1
|
Cutler C, Azab MA, Lucke-Wold B, Khan M, Henson JC, Gill AS, Alt JA, Karsy M. Systematic Review of Treatment Options and Therapeutic Responses for Lesions of the Sella and Orbit: Evidence-Based Recommendations. World Neurosurg 2023; 173:136-145.e30. [PMID: 36639102 DOI: 10.1016/j.wneu.2022.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Inflammatory pathologies of the sella and orbit are rare but require prompt diagnosis to initiate effective treatment. Because uniform recommendations for treatment are currently lacking, we performed an evidence-based review to identify recommendations. METHODS We performed a literature search of the PubMed, Embase, and Web of Science databases to identify papers evaluating treatment of inflammatory pathologies of the sella and orbit. We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to define recommendations, specifically examining aggregated sample sizes, disease-specific patient follow-up, and clinical trials focused on inflammatory diseases of the sella and orbit. RESULTS A total of 169 studies were included and organized by disease pathology. Treatments for various pathologies were recorded. Treatment options included surgery, radiation, steroids, targeted treatments, immunomodulators, intravenous immune globulin, and plasmapheresis. Steroids were the most often employed treatment, second-line management options and timing varied. Pathological diagnosis was highly associated with treatment used. Most evidence were level 3 without available control groups, except for 13 trials in neuromyelitis optica with level 1 or 2 evidence. CONCLUSIONS This is the first evidence-based review to provide recommendations on specific treatments for pathologies of the orbit and sella. The reported data may be useful to help guide randomized clinical trials and provide resource for clinical management decisions based on the available evidence.
Collapse
Affiliation(s)
- Christopher Cutler
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Mohammed A Azab
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Majid Khan
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - J Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amarbir S Gill
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jeremiah A Alt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
2
|
Murata H, Kinoshita M, Yasumizu Y, Motooka D, Beppu S, Shiraishi N, Sugiyama Y, Kihara K, Tada S, Koda T, Konaka H, Takamatsu H, Kumanogoh A, Okuno T, Mochizuki H. Cell-Free DNA Derived From Neutrophils Triggers Type 1 Interferon Signature in Neuromyelitis Optica Spectrum Disorder. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/3/e1149. [PMID: 35210295 PMCID: PMC8874356 DOI: 10.1212/nxi.0000000000001149] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/12/2022] [Indexed: 12/30/2022]
Abstract
Background and Objectives Recently accumulating evidence suggests the pivotal role of type 1 interferon (IFN-1) signature in the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD). However, the mechanism of the initial trigger that augments IFN-1 pathway in the peripheral immune system of NMOSD has yet to be elucidated. Methods Clinical samples were obtained from 32 patients with aquaporin-4 antibody–positive NMOSD and 23 healthy subjects. IFN-1 induction in peripheral blood mononuclear cells (PBMCs) by serum-derived cell-free DNA (cfDNA) was assessed in combination with blockades of DNA sensors in vitro. CfDNA fraction was analyzed for DNA methylation profiles by bisulfite sequencing, elucidating the cellular origin of cfDNA. The induction of neutrophil extracellular trap related cell death (NETosis) was further analyzed in NMOSD and control groups, and the efficacy of pharmacologic intervention of NETosis was assessed. Results Enhanced IFN-1 induction by cfDNA derived from NMOSD was observed in PBMCs with cofactor of LL37 antimicrobial peptide. DNase treatment, cGAS inhibitor, and Toll-like receptor 9 antagonist efficiently inhibited IFN-1 production. DNA methylation pattern of cfDNA in patients with NMOSD demonstrated that the predominant cellular source of cfDNA was neutrophils. Whole blood transcriptome analysis also revealed neutrophil activation in NMOSD. In addition, enhanced NETosis induction was observed with NMOSD-derived sera, and efficient pharmacologic inhibition of NETosis with dipyridamole was observed. Discussion Our study highlights the previously unrevealed role of cfDNA predominantly released by neutrophil in the induction of IFN-1 signature in NMOSD and further indicate a novel pharmacologic target in NMOSD.
Collapse
Affiliation(s)
- Hisashi Murata
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Makoto Kinoshita
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Yoshiaki Yasumizu
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Daisuke Motooka
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shohei Beppu
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Naoyuki Shiraishi
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuko Sugiyama
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Keigo Kihara
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Satoru Tada
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Toru Koda
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hachiro Konaka
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hyota Takamatsu
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Kumanogoh
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsusada Okuno
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideki Mochizuki
- From the Department of Neurology (Hisashi Murata, M.K., Y.Y., S.B., N.S., Y.S., K.K., S.T., T.K., T.O., Hideki Mochizuki), Graduate School of Medicine, Osaka University; Department of Experimental Immunology (Y.Y.), WPI Immunology Frontier Research Center, Osaka University; Integrated Frontier Research for Medical Science Division (Y.Y., D.M., A.K., Hideki Mochizuki), Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University; Genome Information Research Center (D.M.), Research Institute for Microbial Diseases, Osaka University; and Department of Respiratory Medicine and Clinical Immunology (H.K., H.T., A.K.), Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
3
|
The cytokines interleukin-6 and interferon-α induce distinct microglia phenotypes. J Neuroinflammation 2022; 19:96. [PMID: 35429976 PMCID: PMC9013466 DOI: 10.1186/s12974-022-02441-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Elevated production of the cytokines interleukin (IL)-6 or interferon (IFN)-α in the central nervous system (CNS) is implicated in the pathogenesis of neurological diseases such as neuromyelitis optica spectrum disorders or cerebral interferonopathies, respectively. Transgenic mice with CNS-targeted chronic production of IL-6 (GFAP-IL6) or IFN-α (GFAP-IFN) recapitulate important clinical and pathological features of these human diseases. The activation of microglia is a prominent manifestation found both in the human diseases and in the transgenic mice, yet little is known about how this contributes to disease pathology. Methods Here, we used a combination of ex vivo and in situ techniques to characterize the molecular, cellular and transcriptomic phenotypes of microglia in GFAP-IL6 versus GFAP-IFN mice. In addition, a transcriptomic meta-analysis was performed to compare the microglia response from GFAP-IL6 and GFAP-IFN mice to the response of microglia in a range of neurodegenerative and neuroinflammatory disorders. Results We demonstrated that microglia show stimulus-specific responses to IL-6 versus IFN-α in the brain resulting in unique and extensive molecular and cellular adaptations. In GFAP-IL6 mice, microglia proliferated, had shortened, less branched processes and elicited transcriptomic and molecular changes associated with phagocytosis and lipid processing. In comparison, microglia in the brain of GFAP-IFN mice exhibited increased proliferation and apoptosis, had larger, hyper-ramified processes and showed transcriptomic and surface marker changes associated with antigen presentation and antiviral response. Further, a transcriptomic meta-analysis revealed that IL-6 and IFN-α both contribute to the formation of a core microglia response in animal models of neurodegenerative and neuroinflammatory disorders, such as Alzheimer’s disease, tauopathy, multiple sclerosis and lipopolysaccharide-induced endotoxemia. Conclusions Our findings demonstrate that microglia responses to IL-6 and IFN-α are highly stimulus-specific, wide-ranging and give rise to divergent phenotypes that modulate microglia responses in neuroinflammatory and neurodegenerative diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02441-x.
Collapse
|
4
|
Etemadifar M, Salari M, Etemadifar MR, Sabeti F, Fateh ST, Aminzade Z. Centrally-located Transverse Myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS. Mult Scler Relat Disord 2022; 60:103664. [DOI: 10.1016/j.msard.2022.103664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
|
5
|
Yang H, Liu W, Wu YF, Zhu DS, Shen XF, Guan YT. Lymphocyte Subsets Are Associated with Disease Status in Neuromyelitis Optica Spectrum Disorders. Neuroimmunomodulation 2022; 29:296-305. [PMID: 34903694 DOI: 10.1159/000520745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE At present, studies on lymphocytes are mostly conducted on CD19+ B cells and CD27+ B cells in neuromyelitis optica spectrum disorders (NMOSDs), but the exact changes in lymphocyte subsets (CD19+ B cells, CD3+ T cells, CD4+ Th cells, CD8+ Ts cells, the CD4+/CD8+ ratio, and NK [CD56+ CD16] cells) have rarely been studied. This study aimed to assess lymphocyte subset changes in patients with NMOSD. METHODS We performed a cross-sectional study of consecutive patients with acute NMOSD (n = 41), chronic NMOSD (n = 21), and healthy individuals (n = 44). Peripheral blood samples were obtained upon admission, and lymphocyte subsets were analyzed by flow cytometry. Levels of lymphocyte subsets among 3 groups were compared and its correlation with the length of spinal cord lesions was analyzed. RESULTS The levels of peripheral blood CD19+ B cells were significantly higher in patients with acute and chronic NMOSD than in healthy controls (HCs) (17.91 ± 8.7%, 13.08 ± 7.562%, and 12.48 ± 3.575%, respectively; p < 0.001) and were positively correlated with the length of spinal cord lesions in acute NMOSD (r = 0.433, p < 0.05). The peripheral blood CD4+/CD8+ ratio was significantly lower in patients with acute NMOSD and chronic NMOSD than in HCs (1.497 ± 0.6387, 1.33 ± 0.5574, and 1.753 ± 0.659, respectively; p < 0.05), and the levels of peripheral blood NK (CD56+ CD16) cells were significantly lower in patients with acute and chronic NMOSD than in HCs (13.6 ± 10.13, 11.11 ± 7.057, and 14.7 [interquartile range = 9.28], respectively; p < 0.01). CONCLUSIONS The levels of certain subsets of peripheral blood lymphocytes are associated with disease status in NMOSD.
