| | | | - Derek Weycker
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA.
| | - Melody Shaff
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
| | - Linnea Houde
- Policy Analysis Inc. (PAI), 822 Boylston Street, Suite 206, Chestnut Hill, MA, 02467, USA
| | | | - Shamik Bhattacharyya
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Levy
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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Gospe SM, Chen JJ, Bhatti MT. Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment. Eye (Lond) 2021; 35:753-768. [PMID: 33323985 PMCID: PMC8026985 DOI: 10.1038/s41433-020-01334-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Optic neuritis (ON) is the most common cause of acute optic neuropathy in patients younger than 50 years of age and is most frequently idiopathic or associated with multiple sclerosis. However, the discovery of aquaporin-4 immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG as biomarkers for two separate central nervous system inflammatory demyelinating diseases has revealed that neuromyelitis optica spectrum disorder (NMSOD) and MOG-IgG-associated disease (MOGAD) are responsible for clinically distinct subsets of ON. NMOSD-ON and MOGAD-ON both demonstrate tendencies for bilateral optic nerve involvement and often exhibit a relapsing course with the potential for devastating long-term visual outcomes. Early and accurate diagnosis is therefore essential. This review will summarize the current understanding of the clinical spectra of NMOSD and MOGAD, the radiographic and serological findings which support their diagnoses, and the current evidence behind various acute and long-term therapeutic strategies for ON related to these conditions. A particular emphasis is placed on a number of recent multi-centre randomized placebo-controlled trials, which provide the first level I evidence for long-term treatment of NMOSD.
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Affiliation(s)
- Sidney M Gospe
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M Tariq Bhatti
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Brill L, Ganelin-Cohen E, Dabby R, Rabinowicz S, Zohar-Dayan E, Rein N, Aloni E, Karmon Y, Vaknin-Dembinsky A. Age-Related Clinical Presentation of MOG-IgG Seropositivity in Israel. Front Neurol 2021; 11:612304. [PMID: 33584514 PMCID: PMC7874097 DOI: 10.3389/fneur.2020.612304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction: Myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders (MOGAD) have been recognized over the past 10 years as distinct inflammatory, demyelinating diseases of the central nervous system (CNS). Antibodies against MOG are found mostly in patients with optic neuritis (ON), acute disseminated encephalomyelitis (ADEM), and aquaporin-4 antibody (AQP4-abs)-seronegative neuromyelitis optica spectrum disorders (NMOSD). However, data on the disease course and disability outcomes of these patients are scarce. Aim: To describe clinical and paraclinical features associated with MOG antibodies (abs) in a cohort of patients in Israel, and to assess baseline prognostic features of MOG-ab-associated diseases after a first acute demyelinating event. Methods: MOG-abs were identified in serum using a cell-based assay, and clinical data were collected from the patients' medical records. Results: Of 683 patients with demyelinating diseases tested for MOG-abs, 53 were positive (7.7%), with ON the most common presenting phenotype (68%). The age range of MOG-abs seropositive patients was 1-66 years, with increased prevalence in children (19% compared to 6.7% in adults) (p < 0.01). The highest prevalence of seropositivity was observed in children aged younger than 10 years (25.5%), followed by those aged 31-40 years (16.6%). Conclusions: MOGAD are distinct autoimmune diseases that occurs at all stages of life with a significantly higher prevalence in children; the main clinical presenting phenotype in the entire cohort is ON and young children most often presented with ON or ADEM. Our data highlight the need for repeated evaluation of MOG-abs in patients with acquired CNS demyelinating disorders, especially in children under 10 and adults between 31 and 40 years of age.
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Affiliation(s)
- Livnat Brill
- Department of Neurology and Laboratory of Neuroimmunology, The Agnes Ginges Center for Neurogenetics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Ganelin-Cohen
- Schneider Children's Medical Center, Institute of Pediatric Neurology, Affiliated With Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ron Dabby
- Department of Neurology, Edith Wolfson Medical Center, Holon, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shira Rabinowicz
- Pediatric Neurology Unit, Sheba Medical Center, Ramat Gan, Israel. Sackler School of Medicine, The Edmond and Lilly Safra Children's Hospital, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Zohar-Dayan
- Pediatric Neurology Unit, Sheba Medical Center, Ramat Gan, Israel. Sackler School of Medicine, The Edmond and Lilly Safra Children's Hospital, Tel-Aviv University, Tel-Aviv, Israel
| | - Netaniel Rein
- Department of Neurology and Laboratory of Neuroimmunology, The Agnes Ginges Center for Neurogenetics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Aloni
- Department of Ophthalmology, Barzilai University Medical Center, Ashkelon, Israel
| | - Yuval Karmon
- Department of Neurology, Meir General Hospital, Kfar Saba, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology and Laboratory of Neuroimmunology, The Agnes Ginges Center for Neurogenetics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Akaishi T, Takeshita T, Himori N, Takahashi T, Misu T, Ogawa R, Kaneko K, Fujimori J, Abe M, Ishii T, Fujihara K, Aoki M, Nakazawa T, Nakashima I. Rapid Administration of High-Dose Intravenous Methylprednisolone Improves Visual Outcomes After Optic Neuritis in Patients With AQP4-IgG-Positive NMOSD. Front Neurol 2020; 11:932. [PMID: 33013632 PMCID: PMC7505044 DOI: 10.3389/fneur.2020.00932] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: The purpose of this study was to elucidate the rapid impact of high-dose intravenous methylprednisolone pulse therapy (1,000 mg/day for 3 days) on the eventual visual prognosis in patients with serum anti-aquaporin-4 immunoglobulin G (AQP4-IgG)–positive neuromyelitis optica spectrum disorders (NMOSDs) who had an attack of optic neuritis (ON). Methods: Data from 32 consecutive NMOSD patients (1 male and 31 female) with at least one ON attack, involving a total of 36 ON-involved eyes, were evaluated. The following variables at ON onset were evaluated: sex, age at the first ON episode, visual acuity at nadir, visual acuity after 1 year, duration from ON onset to treatment for an acute ON attack, cycles of high-dose intravenous methylprednisolone pulse therapy for the ON attack, and cycles of plasmapheresis for the ON attack. Among the 36 ON-involved eyes, 27 eyes were studied using orbital MRI with a short-T1 inversion recovery sequence and gadolinium-enhanced fat-suppressed T1 imaging before starting treatment in the acute phase. Results: In univariate analyses, a shorter duration from ON onset to the initiation of high-dose intravenous methylprednisolone pulse therapy favorably affected the eventual visual prognosis 1 year later (Spearman's rho = 0.50, p = 0.0018). The lesion length on orbital MRI was also correlated with the eventual visual prognosis (rho = 0.68, p < 0.0001). Meanwhile, the days to steroid pulse therapy and lesion length on orbital MRI did not show a significant correlation. These findings suggest that the rapidness of steroid pulse therapy administration affects the eventual visual prognosis independent of the severity of ON. In multivariate analysis, a shorter time from ON onset to the start of acute treatment (p = 0.0004) and a younger age at onset (p = 0.0071) were significantly associated with better visual outcomes. Conclusions: Rapid initiation of high-dose intravenous methylprednisolone pulse therapy is essential to preserve the eventual visual acuity in patients with serum AQP4-IgG-positive NMOSD. Once clinicians suspect acute ON with serum AQP4-IgG, swift administration of steroid pulse therapy before confirming the positivity of serum AQP4-IgG would be beneficial for preserving visual function.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Takayuki Takeshita
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurology, National Hospital Organization Yonezawa National Hospital, Sendai, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ogawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimihiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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11
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Hamdy SM, Abdel-Naseer M, Shehata HS, Shalaby NM, Hassan A, Elmazny A, Shaker E, Nada MAF, Ahmed SM, Hegazy MI, Mourad HS, Abdelalim A, Magdy R, Othman AS, Mekkawy DA, Kishk NA. Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era. Ther Clin Risk Manag 2020; 16:759-767. [PMID: 32884277 PMCID: PMC7443007 DOI: 10.2147/tcrm.s261753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022] Open
Abstract
The ongoing coronavirus (COVID-19) pandemic is a global health emergency of international concern and has affected management plans of many autoimmune disorders. Immunosuppressive and immunomodulatory therapies are pivotal in the management of neuromyelitis optica spectrum disorder (NMOSD), potentially placing patients at an increased risk of contracting infections such as COVID-19. The optimal management strategy of NMOSD during the COVID-19 era remains unclear. Here, however, we examined the evidence of NMOSD disease-modifying therapies (DMTs) use during the present period and highlighted different scenarios including treatment of relapses as well as initiation and maintenance of DMTs in order to optimize care of NMOSD patients in the COVID-19 era.