Collapse
Affiliation(s)
- Hong Yang
- Department of Neurology, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai, China,
| | - Wei Liu
- Department of Neurology, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai, China
| | - Yi-Fan Wu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - De-Sheng Zhu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xia-Feng Shen
- Department of Neurology, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai, China
| | - Yang-Tai Guan
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
6
|
Agasing A, Quinn JL, Kumar G, Axtell RC. Interferon-β Intensifies Interleukin-23-Driven Pathogenicity of T Helper Cells in Neuroinflammatory Disease. Cells 2021; 10:2139. [PMID: 34440908 PMCID: PMC8392231 DOI: 10.3390/cells10082139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
Interferon (IFN)-β is a popular therapy for multiple sclerosis (MS). However, 25-40% of patients are nonresponsive to this therapy, and it worsens neuromyelitis optica (NMO), another neuroinflammatory disease. We previously identified, in both NMO patients and in mice, that IFN-β treatment had inflammatory effects in T Helper (TH) 17-induced disease through the production of the inflammatory cytokine IL-6. However, other studies have shown that IFN-β inhibits the differentiation and function of TH17 cells. In this manuscript, we identified that IFN-β had differential effects on discrete stages of TH17 development. During early TH17 development, IFN-β inhibits IL-17 production. Conversely, during late TH17 differentiation, IFN-β synergizes with IL-23 to promote a pathogenic T cell that has both TH1 and TH17 characteristics and expresses elevated levels of the potent inflammatory cytokines IL-6 and GM-CSF and the transcription factor BLIMP. Together, these findings help resolve a paradox surrounding IFN-β and TH17-induced disease and illuminate the pathways responsible for the pathophysiology of NMO and MS patients who are IFN-β nonresponders.
Collapse
Affiliation(s)
| | | | | | - Robert C. Axtell
- Department of Arthritis and Clinical Immunology, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA; (A.A.); (J.L.Q.); (G.K.)
| |
Collapse
|
7
|
SIGLEC1 (CD169): a marker of active neuroinflammation in the brain but not in the blood of multiple sclerosis patients. Sci Rep 2021; 11:10299. [PMID: 33986412 PMCID: PMC8119413 DOI: 10.1038/s41598-021-89786-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
We aimed to evaluate SIGLEC1 (CD169) as a biomarker in multiple sclerosis (MS) and Neuromyelitis optica spectrum disorder (NMOSD) and to evaluate the presence of SIGLEC1+ myeloid cells in demyelinating diseases. We performed flow cytometry-based measurements of SIGLEC1 expression on monocytes in 86 MS patients, 41 NMOSD patients and 31 healthy controls. Additionally, we histologically evaluated the presence of SIGLEC1+ myeloid cells in acute and chronic MS brain lesions as well as other neurological diseases. We found elevated SIGLEC1 expression in 16/86 (18.6%) MS patients and 4/41 (9.8%) NMOSD patients. Almost all MS patients with high SIGLEC1 levels received exogenous interferon beta as an immunomodulatory treatment and only a small fraction of MS patients without interferon treatment had increased SIGLEC1 expression. In our cohort, SIGLEC1 expression on monocytes was—apart from those patients receiving interferon treatment—not significantly increased in patients with MS and NMOSD, nor were levels associated with more severe disease. SIGLEC1+ myeloid cells were abundantly present in active MS lesions as well as in a range of acute infectious and malignant diseases of the central nervous system, but not chronic MS lesions. The presence of SIGLEC1+ myeloid cells in brain lesions could be used to investigate the activity in an inflammatory CNS lesion.
Collapse
|
8
|
Paul S, Mondal GP, Bhattacharyya R, Ghosh KC, Bhat IA. Neuromyelitis optica spectrum disorders. J Neurol Sci 2020; 420:117225. [PMID: 33272591 DOI: 10.1016/j.jns.2020.117225] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.
Collapse
Affiliation(s)
- Shabeer Paul
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Gouranga Prasad Mondal
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Ramesh Bhattacharyya
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Kartik Chandra Ghosh
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Imtiyaz Ahmad Bhat
- Department of Immunology & Molecular Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
| |
Collapse
|
9
|
Thoman ME, McKarns SC. Metabolomic Profiling in Neuromyelitis Optica Spectrum Disorder Biomarker Discovery. Metabolites 2020; 10:metabo10090374. [PMID: 32961928 PMCID: PMC7570337 DOI: 10.3390/metabo10090374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 12/21/2022] Open
Abstract
There is no specific test for diagnosing neuromyelitis optica spectrum disorder (NMOSD), a disabling autoimmune disease of the central nervous system. Instead, diagnosis relies on ruling out other related disorders with overlapping clinical symptoms. An urgency for NMOSD biomarker discovery is underscored by adverse responses to treatment following misdiagnosis and poor prognosis following the delayed onset of treatment. Pathogenic autoantibiotics that target the water channel aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) contribute to NMOSD pathology. The importance of early diagnosis between AQP4-Ab+ NMOSD, MOG-Ab+ NMOSD, AQP4-Ab− MOG-Ab− NMOSD, and related disorders cannot be overemphasized. Here, we provide a comprehensive data collection and analysis of the currently known metabolomic perturbations and related proteomic outcomes of NMOSD. We highlight short chain fatty acids, lipoproteins, amino acids, and lactate as candidate diagnostic biomarkers. Although the application of metabolomic profiling to individual NMOSD patient care shows promise, more research is needed.
Collapse
Affiliation(s)
- Maxton E. Thoman
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Laboratory of TGF-β Biology, Epigenetics, and Cytokine Regulation, Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Susan C. McKarns
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA;
- Laboratory of TGF-β Biology, Epigenetics, and Cytokine Regulation, Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Department of Microbiology and Immunology, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Correspondence:
| |
Collapse
|
10
|
Differential Effects of MS Therapeutics on B Cells-Implications for Their Use and Failure in AQP4-Positive NMOSD Patients. Int J Mol Sci 2020; 21:ijms21145021. [PMID: 32708663 PMCID: PMC7404039 DOI: 10.3390/ijms21145021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
B cells are considered major contributors to multiple sclerosis (MS) pathophysiology. While lately approved disease-modifying drugs like ocrelizumab deplete B cells directly, most MS medications were not primarily designed to target B cells. Here, we review the current understanding how approved MS medications affect peripheral B lymphocytes in humans. These highly contrasting effects are of substantial importance when considering these drugs as therapy for neuromyelitis optica spectrum disorders (NMOSD), a frequent differential diagnosis to MS, which is considered being a primarily B cell- and antibody-driven diseases. Data indicates that MS medications, which deplete B cells or induce an anti-inflammatory phenotype of the remaining ones, were effective and safe in aquaporin-4 antibody positive NMOSD. In contrast, drugs such as natalizumab and interferon-β, which lead to activation and accumulation of B cells in the peripheral blood, lack efficacy or even induce catastrophic disease activity in NMOSD. Hence, we conclude that the differential effect of MS drugs on B cells is one potential parameter determining the therapeutic efficacy or failure in antibody-dependent diseases like seropositive NMOSD.
Collapse
|
11
|
Agasing AM, Wu Q, Khatri B, Borisow N, Ruprecht K, Brandt AU, Gawde S, Kumar G, Quinn JL, Ko RM, Mao-Draayer Y, Lessard CJ, Paul F, Axtell RC. Transcriptomics and proteomics reveal a cooperation between interferon and T-helper 17 cells in neuromyelitis optica. Nat Commun 2020; 11:2856. [PMID: 32503977 PMCID: PMC7275086 DOI: 10.1038/s41467-020-16625-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/12/2020] [Indexed: 12/24/2022] Open
Abstract
Type I interferon (IFN-I) and T helper 17 (TH17) drive pathology in neuromyelitis optica spectrum disorder (NMOSD) and in TH17-induced experimental autoimmune encephalomyelitis (TH17-EAE). This is paradoxical because the prevalent theory is that IFN-I inhibits TH17 function. Here we report that a cascade involving IFN-I, IL-6 and B cells promotes TH17-mediated neuro-autoimmunity. In NMOSD, elevated IFN-I signatures, IL-6 and IL-17 are associated with severe disability. Furthermore, IL-6 and IL-17 levels are lower in patients on anti-CD20 therapy. In mice, IFN-I elevates IL-6 and exacerbates TH17-EAE. Strikingly, IL-6 blockade attenuates disease only in mice treated with IFN-I. By contrast, B-cell-deficiency attenuates TH17-EAE in the presence or absence of IFN-I treatment. Finally, IFN-I stimulates B cells to produce IL-6 to drive pathogenic TH17 differentiation in vitro. Our data thus provide an explanation for the paradox surrounding IFN-I and TH17 in neuro-autoimmunity, and may have utility in predicting therapeutic response in NMOSD.
Collapse
Affiliation(s)
- Agnieshka M Agasing
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
- Department of Microbiology and Immunology, Oklahoma University Health Science Center, 940 Stanton L. Young Blvd., BMSB 1053, Oklahoma City, OK, 73104, USA
| | - Qi Wu
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Biomedical Research Building Room 4258, Ann Arbor, MI, 48109, USA
| | - Bhuwan Khatri
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
| | - Nadja Borisow
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany
| | - Alexander Ulrich Brandt
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin, Lindenberger Weg 80, 13125, Berlin, Germany
- Department of Neurology, University of California, Irvine Hall, R105, 252 Health Sciences Rd: 4290, 92697, Irvine, California, USA
| | - Saurabh Gawde
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
- Department of Microbiology and Immunology, Oklahoma University Health Science Center, 940 Stanton L. Young Blvd., BMSB 1053, Oklahoma City, OK, 73104, USA
| | - Gaurav Kumar
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
| | - James L Quinn
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
- Department of Microbiology and Immunology, Oklahoma University Health Science Center, 940 Stanton L. Young Blvd., BMSB 1053, Oklahoma City, OK, 73104, USA
| | - Rose M Ko
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, 109 Zina Pitcher Place, Biomedical Research Building Room 4258, Ann Arbor, MI, 48109, USA
| | - Christopher J Lessard
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin, Lindenberger Weg 80, 13125, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany
| | - Robert C Axtell
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 NE 13th St, Oklahoma City, OK, 73104, USA.
- Department of Microbiology and Immunology, Oklahoma University Health Science Center, 940 Stanton L. Young Blvd., BMSB 1053, Oklahoma City, OK, 73104, USA.
| |
Collapse
|
12
|
Palace J, Lin DY, Zeng D, Majed M, Elsone L, Hamid S, Messina S, Misu T, Sagen J, Whittam D, Takai Y, Leite MI, Weinshenker B, Cabre P, Jacob A, Nakashima I, Fujihara K, Pittock SJ. Outcome prediction models in AQP4-IgG positive neuromyelitis optica spectrum disorders. Brain 2020; 142:1310-1323. [PMID: 30938427 PMCID: PMC6487334 DOI: 10.1093/brain/awz054] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/23/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Abstract
Pathogenic antibodies targeting the aquaporin-4 water channel on astrocytes are associated with relapsing inflammatory neuromyelitis optica spectrum disorders. The clinical phenotype is characterized by recurrent episodes of optic neuritis, longitudinally extensive transverse myelitis, area postrema attacks and less common brainstem and cerebral events. Patients often develop major residual disability from these attacks, so early diagnosis and initiation of attackpreventing medications is important. Accurate prediction of relapse would assist physicians in counselling patients, planning treatment and designing clinical trials. We used a large multicentre dataset of 441 patients from the UK, USA, Japan and Martinique who collectively experienced 1976 attacks, and applied sophisticated mathematical modelling to predict likelihood of relapse and disability at different time points. We found that Japanese patients had a lower risk of subsequent attacks except for brainstem and cerebral events, with an overall relative relapse risk of 0.681 (P = 0.001) compared to Caucasians and African patients, who had a higher likelihood of cerebral attacks, with a relative relapse risk of 3.309 (P = 0.009) compared to Caucasians. Female patients had a higher chance of relapse than male patients (P = 0.009), and patients with younger age of onset were more likely to have optic neuritis relapses (P < 0.001). Immunosuppressant drugs reduced and multiple sclerosis disease-modifying agents increased the likelihood of relapse (P < 0.001). Patients with optic neuritis at onset were more likely to develop blindness (P < 0.001), and those with older age of onset were more likely to develop ambulatory disability. Only 25% of long-term disability was related to initial onset attack, indicating the importance of early attack prevention. With respect to selection of patients for clinical trial design, there would be no gain in power by selecting recent onset patients and only a small gain by selecting patients with recent high disease activity. We provide risk estimates of relapse and disability for patients diagnosed and treated with immunosuppressive treatments over the subsequent 2, 3, 5 and 10 years according to type of attack at onset or the first 2-year course, ethnicity, sex and onset age. This study supports significant effects of onset age, onset phenotype and ethnicity on neuromyelitis optica spectrum disorders outcomes. Our results suggest that powering clinical treatment trials based upon relapse activity in the preceding 2 years may offer little benefit in the way of attack risk yet severely hamper clinical trial success.
Collapse
Affiliation(s)
| | - Dan-Yu Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Masoud Majed
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA.,Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA
| | - Liene Elsone
- The Walton Centre, NHS Foundation Trust, Liverpool, UK
| | - Shahd Hamid
- The Walton Centre, NHS Foundation Trust, Liverpool, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jessica Sagen
- Clinical Research Unit, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA
| | | | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Brian Weinshenker
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA
| | - Philippe Cabre
- Department of Neurology, Fort-de-France University Hospital Center, Pierre Zobda Quitman Hospital, Fort-de-France, Martinique, France
| | - Anu Jacob
- The Walton Centre, NHS Foundation Trust, Liverpool, UK
| | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for NeuroScience, Koriyama, Japan
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA.,Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, Minnesota, USA
| |
Collapse
|
13
|
Hansen MR, Okuda DT. Precision medicine for multiple sclerosis promotes preventative medicine. Ann N Y Acad Sci 2019; 1420:62-71. [PMID: 29878402 DOI: 10.1111/nyas.13846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022]
Abstract
Multiple sclerosis (MS) is a chronic, lifelong disease, currently without a cure that is responsible for significant neurological injury in young adults. Precision medicine for MS aims to provide a more exacting and refined approach toward management by providing recommendations based on disease subtype, clinical status, existing radiological data, para-clinical data, and other biological markers. To achieve better outcomes, the three stages of care-diagnosis, treatment, and management-should be optimized. However, as the temporal profile of disease behavior is highly variable in MS, and unlike outcomes from other chronic conditions (i.e., hypertension, diabetes mellitus, etc.), should precision medicine for MS be one that focuses more on disease prevention and lifestyle modifications beyond recommendations for the use of disease-modifying therapies? As scientific advancements continue within the field of neuroimmunology, and until reliable biomarkers that predict disease outcomes are available, success may be better achieved by focusing on modifiable factors to reduce future disability.
Collapse
Affiliation(s)
- Madison R Hansen
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Dallas, Texas
| | - Darin T Okuda
- UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, Clinical Center for Multiple Sclerosis, Dallas, Texas
| |
Collapse
|
14
|
Gao D, He M, Xu Q, Huang D, Wei S, Tian Y. Neuromyelitis optica spectrum disorder occurred after interferon alpha therapy in malignant melanoma. Mult Scler Relat Disord 2019; 32:33-36. [PMID: 31030016 DOI: 10.1016/j.msard.2019.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/07/2019] [Accepted: 04/20/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several cases of neuromyelitis optica spectrum disorder (NMOSD) caused by interferon alpha (IFN-α) treatment in hepatitis C were reported in past literatures, but NMOSD resulted from IFN-α treatment in tumor has not yet been reported previously. METHODS A unique case of NMOSD caused by IFN-α therapy in malignant melanoma is presented. Related cases about NMOSD caused by IFN-α therapy on Pubmed were reviewed further. RESULTS A 40-year-old Chinese woman was diagnosed as right breast skin malignant melanoma and received melanoma resection in April 2012, then underwent IFN-α-2b therapy (5 million IU every time, 3 times/week) from May 2012 to Sep 2016. In December 2016, the patient developed bilateral optic neuritis, with no light perception at her worst. After a month-long glucocorticoid treatment, she could see finger movement from 40 cm. Serum positive anti-AQP-4 antibody was found by enzyme-linked immunosorbent assay (ELISA, 75.9 u/ml) in Feb 2017 and indirect immunofluorescence testing (IIFT, 1:320) in Sep 2017. Methylprednisolone (8 mg/day) and rituximab (0.1 g/every 6 months) were used for prevention. On the follow up visit in Jan 2019, she could see finger movement from 1 m, and no melanoma and NMOSD relapse were complained. Literature review only found 3 cases of NMOSD caused by IFN-α treatment in hepatitis. CONCLUSIONS A unique case of NMOSD with positive anti-AQP-4 antibody after IFN-α treatment in malignant melanoma was reported. Type I IFNs may be pro-inflammatory in NMOSD and this possible consequence of IFNs use should be cautioned in future practice.