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Affiliation(s)
- Sherif M Hamdy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maged Abdel-Naseer
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hatem S Shehata
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin M Shalaby
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Elmazny
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehab Shaker
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona A F Nada
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sandra M Ahmed
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed I Hegazy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Husam S Mourad
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdelalim
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alshimaa S Othman
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa A Mekkawy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nirmeen A Kishk
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial. Lancet Neurol 2020; 19:402-412. [PMID: 32333898 DOI: 10.1016/s1474-4422(20)30078-8] [Citation(s) in RCA: 243] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Satralizumab, a humanised monoclonal antibody targeting the interleukin-6 receptor, reduced the risk of relapse in patients with neuromyelitis optica spectrum disorder (NMOSD) when added to immunosuppressant therapy. This study assessed the safety and efficacy of satralizumab monotherapy in patients with the disorder. METHODS In this phase 3, double-blind, placebo-controlled, parallel-group trial, we enrolled adults aged 18-74 years with aquaporin-4 antibody seropositive or seronegative NMOSD at 44 investigational sites in 13 countries. Eligible participants had experienced at least one documented NMOSD attack or relapse in the past 12 months and had a score of 6·5 or less on the Expanded Disability Status Scale. Exclusion criteria included clinical relapse 30 days or fewer before baseline. Participants were randomly assigned (2:1) to receive satralizumab 120 mg or visually matched placebo subcutaneously at weeks 0, 2, 4, and every 4 weeks thereafter. Taking immunosuppressants concomitantly was prohibited. The primary endpoint was time to the first protocol-defined relapse, based on the intention-to-treat population and analysed with stratification for two randomisation factors (previous therapy for prevention of attacks and nature of the most recent attack). Safety was assessed in all participants who received at least one dose of satralizumab or placebo. The double-blind phase was due to last until 44 protocol-defined relapses occurred or 1·5 years after random assignment of the last patient enrolled, whichever occurred first; participants could enter an open-label phase after the occurrence of a protocol-defined relapse or at the end of the double-blind phase. The study is registered with ClinicalTrials.gov, NCT02073279. FINDINGS 95 (57%) of 168 screened participants were randomly assigned to treatment (63 to satralizumab; 32 to placebo) between Aug 5, 2014, and April 2, 2017. Protocol-defined relapses occurred in 19 (30%) patients receiving satralizumab and 16 (50%) receiving placebo (hazard ratio 0·45, 95% CI 0·23-0·89; p=0·018). 473·9 adverse events per 100 patient-years occurred in the satralizumab group, as did 495·2 per 100 patient-years in the placebo group; the incidence of serious adverse events and adverse events leading to withdrawal was similar between groups. INTERPRETATION Satralizumab monotherapy reduced the rate of NMOSD relapse compared with placebo in the overall trial population, with a favourable safety profile. The patient population included a ratio of aquaporin-4 antibody seropositive and seronegative patients that was reflective of clinical practice. Satralizumab has the potential to become a valuable treatment option for patients with NMOSD. FUNDING Chugai Pharmaceutical (Roche).
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13
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Ramakrishnan P, Nagarajan D. Neuromyelitis optica spectrum disorder: an overview. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Yamamura T, Kleiter I, Fujihara K, Palace J, Greenberg B, Zakrzewska-Pniewska B, Patti F, Tsai CP, Saiz A, Yamazaki H, Kawata Y, Wright P, De Seze J. Trial of Satralizumab in Neuromyelitis Optica Spectrum Disorder. N Engl J Med 2019; 381:2114-2124. [PMID: 31774956 DOI: 10.1056/nejmoa1901747] [Citation(s) in RCA: 339] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system and is associated with autoantibodies to anti-aquaporin-4 (AQP4-IgG) in approximately two thirds of patients. Interleukin-6 is involved in the pathogenesis of the disorder. Satralizumab is a humanized monoclonal antibody targeting the interleukin-6 receptor. The efficacy of satralizumab added to immunosuppressant treatment in patients with NMOSD is unclear. METHODS In a phase 3, randomized, double-blind, placebo-controlled trial, we randomly assigned, in a 1:1 ratio, patients with NMOSD who were seropositive or seronegative for AQP4-IgG to receive either satralizumab, at a dose of 120 mg, or placebo, administered subcutaneously at weeks 0, 2, and 4 and every 4 weeks thereafter, added to stable immunosuppressant treatment. The primary end point was the first protocol-defined relapse in a time-to-event analysis. Key secondary end points were the change from baseline to week 24 in the visual-analogue scale (VAS) pain score (range, 0 to 100, with higher scores indicating more pain) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) score (range, 0 to 52, with lower scores indicating more fatigue). Safety was also assessed. RESULTS A total of 83 patients were enrolled, with 41 assigned to the satralizumab group and 42 to the placebo group. The median treatment duration with satralizumab in the double-blind period was 107.4 weeks. Relapse occurred in 8 patients (20%) receiving satralizumab and in 18 (43%) receiving placebo (hazard ratio, 0.38; 95% confidence interval [CI], 0.16 to 0.88). Multiple imputation for censored data resulted in hazard ratios ranging from 0.34 to 0.44 (with corresponding P values of 0.01 to 0.04). Among 55 AQP4-IgG-seropositive patients, relapse occurred in 11% of those in the satralizumab group and in 43% of those in the placebo group (hazard ratio, 0.21; 95% CI, 0.06 to 0.75); among 28 AQP4-IgG-seronegative patients, relapse occurred in 36% and 43%, respectively (hazard ratio, 0.66; 95% CI, 0.20 to 2.24). The between-group difference in the change in the mean VAS pain score was 4.08 (95% CI, -8.44 to 16.61); the between-group difference in the change in the mean FACIT-F score was -3.10 (95% CI, -8.38 to 2.18). The rates of serious adverse events and infections did not differ between groups. CONCLUSIONS Among patients with NMOSD, satralizumab added to immunosuppressant treatment led to a lower risk of relapse than placebo but did not differ from placebo in its effect on pain or fatigue. (Funded by Chugai Pharmaceutical; ClinicalTrials.gov number, NCT02028884.).