Collapse
Affiliation(s)
- Dan Gao
- Medical school of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China; Core Laboratory of Translational Medicine, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28# Fu-Xing Road, Beijing 100853, People's Republic of China
| | - Mianwang He
- Neurology Department, Chinese PLA General hospital, 28# Fuxing Road, Beijing, People's Republic of China.
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, 28# Fuxing Road, Beijing 100853, People's Republic of China
| | - Dehui Huang
- Neurology Department, Chinese PLA General hospital, 28# Fuxing Road, Beijing, People's Republic of China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, 28# Fuxing Road, Beijing 100853, People's Republic of China.
| | - Yaping Tian
- Medical school of Nankai University, 29# Weijing Road, Tianjin, People's Republic of China; Core Laboratory of Translational Medicine, State Key Laboratory of Kidney Disease, Chinese PLA General Hospital, 28# Fu-Xing Road, Beijing 100853, People's Republic of China.
| |
Collapse
|
15
|
Enriquez CAG, Espiritu AI, Pasco PMD. Efficacy and tolerability of mitoxantrone for neuromyelitis optica spectrum disorder: A systematic review. J Neuroimmunol 2019; 332:126-134. [DOI: 10.1016/j.jneuroim.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 11/26/2022]
|
16
|
West PK, Viengkhou B, Campbell IL, Hofer MJ. Microglia responses to interleukin‐6 and type I interferons in neuroinflammatory disease. Glia 2019; 67:1821-1841. [DOI: 10.1002/glia.23634] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Phillip K. West
- School of Life and Environmental Sciences, The Marie Bashir Institute for Infectious Diseases and Biosecurity, The Charles Perkins Centre, and The Bosch InstituteThe University of Sydney Sydney New South Wales Australia
| | - Barney Viengkhou
- School of Life and Environmental Sciences, The Marie Bashir Institute for Infectious Diseases and Biosecurity, The Charles Perkins Centre, and The Bosch InstituteThe University of Sydney Sydney New South Wales Australia
| | - Iain L. Campbell
- School of Life and Environmental Sciences, The Marie Bashir Institute for Infectious Diseases and Biosecurity, The Charles Perkins Centre, and The Bosch InstituteThe University of Sydney Sydney New South Wales Australia
| | - Markus J. Hofer
- School of Life and Environmental Sciences, The Marie Bashir Institute for Infectious Diseases and Biosecurity, The Charles Perkins Centre, and The Bosch InstituteThe University of Sydney Sydney New South Wales Australia
| |
Collapse
|
17
|
Mekhasingharak N, Laowanapiban P, Siritho S, Satukijchai C, Prayoonwiwat N, Jitprapaikulsan J, Chirapapaisan N. Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis. Int J Ophthalmol 2018; 11:1649-1656. [PMID: 30364209 DOI: 10.18240/ijo.2018.10.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/10/2018] [Indexed: 12/20/2022] Open
Abstract
AIM To compare the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) among patients with various forms of optic neuritis (ON) and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON. METHODS This prospective study was conducted at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Thailand, between January, 2015 and December, 2016. We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups: 1) aquaporin 4 antibodies (AQP4-IgG) positive; 2) multiple sclerosis (MS); 3) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) positive; 4) idiopathic-ON patients. Healthy controls were also included during the same study period. All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography (OCT) imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON. The generalized estimating equation (GEE) models were used to compare the data amongst ON groups. RESULTS Among 87 previous ON eyes from 57 patients (43 AQP4-IgG+ON, 17 MS-ON, 8 MOG-IgG+ON, and 19 idiopathic-ON), mean logMAR visual acuity of AQP4-IgG+ON, MS-ON, MOG-IgG+ON, and idiopathic-ON groups was 0.76±0.88, 0.12±0.25, 0.39±0.31, and 0.75±1.08, respectively. Average, superior, and inferior RNFL were significantly reduced in AQP4-IgG+ON, MOG-IgG+ON and idiopathic-ON eyes, relative to those of MS-ON. Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG+ON and MOG-IgG+ON groups, whereas visual acuity in MOG-IgG+ON was slightly, but not significantly, better (0.39 vs 0.76). Although RNFL thickness in MOG-IgG+ON was significantly reduced as compared to MS-ON, mean visual acuity and GCIPL were not different. CONCLUSION Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG+ON and AQP4-IgG+ON. Long term visual acuity in MOG-IgG+ON is often better than AQP4-IgG+ON, whereas the structural change from OCT is comparable.
Collapse
Affiliation(s)
- Nattapong Mekhasingharak
- Department of Ophthalmology, Naresuan University Hospital, Naresuan University, Phitsanulok 65000, Thailand
| | | | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.,Bumrungrad International Hospital, Bangkok 10110, Thailand
| | - Chanjira Satukijchai
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.,Bangkok Hospital Headquarters, Bangkok 10310, Thailand
| | - Naraporn Prayoonwiwat
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jiraporn Jitprapaikulsan
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Niphon Chirapapaisan
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW The discovery of aquaporin-4 (AQP4) antibodies with high specificity for neuromyelitis optica spectrum disorder (NMOSD) has induced tremendous changes in the approach and management of central nervous system (CNS) neuroinflammatory disorders. Owing to the increasing availability of the AQP4 antibody assay and evolution of diagnostic criteria for multiple sclerosis and NMOSD, recent studies have reevaluated CNS neuroinflammatory disorders. This review describes recent advances in the understanding of CNS neuroinflammatory disorders in Asian/Pacific regions. RECENT FINDINGS Although multiple sclerosis prevalence is lower in Asian countries than in Western countries, the overall clinical features of multiple sclerosis are comparable between these countries. Hospital-based studies have reported that the frequency of NMOSD is higher in Asian populations (22-42%) than in white populations (2-26%). Despite improvements in the AQP4 antibody assay, AQP4 antibodies are not detected in certain patients with NMOSD. Recently, myelin oligodendrocyte glycoprotein (MOG) antibodies have been identified in AQP4 antibody-negative patients with the NMOSD phenotype, and the clinical features differ slightly between MOG antibody-positive patients and AQP4 antibody-positive patients. SUMMARY The understanding of CNS neuroinflammatory disorders in Asian/Pacific regions continues to evolve owing to the discovery of new biological markers and recognition of broader clinical phenotypes.
Collapse
|
19
|
Jarius S, König FB, Metz I, Ruprecht K, Paul F, Brück W, Wildemann B. Pattern II and pattern III MS are entities distinct from pattern I MS: evidence from cerebrospinal fluid analysis. J Neuroinflammation 2017; 14:171. [PMID: 28851393 PMCID: PMC5576197 DOI: 10.1186/s12974-017-0929-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023] Open
Abstract
Background The diagnosis of multiple sclerosis (MS) is currently based solely on clinical and magnetic resonance imaging features. However, histopathological studies have revealed four different patterns of lesion pathology in patients diagnosed with MS, suggesting that MS may be a pathologically heterogeneous syndrome rather than a single disease entity. Objective The aim of this study was to investigate whether patients with pattern I MS differ from patients with pattern II or III MS with regard to cerebrospinal fluid (CSF) findings, especially with reference to intrathecal IgG synthesis, which is found in most patients with MS but is frequently missing in MS mimics such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein-IgG-positive encephalomyelitis. Methods Findings from 68 lumbar punctures in patients who underwent brain biopsy as part of their diagnostic work-up and who could be unequivocally classified as having pattern I, pattern II or pattern III MS were analysed retrospectively. Results Oligoclonal bands (OCBs) were present in 88.2% of samples from pattern I MS patients but in only 27% of samples from patients with pattern II or pattern III MS (P < 0.00004); moreover, OCBs were present only transiently in some of the latter patients. A polyspecific intrathecal IgG response to measles, rubella and/or varicella zoster virus (so-called MRZ reaction) was previously reported in 60–80% of MS patients, but was absent in all pattern II or III MS patients tested (P < 0.00001 vs. previous cohorts). In contrast, the albumin CSF/serum ratio (QAlb), a marker of blood–CSF barrier function, was more frequently elevated in samples from pattern II and III MS patients (P < 0.002). Accordingly, QAlb values and albumin and total protein levels were higher in pattern II and III MS samples than in pattern I MS samples (P < 0.005, P < 0.009 and P < 0.006, respectively). Conclusions Patients with pattern II or pattern III MS differ significantly from patients with pattern I MS as well as from previous, histologically non-classified MS cohorts with regard to both intrathecal IgG synthesis and blood–CSF barrier function. Our findings strongly corroborate the notion that pattern II and pattern III MS are entities distinct from pattern I MS.
Collapse
Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - F B König
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - I Metz
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - K Ruprecht
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - F Paul
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Berlin, Germany
| | - W Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany.
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
20
|
Abstract
Treatments with a range of efficacy and risk of adverse events have become available for the management of multiple sclerosis (MS). However, now the heterogeneity of clinical expression and responses to treatment pose major challenges to improving patient care. Selecting and managing the drug best balancing benefit and risk demands a new focus on the individual patient. Personalised medicine for MS is based on improving the precision of diagnosis for each patient in order to capture prognosis and provide an evidence-based framework for predicting treatment response and personalising patient monitoring. It involves development of predictive models involving the integration of clinical and biological data with an understanding of the impact of disease on the lives of individual patients. Here, we provide a brief, selective review of challenges to personalisation of the management of MS and suggest an agenda for stakeholder engagement and research to address them.
Collapse
Affiliation(s)
- Arie Gafson
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Matt J Craner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul M Matthews
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK/Centre for Neurotechnology, Imperial College London, London, UK
| |
Collapse
|
21
|
Lin J, Li X, Xia J. Th17 cells in neuromyelitis optica spectrum disorder: a review. Int J Neurosci 2016; 126:1051-60. [DOI: 10.3109/00207454.2016.1163550] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Oji S, Nicolussi EM, Kaufmann N, Zeka B, Schanda K, Fujihara K, Illes Z, Dahle C, Reindl M, Lassmann H, Bradl M. Experimental Neuromyelitis Optica Induces a Type I Interferon Signature in the Spinal Cord. PLoS One 2016; 11:e0151244. [PMID: 26990978 PMCID: PMC4798752 DOI: 10.1371/journal.pone.0151244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/25/2016] [Indexed: 12/15/2022] Open
Abstract
Neuromyelitis optica (NMO) is an acute inflammatory disease of the central nervous system (CNS) which predominantly affects spinal cord and optic nerves. Most patients harbor pathogenic autoantibodies, the so-called NMO-IgGs, which are directed against the water channel aquaporin 4 (AQP4) on astrocytes. When these antibodies gain access to the CNS, they mediate astrocyte destruction by complement-dependent and by antibody-dependent cellular cytotoxicity. In contrast to multiple sclerosis (MS) patients who benefit from therapies involving type I interferons (I-IFN), NMO patients typically do not profit from such treatments. How is I-IFN involved in NMO pathogenesis? To address this question, we made gene expression profiles of spinal cords from Lewis rat models of experimental neuromyelitis optica (ENMO) and experimental autoimmune encephalomyelitis (EAE). We found an upregulation of I-IFN signature genes in EAE spinal cords, and a further upregulation of these genes in ENMO. To learn whether the local I-IFN signature is harmful or beneficial, we induced ENMO by transfer of CNS antigen-specific T cells and NMO-IgG, and treated the animals with I-IFN at the very onset of clinical symptoms, when the blood-brain barrier was open. With this treatment regimen, we could amplify possible effects of the I-IFN induced genes on the transmigration of infiltrating cells through the blood brain barrier, and on lesion formation and expansion, but could avoid effects of I-IFN on the differentiation of pathogenic T and B cells in the lymph nodes. We observed that I-IFN treated ENMO rats had spinal cord lesions with fewer T cells, macrophages/activated microglia and activated neutrophils, and less astrocyte damage than their vehicle treated counterparts, suggesting beneficial effects of I-IFN.
Collapse
Affiliation(s)
- Satoru Oji
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Eva-Maria Nicolussi
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Nathalie Kaufmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Bleranda Zeka
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Kazuo Fujihara
- Departments of Multiple Sclerosis Therapeutics and Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Zsolt Illes
- Department of Neurology, University of Southern Denmark, Odense, Denmark
| | - Charlotte Dahle
- Department of Clinical Immunology and Transfusion Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Markus Reindl
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| | - Monika Bradl
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
- * E-mail:
| |
Collapse
|
23
|
Hegen H, Adrianto I, Lessard CJ, Millonig A, Bertolotto A, Comabella M, Giovannoni G, Guger M, Hoelzl M, Khalil M, Fazekas F, Killestein J, Lindberg RLP, Malucchi S, Mehling M, Montalban X, Rudzki D, Schautzer F, Sellebjerg F, Sorensen PS, Deisenhammer F, Steinman L, Axtell RC. Cytokine profiles show heterogeneity of interferon-β response in multiple sclerosis patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e202. [PMID: 26894205 PMCID: PMC4747480 DOI: 10.1212/nxi.0000000000000202] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/16/2015] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate serum cytokine profiles for their utility to determine the heterogeneous responses to interferon (IFN)–β treatment in patients with multiple sclerosis (MS). Methods: Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome receiving de novo IFN-β treatment were included in this prospective, observational study. Number of relapses and changes in disability were assessed 2 years prior to and 2 years after initiation of treatment. Sera were collected at baseline and after 3 months on therapy. Cytokine levels in sera were assessed by Luminex multiplex assays. Baseline cytokine profiles were grouped by hierarchical clustering analysis. Demographic features, changes in cytokines, and clinical outcome were then assessed in the clustered patient groups. Results: A total of 157 patients were included in the study and clustered into 6 distinct subsets by baseline cytokine profiles. These subsets differed significantly in their clinical and biological response to IFN-β therapy. Two subsets were associated with patients who responded poorly to therapy. Two other subsets, associated with a good response to therapy, showed a significant reduction in relapse rates and no worsening of disability. Each subset also had differential changes in cytokine levels after 3 months of IFN-β treatment. Conclusions: There is heterogeneity in the immunologic pathways of the RRMS population, which correlates with IFN-β response.
Collapse
Affiliation(s)
- Harald Hegen
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Indra Adrianto
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Christopher J Lessard
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Alban Millonig
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Antonio Bertolotto
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Manuel Comabella
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Gavin Giovannoni
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Michael Guger
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Martina Hoelzl
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Michael Khalil
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Franz Fazekas
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Joep Killestein
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Raija L P Lindberg
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Simona Malucchi
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Matthias Mehling
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Xavier Montalban
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Dagmar Rudzki
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Franz Schautzer
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Finn Sellebjerg
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Per Soelberg Sorensen
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Florian Deisenhammer
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Lawrence Steinman
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| | - Robert C Axtell
- Department of Neurology (H.H., A.M., M.H., D.R., F.D.), Medical University of Innsbruck, Austria; Department of Arthritis and Clinical Immunology (I.A., C.J.L., R.C.A.), Oklahoma Medical Research Foundation, Oklahoma City; Centro di Riferimento Regionale Sclerosi Multipla (A.B., S.N.), Neurologia 2, Azienda Ospedaliero Universitaria San Luigi Gonzaga, Orbassano, Turin, Italy; Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (M.C., X.M.), Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Queen Mary University London (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Clinical Department of Neurology (M.G.), Allgemeines Krankenhaus Linz, Austria; Department of Neurology (M.K., F.F.), Medical University of Graz, Austria; Department of Neurology (J.K.), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; Department of Biomedicines and Neurology (R.L.P.L., M.M.), Clinical Neuroimmunology, University of Basel, University Hospital Basel, Switzerland; Clinical Department of Neurology (F. Schautzer), Landeskrankenhaus Villach, Austria; Danish Multiple Sclerosis Center (F. Sellebjerg, P.S.S.), Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; and Department of Neurology and Neurological Sciences (L.S.), Stanford University School of Medicine, CA
| |
Collapse
|
24
|
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are important evolving entities, which have reached much attention in the recent years. NMOSD are characterized by inflammatory lesions in the optic nerves, spinal cord, and central parts of the brain, as well as an autoimmune process directed against aquaporin-4. As disability in NMOSD accumulates by inflammatory damage from attacks, both the treatment and prevention of attacks are decisive for the long-term outcome. NMOSD attacks are treated with high-dose intravenous corticosteroids and apheresis therapies, in particular therapeutic plasma exchange. In cases of incomplete remission, escalation of attack treatment is recommended. Preventive therapy is immunosuppressive and should by commenced as early as possible. Apart from classical immunosuppressants such as azathioprine and mycophenolate mofetil, repurposed biologicals are increasingly used. B-cell depletion with rituximab and other agents, inhibition of the interleukin-6 receptor with tocilizumab, and blockade of complement-mediated damage by eculizumab all are promising therapeutic strategies evaluated in randomized controlled trials. In this review, we will discuss present and future immunotherapies for NMOSD and also consider combination of treatments, plasma, cellular and other therapies. Current advances in immunopathological knowledge are translated into innovative concepts and begin a new era of NMOSD therapy.