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Affiliation(s)
- Takashi Yamamura
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Ingo Kleiter
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Kazuo Fujihara
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Jacqueline Palace
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Benjamin Greenberg
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Beata Zakrzewska-Pniewska
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Francesco Patti
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Ching-Piao Tsai
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Albert Saiz
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Hayato Yamazaki
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Yuichi Kawata
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Padraig Wright
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
| | - Jerome De Seze
- From the Department of Immunology, National Institute of Neuroscience, and the Multiple Sclerosis Center, National Center of Neurology and Psychiatry (T.Y.), and Chugai Pharmaceutical (H.Y., Y.K.), Tokyo, and the Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, and the Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama (K.F.) - all in Japan; the Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, and Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg - both in Germany (I.K.); the Department of Clinical Neurology, John Radcliffe Hospital, Oxford (J.P.), and Chugai Pharma Europe, London (P.W.) - both in the United Kingdom; the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (B.G.); the Department of Neurology, Warsaw Medical University, Warsaw, Poland (B.Z.-P.); the Department G.F. Ingrassia, Neuroscience Section, University of Catania, Catania, Italy (F.P.); the Neurologic Institute, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan (C.-P.T.); the Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Barcelona (A.S.); and the Department of Neurology, Hôpital de Hautepierre, Clinical Investigation Center, INSERM 1434, and Fédération de Médecine Translationelle, INSERM 1119 - all in Strasbourg, France (J.D.S.)
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Kumawat BL, Choudhary R, Sharma CM, Jain D, Hiremath A. Plasma Exchange as a First Line Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorders. Ann Indian Acad Neurol 2019; 22:389-394. [PMID: 31736557 PMCID: PMC6839304 DOI: 10.4103/aian.aian_365_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background and Aims: Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disorder of central nervous system with deleterious effects. At present Intravenous corticosteroids are used for the relapse as the first line of treatment, but with only a class evidence III-IV. Having an underlying humoral immune mechanism in the pathogenesis of NMOSD and as it is rightly said that “Time is Cord and Eyes”, delaying the time to start plasma exchange (PLEX) awaiting favorable outcome in response to corticosteroids is detrimental for the patient. Hence, PLEX may be a promising first line therapeutic approach in the management of severe attacks of NMOSD. The aim of this study is to evaluate the efficacy of PLEX as the first line of treatment for the acute attacks in patients with NMOSD that is being largely used as an add-on therapy for more than 10 years, and also to define the time opportunity window for the starting of PLEX. Methods: The study analysed the therapeutic efficacy and safety profile of PLEX as a first line therapy in 30 patients diagnosed with NMOSD over a period of 30 months. PLEX was performed using a Hemonetics Mobile Collection System plus machine with due written consent including the risks and benefits of the treatment that is being proposed to the patient/relative in their own language. Results: A total of 30 patients were analysed, out of which 16 were females and rest males. 85% of the patients were in the age group of 25-35 years. All the patients had severe Expanded Disability Status Scale (EDSS) scores at the baseline, and 73.33% showed significant improvement following PLEX. The only predictor of good outcome was the time to PLEX i.e shorter delay betters the outcome. Conclusion: The study ascertained the importance of early PLEX as a therapeutic intervention in severe attacks of NMOSD irrespective of their Anti-Aquaporin 4 (AQP4) antibody status.
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Affiliation(s)
- B L Kumawat
- Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India
| | - Reenu Choudhary
- Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India
| | - C M Sharma
- Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India
| | - Deepak Jain
- Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India
| | - Ashwini Hiremath
- Department of Neurology, SMS Medical College, Jaipur, Rajeshthan, India
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16
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17
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Song W, Qu Y, Huang X. Plasma exchange: an effective add-on treatment of optic neuritis in neuromyelitis optica spectrum disorders. Int Ophthalmol 2019; 39:2477-2483. [DOI: 10.1007/s10792-019-01090-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/23/2019] [Indexed: 11/29/2022]
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18
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Sakalauskaitė-Juodeikienė E, Armalienė G, Kizlaitienė R, Bagdonaitė L, Giedraitienė N, Mickevičienė D, Rastenytė D, Kaubrys G, Jatužis D. Detection of aquaporin-4 antibodies for patients with CNS inflammatory demyelinating diseases other than typical MS in Lithuania. Brain Behav 2018; 8:e01129. [PMID: 30284401 PMCID: PMC6236230 DOI: 10.1002/brb3.1129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/31/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Neuromyelitis optica (NMO) is frequently associated with aquaporin-4 autoantibodies (AQP4-Ab); however, studies of NMO in Lithuania are lacking. Therefore, the main objective of our study is to assess positivity for AQP4-Ab in patients presenting with inflammatory demyelinating central nervous system (CNS) diseases other than typical multiple sclerosis (MS) in Lithuania. MATERIALS AND METHODS Data were collected from the two largest University hospitals in Lithuania. During the study period, there were 121 newly diagnosed typical MS cases, which were included in the MS registry database. After excluding these typical MS cases, we analyzed the remaining 29 cases of other CNS inflammatory demyelinating diseases, including atypical MS (n = 14), acute transverse myelitis, TM (n = 8), acute disseminated encephalomyelitis, ADEM (n = 3), clinically isolated syndrome, CIS (n = 2), atypical optic neuritis, ON (n = 1), and NMO (n = 1). We assessed positivity for AQP4-Ab for the 29 patients and evaluated clinical, laboratory, and instrumental differences between AQP4-Ab seropositive and AQP4-Ab seronegative patient groups. RESULTS AQP4-Ab test was positive for three (10.3%) patients in our study, with initial diagnoses of atypical MS (n = 2) and ADEM (n = 1). One study patient was AQP4-Ab negative despite being previously clinically diagnosed with NMO. There were no significant clinical, laboratory, or instrumental differences between the groups of AQP4-Ab positive (3 [10.3%]) and negative (26 [89.7%]) patients. CONCLUSIONS AQP4-Ab test was positive for one-tenth of patients with CNS inflammatory demyelinating diseases other than typical MS in our study. AQP4-Ab testing is highly recommended for patients presenting with not only TM and ON but also an atypical course of MS and ADEM.