Collapse
Affiliation(s)
- Ingo Kleiter
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| |
Collapse
|
25
|
Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating condition of the central nervous system often associated with aquaporin-4 (AQP4) autoantibodies manifesting as severe optic neuritis and long segment myelitis with tendency to relapse. Seronegative patients and who do not meet the NMO criteria are classified as having NMO Spectrum Disorder (NMOSD), but are treated identically to clinically definite NMO. Acute relapse is treated with intravenous methylprednisolone for 5 days with or without subsequent treatment with plasma exchange (PE). This must be followed by oral steroid to prevent rebound worsening and further relapse. For relapse prevention, immunosuppressive agents that have been found to be effective are azathioprine, rituximab, mycophenolate mofetil, methotrexate, and mitoxantrone; although none of which have been validated in randomized, controlled trial. Some patients do relapse with monotherapy, and switching to more effective agent or use of combination therapy is beneficial in such situation. There is no consensus about the duration of preventive therapy, but generally 2-3 years of relapse-free period is considered the minimum, taking into account the risks of long-term toxicity of these agents.
Collapse
Affiliation(s)
- Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, India
| | - Arabinda Mukherjee
- Department of Neurology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| |
Collapse
|
26
|
Harmel J, Ringelstein M, Ingwersen J, Mathys C, Goebels N, Hartung HP, Jarius S, Aktas O. Interferon-β-related tumefactive brain lesion in a Caucasian patient with neuromyelitis optica and clinical stabilization with tocilizumab. BMC Neurol 2014; 14:247. [PMID: 25516429 PMCID: PMC4301061 DOI: 10.1186/s12883-014-0247-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
Background Neuromyelitis optica (NMO) is a severely disabling inflammatory disorder of the central nervous system and is often misdiagnosed as multiple sclerosis (MS). There is increasing evidence that treatment options shown to be beneficial in MS, including interferon-β (IFN-β), are detrimental in NMO. Case presentation We here report the first Caucasian patient with aquaporin 4 (AQP4) antibody (NMO-IgG)-seropositive NMO presenting with a tumefactive brain lesion on treatment with IFN-β. Disease started with relapsing optic neuritis and an episode of longitudinally extensive transverse myelitis (LETM) in the absence of any brain MRI lesions or cerebrospinal fluid-restricted oligoclonal bands. After initial misdiagnosis of multiple sclerosis (MS) the patient received subcutaneous IFN-β1b and, subsequently, subcutaneous IFN-β1a therapy for several years. Under this treatment, the patient showed persisting relapse activity and finally presented with a severe episode of subacute aphasia and right-sided hemiparesis due to a large T2 hyperintensive tumefactive lesion of the left brain hemisphere and a smaller T2 lesion on the right side. Despite rituximab therapy two further LETM episodes occurred, resulting in severe neurological deficits. Therapeutic blockade of the interleukin (IL)-6 signalling pathway by tocilizumab was initiated, followed by clinical and radiological stabilization. Conclusion Our case (i) illustrates the relevance of correctly distinguishing NMO and MS since these disorders differ markedly in their responsiveness to immunomodulatory and -suppressive therapies; (ii) confirms and extends a previous report describing the development of tumefactive brain lesions under IFN-β therapy in two Asian NMO patients; and (iii) suggests tocilizumab as a promising therapeutic alternative in highly active NMO disease courses.
Collapse
|
27
|
Kuchling J, Sinnecker T, Bozin I, Dörr J, Madai VI, Sobesky J, Niendorf T, Paul F, Wuerfel J. [Ultrahigh field MRI in context of neurological diseases]. DER NERVENARZT 2014; 85:445-58. [PMID: 24549692 DOI: 10.1007/s00115-013-3967-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ultrahigh field magnetic resonance imaging (UHF-MRI) has recently gained substantial scientific interest. At field strengths of 7 Tesla (T) and higher UHF-MRI provides unprecedented spatial resolution due to an increased signal-to-noise ratio (SNR). The UHF-MRI method has been successfully applied in various neurological disorders. In neuroinflammatory diseases UHF-MRI has already provided a detailed insight into individual pathological disease processes and elucidated differential diagnoses of several disease entities, e.g. multiple sclerosis (MS), neuromyelitis optica (NMO) and Susac's syndrome. The excellent depiction of normal blood vessels, vessel abnormalities and infarct morphology by UHF-MRI can be utilized in vascular diseases. Detailed imaging of the hippocampus in Alzheimer's disease and the substantia nigra in Parkinson's disease as well as sensitivity to iron depositions could be valuable in neurodegenerative diseases. Current UHF-MRI studies still suffer from small sample sizes, selection bias or propensity to image artefacts. In addition, the increasing clinical relevance of 3T-MRI has not been sufficiently appreciated in previous studies. Although UHF-MRI is only available at a small number of medical research centers it could provide a high-end diagnostic tool for healthcare optimization in the foreseeable future. The potential of UHF-MRI still has to be carefully validated by profound prospective research to define its place in future medicine.
Collapse
Affiliation(s)
- J Kuchling
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Biomarkers for neuromyelitis optica. Clin Chim Acta 2014; 440:64-71. [PMID: 25444748 DOI: 10.1016/j.cca.2014.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/31/2014] [Accepted: 11/01/2014] [Indexed: 02/06/2023]
Abstract
Neuromyelitis optica (NMO) is an acquired, heterogeneous inflammatory disorder, which is characterized by recurrent optic neuritis and longitudinally extensive spinal cord lesions. The discovery of the serum autoantibody marker, anti-aquaporin 4 (anti-AQP4) antibody, revolutionizes our understanding of pathogenesis of NMO. In addition to anti-AQP4 antibody, other biomarkers for NMO are also reported. These candidate biomarkers are particularly involved in T helper (Th)17 and astrocytic damages, which play a critical role in the development of NMO lesions. Among them, IL-6 in the peripheral blood is associated with anti-AQP4 antibody production. Glial fibrillary acidic protein (GFAP) in CSF demonstrates good correlations with clinical severity of NMO relapses. Detecting these useful biomarkers may be useful in the diagnosis and evaluation of disease activity of NMO. Development of compounds targeting these biomarkers may provide novel therapeutic strategies for NMO. This article will review the related biomarker studies in NMO and discuss the potential therapeutics targeting these biomarkers.
Collapse
|
29
|
Uzawa A, Mori M, Masahiro M, Kuwabara S. Cytokines and chemokines in neuromyelitis optica: pathogenetic and therapeutic implications. Brain Pathol 2014; 24:67-73. [PMID: 24345220 DOI: 10.1111/bpa.12097] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 10/21/2013] [Indexed: 12/27/2022] Open
Abstract
Neuromyelitis optica (NMO) is characterized by severe optic neuritis and longitudinally extensive transverse myelitis. The discovery of an NMO-specific autoantibody to the aquaporin-4 (AQP4) water channel has improved knowledge of NMO pathogenesis. Many studies have focused on inflammatory and pathological biomarkers of NMO, including cytokines and chemokines. Increased concentrations of T helper (Th)17- and Th2-related cytokines and chemokines may be essential factors for developing NMO inflammatory lesions. For example, interleukin-6 could play important roles in NMO pathogenesis, as it is involved in the survival of plasmablasts that produce anti-AQP4 antibody in peripheral circulation and in the enhancement of inflammation in the central nervous system. Therefore, assessment of these useful biomarkers may become a supportive criterion for diagnosing NMO. Significant advances in the understanding of NMO pathogenesis will lead to the development of novel treatment strategies. This review focuses on the current advances in NMO immunological research, particularly that of cytokines and chemokines.
Collapse
Affiliation(s)
- Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba
| | | | | | | |
Collapse
|
30
|
de Seze J, Collongues N. Novel advances in the diagnosis and treatment of neuromyelitis optica: is there a need to redefine the gold standard? Expert Rev Clin Immunol 2014; 9:979-86. [PMID: 24128159 DOI: 10.1586/1744666x.2013.839944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuromyelitis optica (NMO) is an inflammatory disease of the central nervous system characterized by severe attacks of optic neuritis and myelitis and, unlike multiple sclerosis, was initially thought to spare the brain in the early stages. The term NMO spectrum disorder (NMOSD) was recently used to qualify restricted forms of the disorder, which include recurrent optic neuritis, relapsing transverse myelitis and some encephalitic/brainstem presentations associated with positive aquaporin4 antibodies. It was also recently found that other immunological targets such as myelin oligodendrocyte glycoprotein (MOG) may be associated with seronegative NMO patients. In the present study, we detail the moving concept of NMOSD from the recent years and propose some therapeutic strategies that are clearly different compared with multiple sclerosis treatment.
Collapse
Affiliation(s)
- Jérome de Seze
- Department of Neurology, Strasbourg University, Clinical Investigation Center and INSERM BMNST (UMR1119) Strasbourg Hospital, France
| | | |
Collapse
|
31
|
Jarius S, Wildemann B, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014; 176:149-64. [PMID: 24666204 DOI: 10.1111/cei.12271] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 12/11/2022] Open
Abstract
The term 'neuromyelitis optica' ('Devic's syndrome', NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition.
Collapse
Affiliation(s)
- S Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | | |
Collapse
|
32
|
Jarius S, Wildemann B. Aquaporin-4 antibodies (NMO-IgG) as a serological marker of neuromyelitis optica: a critical review of the literature. Brain Pathol 2014; 23:661-83. [PMID: 24118483 DOI: 10.1111/bpa.12084] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 01/19/2023] Open
Abstract
Antibodies to aquaporin-4 (called NMO-IgG or AQP4-Ab) constitute a sensitive and highly specific serum marker of neuromyelitis optica (NMO) that can facilitate the differential diagnosis of NMO and classic multiple sclerosis. NMO-IgG/AQP4-Ab seropositive status has also important prognostic and therapeutic implications in patients with isolated longitudinally extensive myelitis (LETM) or optic neuritis (ON). In this article, we comprehensively review and critically appraise the existing literature on NMO-IgG/AQP4-Ab testing. All available immunoassays-including tissue-based (IHC), cell-based (ICC, FACS) and protein-based (RIPA, FIPA, ELISA, Western blotting) assays-and their differential advantages and disadvantages are discussed. Estimates for sensitivity, specificity, and positive and negative likelihood ratios are calculated for all published studies and accuracies of the various immunoassay techniques compared. Subgroup analyses are provided for NMO, LETM and ON, for relapsing vs. monophasic disease, and for various control groups (eg, MS vs. other controls). Numerous aspects of NMO-IgG/AQP4-Ab testing relevant for clinicians (eg, impact of antibody titers and longitudinal testing, indications for repeat testing, relevance of CSF testing and subclass analysis, NMO-IgG/AQP4-Ab in patients with rheumatic diseases) as well as technical aspects (eg, AQP4-M1 vs. AQP4-M23-based assays, intact AQP4 vs. peptide substrates, effect of storage conditions and freeze/thaw cycles) and pitfalls are discussed. Finally, recommendations for the clinical application of NMO-IgG/AQP4-Ab serology are given.
Collapse
Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
33
|
Poor responses to interferon-beta treatment in patients with neuromyelitis optica and multiple sclerosis with long spinal cord lesions. PLoS One 2014; 9:e98192. [PMID: 24887452 PMCID: PMC4041653 DOI: 10.1371/journal.pone.0098192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 04/30/2014] [Indexed: 11/19/2022] Open
Abstract
Interferon-beta (IFN-β) treatment may not be effective in neuromyelitis optica (NMO). Whether the poor response to IFN-β is related to long spinal cord lesions (LSCL) or the NMO disease entity itself is unclear. We evaluated the spinal cord involvement of patients with multiple sclerosis (MS) and NMO, as well as the response after receiving IFN-β. Forty-nine MS and 21 NMO patients treated with IFN-β for at least 2 years from 2002–2008 were enrolled in this study and the treatment response was analyzed 2 years post-treatment. In the study, spinal cord lesions were present in 57.1% (28/49) of the MS patients, of which 16.3% (8/49) presented spinal cord lesions longer than 3 vertebral segments (LSCL). Responses to IFN-β treatment were seen in 69.3% (34/49) of all the MS cases, of which the appropriate response rates were 76.1% (16/21) in MS patients without spinal cord lesions and 37.5% (3/8) in patients with LSCL. Only 14.2% (3/21) of NMO patients responded to IFN-β treatment. In conclusion, spinal cord lesion is common in MS patients in Taiwan. Both NMO and MS patients with LSCL had a poor response to IFN-β treatment. NMO patients had a worse response to IFN-β treatment than MS patients with LSCL, which shows that the crucial structural defect is something other than LSCL such as the elevated serum IL17 level in NMO compared to MS.
Collapse
|
34
|
Ainiding G, Kawano Y, Sato S, Isobe N, Matsushita T, Yoshimura S, Yonekawa T, Yamasaki R, Murai H, Kira JI. Interleukin 2 receptor α chain gene polymorphisms and risks of multiple sclerosis and neuromyelitis optica in southern Japanese. J Neurol Sci 2014; 337:147-50. [DOI: 10.1016/j.jns.2013.11.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/13/2013] [Accepted: 11/25/2013] [Indexed: 12/21/2022]
|
35
|
Neuromyelitis optica: Concept, immunology and treatment. J Clin Neurosci 2014; 21:12-21. [DOI: 10.1016/j.jocn.2012.12.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/18/2012] [Accepted: 12/01/2012] [Indexed: 12/31/2022]
|
36
|
Trebst C, Jarius S, Berthele A, Paul F, Schippling S, Wildemann B, Borisow N, Kleiter I, Aktas O, Kümpfel T. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol 2013; 261:1-16. [PMID: 24272588 PMCID: PMC3895189 DOI: 10.1007/s00415-013-7169-7] [Citation(s) in RCA: 397] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 12/26/2022]
Abstract
Neuromyelitis optica (NMO, Devic’s syndrome), long considered a clinical variant of multiple sclerosis, is now regarded as a distinct disease entity. Major progress has been made in the diagnosis and treatment of NMO since aquaporin-4 antibodies (AQP4-Ab; also termed NMO-IgG) were first described in 2004. In this review, the Neuromyelitis Optica Study Group (NEMOS) summarizes recently obtained knowledge on NMO and highlights new developments in its diagnosis and treatment, based on current guidelines, the published literature and expert discussion at regular NEMOS meetings. Testing of AQP4-Ab is essential and is the most important test in the diagnostic work-up of suspected NMO, and helps to distinguish NMO from other autoimmune diseases. Furthermore, AQP4-Ab testing has expanded our knowledge of the clinical presentation of NMO spectrum disorders (NMOSD). In addition, imaging techniques, particularly magnetic resonance imaging of the brain and spinal cord, are obligatory in the diagnostic workup. It is important to note that brain lesions in NMO and NMOSD are not uncommon, do not rule out the diagnosis, and show characteristic patterns. Other imaging modalities such as optical coherence tomography are proposed as useful tools in the assessment of retinal damage. Therapy of NMO should be initiated early. Azathioprine and rituximab are suggested as first-line treatments, the latter being increasingly regarded as an established therapy with long-term efficacy and an acceptable safety profile in NMO patients. Other immunosuppressive drugs, such as methotrexate, mycophenolate mofetil and mitoxantrone, are recommended as second-line treatments. Promising new therapies are emerging in the form of anti-IL6 receptor, anti-complement or anti-AQP4-Ab biologicals.
Collapse
Affiliation(s)
- Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Borisow N, Prüss H, Paul F. [Therapeutic options for autoimmune encephalomyelitis]. DER NERVENARZT 2013; 84:461-5. [PMID: 23568167 DOI: 10.1007/s00115-012-3608-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Autoantibodies to neuronal tissue are becoming increasingly more important in the evaluation and classification of several neurological diseases, e.g. neuromyelitis optica, paraneoplastic syndromes of the central nervous system (CNS), stiff person syndrome or autoimmune epilepsy. As these disorders are rare, no evidence-based recommendations for therapy are available. Currently, immunomodulating or immunosuppressive drugs are administered in most cases. In paraneoplastic syndromes treatment of the underlying cancer is of considerable importance. This overview summarizes current experiences and recommendations in the treatment of autoimmune neurological disorders.