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Affiliation(s)
- Eglė Sakalauskaitė-Juodeikienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedrė Armalienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Kizlaitienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Loreta Bagdonaitė
- Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Nataša Giedraitienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dalia Mickevičienė
- Department of Neurology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.,Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Rastenytė
- Department of Neurology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.,Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dalius Jatužis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Yamagami A, Wakakura M, Inoue K, Ishikawa H, Takahashi T, Tanaka K. Clinical Characteristics of Anti-aquaporin 4 Antibody Positive Optic Neuritis in Japan. Neuroophthalmology 2018; 43:71-80. [PMID: 31312230 DOI: 10.1080/01658107.2018.1520905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/23/2023] Open
Abstract
To investigate the clinical characteristics and the effectiveness of maintenance therapy of anti-AQP4 antibody positive optic neuritis in Japanese patients, medical records from 69 patients (103 eyes) were retrospective reviewed. The status of relapse in patients who received maintenance therapy following acute therapy was compared with that before maintenance therapy in patients who started maintenance therapy ≥6 months after acute therapy. In Japan, anti-AQP4 antibody positive optic neuritis was characterized by older onset age and poor visual outcome. The yearly rate and total number of relapses were lower when maintenance therapy was followed immediately after acute therapy.
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Affiliation(s)
| | | | | | - Hitoshi Ishikawa
- Department of Ophthalmology, Kitasato University Hospital, Sagamihara, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Hospital, Miyagi, Japan.,Department of Neurology, Yonezawa National Hospital, Yamagata, Japan
| | - Keiko Tanaka
- Department of Cellular Neurobiology, Brain Research Institute, Niigata University, Niigata, Japan
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20
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Zhu Z, Jiao L, Li T, Wang H, Wei W, Qian H. Expression of AQP3 and AQP5 as a prognostic marker in triple-negative breast cancer. Oncol Lett 2018; 16:2661-2667. [PMID: 30013662 DOI: 10.3892/ol.2018.8955] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 12/16/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is a common type of breast malignancy with high a propensity for metastasis and locoregional recurrence. The aim of the present study was to investigate the expression of aquaporin (AQP) 3 and AQP5, analyze their association with clinicopathological parameters and explore their clinical significance in tissue samples from patients with TNBC. Immunohistochemistry was performed to detect the expression patterns of AQP3 and AQP5 in 96 patients with TNBC who underwent surgery between 2007 and 2012. AQP3 and AQP5 were expressed primarily in the membrane and cytoplasm of tumor cells within TNBC tissues. AQP3 and AQP5 expression was notably stronger in carcinoma tissue compared with adjacent normal tissue. Overexpression of AQP3 and AQP5 was significantly associated with tumor size, lymph node status and local relapse/distant metastasis. In addition, aberrant overexpression of AQP5 was observed more frequently in TNBC tissues with higher Ki-67 expression than in those with lower Ki-67 expression. In univariate analysis, patients with TNBC with high AQP3 and AQP5 expression demonstrated poorer 5-year disease-free survival and overall survival compared with patients with low AQP3 and AQP5 expression. In multivariate analysis, the combined expression of AQP3 and AQP5 was an independent prognostic marker in patients with TNBC. The results of the present study suggest that the overexpression of AQP3 and AQP5 may serve as a novel therapeutic marker in patients with TNBC.
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Affiliation(s)
- Zhengcai Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China.,Department of General Surgery, Taizhou People's Hospital, Taizhou, Jiangsu 215300, P.R. China
| | - Lianghe Jiao
- Department of General Surgery, Taizhou People's Hospital, Taizhou, Jiangsu 215300, P.R. China
| | - Tao Li
- Department of General Surgery, Taizhou People's Hospital, Taizhou, Jiangsu 215300, P.R. China
| | - Honggang Wang
- Department of General Surgery, Taizhou People's Hospital, Taizhou, Jiangsu 215300, P.R. China
| | - Wei Wei
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210029, P.R. China
| | - Haixin Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
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Miao J, Aboagye DE, Chulpayev B, Liu L, Ishkanian G, Kolanuvada B, Alaie D, Petrillo RL. Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:41-46. [PMID: 29321467 PMCID: PMC5772341 DOI: 10.12659/ajcr.906150] [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] [Indexed: 11/09/2022]
Abstract
Patient: Female, 58 Final Diagnosis: NMO Symptoms: New-onset right leg weakness and pain Medication: — Clinical Procedure: Progressive and recurring Specialty: Neurology
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Affiliation(s)
- Jing Miao
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Doreen E Aboagye
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Boris Chulpayev
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Lin Liu
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Gary Ishkanian
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Bangaruraju Kolanuvada
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Dariush Alaie
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Richard L Petrillo
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
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22
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Jeon T, Park KS, Park SH, Hwang JH, Hwang SK. Expression of Aquaporin 1 and 4 in the Choroid Plexus and Brain Parenchyma of Kaolin-Induced Hydrocephalic Rats. Korean J Neurotrauma 2017; 13:68-75. [PMID: 29201837 PMCID: PMC5702761 DOI: 10.13004/kjnt.2017.13.2.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Aquaporin (AQP) is a recently discovered protein that regulates water homeostasis. The present study examines changes in AQP 1 and 4 in kaolin induced experimental hydrocephalic rats to elucidate the pathophysiology of water homeostasis in the disease. Methods Hydrocephalus was induced by percutaneous intracisternal injection of kaolin. The brain parenchyma and choroid plexus were obtained at 3, 7, 14 and 30 days after injection. Protein expressions of AQP 1 and 4 were measured by western blot, immunohistochemistry (IHC) and immunofluorescence (IF) stains. Results In the choroid plexus of the kaolin-induced hydrocephalus group, AQP 1 expression identified by western blot exhibited sharp decrease in the early stage (55% by the 3rd day and 22% by the 7th day), but indicated a 2.2-fold increase in the later stage (30th day) in comparison with control groups. In the parenchyma, a quantitative measurement of AQP 4 expression revealed variable results on the 3rd and 7th days, but indicated expression 2.1 times higher than the control in the later stage (30th day). In addition, the IHC and IF findings supported the patterns of expression of AQP 1 in the choroid plexus and AQP 4 in the parenchyma. Conclusion Expression of AQP 1 decreased sharply in the choroid plexus of acute hydrocephalus rats and increased at later stages. Expression of AQP 4 in the brain parenchyma was variable in the early stage in the hydrocephalus group, but was higher than in the control in the later stage. These findings suggest a compensating role of AQPs in water physiology in hydrocephalus.
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Affiliation(s)
- Taehyung Jeon
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Ki-Su Park
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Sung Kyoo Hwang
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
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Neuromyelitis Optica in a Nepalese Man. Case Rep Neurol Med 2017; 2017:8596781. [PMID: 28932609 PMCID: PMC5591917 DOI: 10.1155/2017/8596781] [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: 06/02/2017] [Accepted: 07/12/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Neuromyelitis optica is a severely disabling inflammatory disorder of the central nervous system of autoimmune etiology that mainly affects the optic nerves and spinal cord. Here, we present a case report detailing a patient with tingling and weakness of right upper and lower limbs who was neuromyelitis optica immunoglobulin G-positive. Case Presentation. A 46-year-old Nepalese man presented to the hospital with a history of tingling and weakness of right upper and lower limbs that developed over a period of two months. Clinical evaluation showed diminished power across all major muscle groups in the right upper and lower limbs. Magnetic resonance imaging of his cervical spine showed T1 iso- to hypointense signal and T2 hyperintense signal in central cervical spinal cord from first to sixth cervical level, probably suggestive of myelitis or demyelination. The patient was immediately started on intravenous methylprednisolone. The diagnosis of neuromyelitis optica was later confirmed with strongly positive neuromyelitis optica immunoglobulin G. Conclusion. In resource limited setting, in the absence of tests for neuromyelitis optica immunoglobulin G, treatment was started and the patient’s condition started to get better. Hence, early initiation of aggressive immunosuppressive treatment is essential in such cases.
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Liu Y, Harlow DE, Given KS, Owens GP, Macklin WB, Bennett JL. Variable sensitivity to complement-dependent cytotoxicity in murine models of neuromyelitis optica. J Neuroinflammation 2016; 13:301. [PMID: 27905992 PMCID: PMC5134246 DOI: 10.1186/s12974-016-0767-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/21/2016] [Indexed: 01/06/2023] Open
Abstract
Background Studies of neuromyelitis optica (NMO), an autoimmune disease of the central nervous system (CNS), have demonstrated that autoantibodies against the water channel aquaporin-4 (AQP4) induce astrocyte damage through complement-dependent cytotoxicity (CDC). In developing experimental models of NMO using cells, tissues or animals from mice, co-administration of AQP4-IgG and normal human serum, which serves as the source of human complement (HC), is required. The sensitivity of mouse CNS cells to HC and CDC in these models is not known. Methods We used HC and recombinant monoclonal antibodies (rAbs) against AQP4 to investigate CDC on mouse neurons, astrocytes, differentiated oligodendrocytes (OLs), and oligodendrocyte progenitors (OPCs) in the context of purified monocultures, neuroglial mixed cultures, and organotypic cerebellar slices. Results We found that murine neurons, OLs, and OPCs were sensitive to HC in monocultures. In mixed murine neuroglial cultures, HC-mediated toxicity to neurons and OLs was reduced; however, astrocyte damage induced by an AQP-specific rAb #53 and HC increased neuronal and oligodendroglial loss. OPCs were resistant to HC toxicity in neuroglial mixed cultures. In mouse cerebellar slices, damage to neurons and OLs following rAb #53-mediated CDC was further reduced, but in contrast to neuroglial mixed cultures, astrocyte damage sensitized OPCs to complement damage. Finally, we established that some injury to neurons, OLs, and OPCs in cell and slice cultures resulted from the activation of HC by anti-tissue antibodies to mouse cells. Conclusions Murine neurons and oligodendroglia demonstrate variable sensitivity to activated complement based on their differentiation and culture conditions. In organotypic cultures, the protection of neurons, OLs, and OPCs against CDC is eliminated by targeted astrocyte destruction. The activation of human complement proteins on mouse CNS cells necessitates caution when interpreting the results of mouse experimental models of NMO using HC. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0767-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yiting Liu
- Department of Neurology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA
| | - Danielle E Harlow
- Department of Cell & Developmental Biology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA
| | - Katherine S Given
- Department of Cell & Developmental Biology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA
| | - Gregory P Owens
- Department of Neurology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA
| | - Wendy B Macklin
- Department of Cell & Developmental Biology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA.,Program in Neuroscience, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA
| | - Jeffrey L Bennett
- Department of Neurology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA. .,Department of Ophthalmology, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA. .,Program in Neuroscience, University of Colorado, School of Medicine, 12700 E. 19th Ave, Aurora, CO, USA.
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Abstract
INTRODUCTION Since the discovery of aquaporin-1 (AQP1) as a water channel, more than 2,000 articles, reviews and chapters have been published. The wide tissue expression, functional and biological roles have documented the major and essential physiological importance of these channels both in health and disease. Thus, over the years, studies have revealed essential importance of aquaporins in mammalian pathophysiology revealing aquaporins as potential drug targets. Areas covered: Starting from a brief description of the main structural and functional features of aquaporins, their roles in physiology and pathophysiology of different human diseases, this review describes the main classes of small molecules and biologicals patented, published from 2010 to 2015, able to regulate AQPs for diagnostic and therapeutic applications. Expert opinion: Several patents report on AQP modulators, mostly inhibitors, and related pharmaceutical formulations, to be used for treatments of water imbalance disorders, such as edema. Noteworthy, a unique class of gold-based compounds as selective inhibitors of aquaglyceroporin isoforms may provide new chemical tools for therapeutic applications, especially in cancer. AQP4-targeted therapies for neuromyelitis optica, enhancement of AQP2 function for nephrogenic diabetes insipidus and AQP1-5 gene transfer for the Sjogren's syndrome represent promising therapies that deserve further investigation by clinical trials.
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Affiliation(s)
- Graça Soveral
- a Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy , Universidade de Lisboa , Lisbon , Portugal
| | - Angela Casini
- b School of Chemistry , Cardiff University , Cardiff , UK
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Olson D, Moen A, Barr E, Mirsky D, Schreiner T, Abzug MJ. An 8-Year-Old Boy With Ascending Paralysis. J Pediatric Infect Dis Soc 2015; 4:385-8. [PMID: 26407267 DOI: 10.1093/jpids/piv034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/02/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Daniel Olson
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Amanda Moen
- Department of Pediatrics, Section of Neurology, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Emily Barr
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | | | - Teri Schreiner
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Mark J Abzug
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
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Golnik KC. Neuro-Ophthalmology Annual Review. Asia Pac J Ophthalmol (Phila) 2015; 4:307-15. [PMID: 26417928 DOI: 10.1097/apo.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this review was to update the practicing ophthalmologist on the English language neuro-ophthalmology literature from the past year. DESIGN A review of English language literature from August 1, 2013, to August 1, 2014, was conducted. METHODS The author searched PubMed from August 1, 2013, to August 1, 2014, limited to English language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. The following topics were searched: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis, demyelinating diseases including multiple sclerosis, lesions of the optic chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual function, and neuroimaging advances. The focus of this review is on clinically relevant literature in the past year for the practicing ophthalmologist. The aim was to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year. RESULTS Initially, more than 11,000 articles were identified. One hundred were selected that met criteria specified above. CONCLUSIONS This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.
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Affiliation(s)
- Karl C Golnik
- From the Department of Ophthalmology, University of Cincinnati and the Cincinnati Eye Institute, Cincinnati, OH
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Kowarik MC, Dzieciatkowska M, Wemlinger S, Ritchie AM, Hemmer B, Owens GP, Bennett JL. The cerebrospinal fluid immunoglobulin transcriptome and proteome in neuromyelitis optica reveals central nervous system-specific B cell populations. J Neuroinflammation 2015; 12:19. [PMID: 25626447 PMCID: PMC4323273 DOI: 10.1186/s12974-015-0240-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 01/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is a severe demyelinating disorder of the central nervous system (CNS) associated with the presence of an autoimmune antibody response (AQP4-IgG) against the water channel aquaporin-4 (AQP4). It remains unclear whether pathologic AQP4-IgG in the CNS is produced entirely by peripheral plasma cells or is generated in part by infiltrating B cells. To determine the overlap of AQP4-IgG idiotypes between the CNS and periphery, we compared the immunoglobulin G (IgG) transcriptome of cerebrospinal fluid (CSF) plasmablasts with the CSF and serum IgG proteomes in 7 AQP4-seropositive NMO patients following exacerbation. Methods CSF variable region Ig heavy- (VH) and light-chain (VL) transcriptome libraries were generated for each patient from CSF plasmablasts by single cell sorting, reverse transcriptase polymerase chain reaction (RT-PCR), and DNA sequencing. Recombinant antibodies were generated from clonally expanded, paired VH and VL sequences and tested for AQP4-reactivity by cell-binding assay. CSF and serum IgG fractions were searched for sequences that matched their respective CSF IgG transcriptome. Matching peptides within the same patient’s CSF and serum IgG proteomes were also identified. Results In each NMO patient, we recovered CSF IgG VH and VL sequences that matched germline-mutated IgG protein sequences from the patient’s CSF and serum IgG proteomes. Although a modest variation was observed between patients, the overlap between the transcriptome and proteome sequences was found primarily, but not exclusively, within the CSF. More than 50% of the CSF IgG transcriptome sequences were exclusively found in the CSF IgG proteome, whereas 28% were found in both the CSF and blood IgG proteome, and 18% were found exclusively in the blood proteome. A comparable distribution was noted when only AQP4-specific IgG clones were considered. Similarly, on average, only 50% of the CSF IgG proteome matched corresponding peptide sequences in the serum. Conclusions During NMO exacerbations, a substantial fraction of the intrathecal Ig proteome is generated by an intrathecal B cell population composed of both novel and peripherally-derived clones. Intrathecal CSF B cell clones may contribute to NMO disease exacerbation and lesion formation and may be an important target for preventative therapies.
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Affiliation(s)
- Markus C Kowarik
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | | | - Scott Wemlinger
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Alanna M Ritchie
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Bernhard Hemmer
- Department of Neurology, TU-München, Klinikum Rechts der Isar, Munich, Germany. .,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
| | - Gregory P Owens
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA.
| | - Jeffrey L Bennett
- Department of Neurology, 12700 E. 19th Ave, Box B-182, Aurora, CO, 80045, USA. .,Department of Ophthalmology, Neuroscience Program, Denver, CO, USA.
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Peng JT, Cong HR, Yan R, Kong XY, Jiang HQ, Wei WB, Zhang XJ. Neurological outcome and predictive factors of idiopathic optic neuritis in China. J Neurol Sci 2014; 349:94-8. [PMID: 25577315 DOI: 10.1016/j.jns.2014.12.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND The neurological outcome and predictive factors of idiopathic optic neuritis (ION) in China are largely unknown. OBJECTIVE The aim of this paper is to study the neurological outcome of Chinese ION and to investigate the early predictors for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). METHOD Retrospective medical record review and supplementary follow-up of 107 ION patients was performed. Statistical analysis of the baseline characteristics as risk factors for ION patients converting into MS or NMOSD was performed. RESULTS With an average disease course of 9.5years, 19 of the 107 (17.7%) ION patients developed either MS (9, 8.4%) or NMOSD (10, 9.3%). The estimated 5-year and 10-year combined accumulative risk rates were 14.1% and 26.0%, respectively. Significantly higher estimated accumulative conversion risk was found in female versus male (P=0.047), adult versus children (P=0.032), patients with brain MRI lesions versus patients without leasions (P=0.026), patients with CSF positive oligoclonal bands and/or elevated IgG index versus without (P=0.003) and patients with poor visual recovery versus patients with good recovery (P=0.007). Furthermore, brain white matter lesions and good visual recovery were statistically more common typically in MS converters compared with the NMOSD converters (P=0.01 and P=0.006, respectively). CONCLUSION The combined conversion rate for ION to MS/NMO in Chinese population was lower than the reported rate for Western countries. In addition to some previously reported high risk factors, white matter lesions on the brain MRI at baseline and good visual recovery were found to be good predictors for Chinese ION converting into MS whereas poor visual recovery with a normal brain MRI suggested a higher likelihood of the ION converting into NMOSD.
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Affiliation(s)
- Jing-ting Peng
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Heng-ri Cong
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Rong Yan
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Xiu-yun Kong
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Han-qiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Wen-bin Wei
- Eye Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
| | - Xiao-jun Zhang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing 100730, China.
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