Collapse
Affiliation(s)
- N Borisow
- NeuroCure Clinical Research Center und Clinical and Experimental Research Center, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Deutschland.
| | | | | |
Collapse
|
38
|
Jarius S, Wildemann B. Aquaporin-4 antibodies (NMO-IgG) as a serological marker of neuromyelitis optica: a critical review of the literature. BRAIN PATHOLOGY (ZURICH, SWITZERLAND) 2013. [PMID: 24118483 DOI: 10.1111/bpa.12084"] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Antibodies to aquaporin-4 (called NMO-IgG or AQP4-Ab) constitute a sensitive and highly specific serum marker of neuromyelitis optica (NMO) that can facilitate the differential diagnosis of NMO and classic multiple sclerosis. NMO-IgG/AQP4-Ab seropositive status has also important prognostic and therapeutic implications in patients with isolated longitudinally extensive myelitis (LETM) or optic neuritis (ON). In this article, we comprehensively review and critically appraise the existing literature on NMO-IgG/AQP4-Ab testing. All available immunoassays-including tissue-based (IHC), cell-based (ICC, FACS) and protein-based (RIPA, FIPA, ELISA, Western blotting) assays-and their differential advantages and disadvantages are discussed. Estimates for sensitivity, specificity, and positive and negative likelihood ratios are calculated for all published studies and accuracies of the various immunoassay techniques compared. Subgroup analyses are provided for NMO, LETM and ON, for relapsing vs. monophasic disease, and for various control groups (eg, MS vs. other controls). Numerous aspects of NMO-IgG/AQP4-Ab testing relevant for clinicians (eg, impact of antibody titers and longitudinal testing, indications for repeat testing, relevance of CSF testing and subclass analysis, NMO-IgG/AQP4-Ab in patients with rheumatic diseases) as well as technical aspects (eg, AQP4-M1 vs. AQP4-M23-based assays, intact AQP4 vs. peptide substrates, effect of storage conditions and freeze/thaw cycles) and pitfalls are discussed. Finally, recommendations for the clinical application of NMO-IgG/AQP4-Ab serology are given.
Collapse
Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | |
Collapse
|
39
|
Wang KC, Lee CL, Chen SY, Chen JC, Yang CW, Chen SJ, Tsai CP. Distinct serum cytokine profiles in neuromyelitis optica and multiple sclerosis. J Interferon Cytokine Res 2013; 33:58-64. [PMID: 23398365 DOI: 10.1089/jir.2012.0040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Multiple sclerosis (MS) is the most common prototypic inflammatory demyelinating disease. Neuromyelitis optica (NMO) is another inflammatory demyelinating disease of the central nervous system that exhibits clinical symptoms mainly associated with optic neuritis and myelopathy. The inflammatory reaction in MS is associated with an upregulation of a variety of T helper 1 (Th1)- or Th17-mediated cytokines. However, NMO and MS are intertwined both clinically and pathologically, which complicates their diagnosis and treatment. The aim of this study was to evaluate the differences in serum cytokine levels in patients with NMO and MS. We collected peripheral serum from patients with these central nervous system demyelinating diseases for the study. A cytometric bead array was used to assess the cytokine levels using flow cytometry. We found more inflammatory [interleukin (IL)-2 and interferon-γ) and anti-inflammatory (IL-4 and IL-10) cytokines in NMO than in MS. The differences in the optimal cutoff points of serum cytokines, including IL-2 ≥5 pg/mL, can differentiate NMO from MS. In conclusion, patients with NMO had an increased Th1-mediated inflammatory response, but similar Th17-mediated inflammation changes compared to patients with MS. Serum cytokine studies can differentiate NMO cases from MS.
Collapse
Affiliation(s)
- Kai Chen Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
In relapsing remitting multiple sclerosis (RRMS), type I interferon (IFN) is considered immuno-modulatory, and recombinant forms of IFN-β are the most prescribed treatment for this disease. However, within the RRMS population, 30-50% of MS patients are nonresponsive to this treatment, and it consistently worsens neuromyelitis optica (NMO), a disease once considered to be a form of RRMS. In contrast to RRMS, type I IFNs have been shown to have properties that drive the inflammatory pathologies in many other autoimmune diseases. These diseases include Sjögren's syndrome, system lupus erythematosus (SLE), neuromyelitis optica (NMO), rheumatoid arthritis (RA) and psoriasis. Historically, autoimmune diseases were thought to be driven by a TH1 response to auto-antigens. However, since the discovery of the TH17 in experimental autoimmune encephalomyelitis (EAE), it is now generally thought that TH17 plays an important role in MS and all other autoimmune diseases. In this article, we will discuss recent clinical and basic research advances in the field of autoimmunity and argue that IFN-β and other type I IFNs are immuno-modulatory in diseases driven predominantly by TH1 but in contrast are inflammatory in diseases that have a predominant Th17 response.
Collapse
|
41
|
Yonezu T, Ito S, Mori M, Ogawa Y, Makino T, Uzawa A, Kuwabara S. “Bright spotty lesions” on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler 2013; 20:331-7. [DOI: 10.1177/1352458513495581] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Spinal magnetic resonance imaging (MRI) finding of longitudinally extensive spinal cord lesions (LESCL) extending over three vertebral segments and involvements of spinal central gray matter have been reported in patients with neuromyelitis optica (NMO). Objectives: We aimed to review spinal MRI findings in NMO and multiple sclerosis (MS), and to determine whether the “bright spotty lesions” (BSLs) are a discriminative finding of NMO. Methods: For this study, 24 consecutive patients with NMO and 34 patients with MS were enrolled. BSLs were defined as very hyperintense spotty lesions on axial T2WI. We also studied the length, distribution, signal homogeneity, size, and presence of contrast-enhanced lesions. Results: BSLs were more frequently found in patients with NMO (54%) than in those with MS (3%; p < 0.01). LESCL were found in 67% of the NMO patients. BSLs were seen in 63% of the patients without LESCL. BSLs or LESCL were found in 88% of the NMO patients. Inhomogeneous lesions, transversally extensive lesions, and central lesions were more frequently seen in NMO than in MS. Conclusions: BSLs are a newly defined spinal MRI finding specifically seen in NMO. In combination with LESCL, BSLs can help differentiate patients with NMO from those with MS with higher sensitivity than LESCL alone.
Collapse
Affiliation(s)
- Tadahiro Yonezu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitsugu Ogawa
- Department of Neurology, Chiba Cardiovascular Center, Chiba, Japan
| | - Takahiro Makino
- Department of Neurology, Kashima Rosai Hospital, Ibaraki, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
42
|
Mitsdoerffer M, Kuchroo V, Korn T. Immunology of neuromyelitis optica: a T cell-B cell collaboration. Ann N Y Acad Sci 2013; 1283:57-66. [PMID: 23617588 DOI: 10.1111/nyas.12118] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuromyelitis optica (NMO) is a debilitating autoimmune inflammatory disease of the central nervous system (CNS) that is distinct from multiple sclerosis (MS). The discovery of NMO-immunoglobulin G (IgG) in the serum of NMO-but not MS-patients was a breakthrough in defining diagnostic criteria for NMO. NMO-IgG is an antibody directed against the astrocytic water channel protein aquaporin-4 (AQP4). While there is evidence that NMO-IgG is also involved in mediating tissue damage in the CNS, many aspects of the pathogenic cascade in NMO remain to be determined. It is clear that antigen-specific T cells contribute to the generation of NMO-IgG in the peripheral immune compartment, as well as to the development of NMO lesions in the CNS. T helper 17 (Th17) cells, equipped both in providing B cell help and inducing tissue inflammation, may be involved in NMO development and pathogenesis. Here, we review immunologic aspects of NMO, placing recent findings in the biology of T-B cell cooperation into perspective with autoimmunity of the CNS.
Collapse
Affiliation(s)
- Meike Mitsdoerffer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | |
Collapse
|
43
|
Uzawa A, Mori M, Kuwabara S. Role of interleukin-6 in the pathogenesis of neuromyelitis optica. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/cen3.12024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Akiyuki Uzawa
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba; Japan
| | - Masahiro Mori
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba; Japan
| | - Satoshi Kuwabara
- Department of Neurology; Graduate School of Medicine; Chiba University; Chiba; Japan
| |
Collapse
|
44
|
Raveendra B, Hao W, Baccala R, Reddy MM, Schilke J, Bennett JL, Theofilopoulos AN, Kodadek T. Discovery of peptoid ligands for anti-aquaporin 4 antibodies. CHEMISTRY & BIOLOGY 2013; 20:351-9. [PMID: 23521793 PMCID: PMC3640264 DOI: 10.1016/j.chembiol.2012.12.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/02/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune inflammatory disorder of the central nervous system. In most NMO patients, autoantibodies to the water channel protein Aquaporin 4 (AQP4) are present at high levels and are thought to drive pathology by mediating complement-dependent destruction of astrocytes. Here, we apply recently developed chemical library screening technology to identify a synthetic peptoid that binds anti-AQP4 antibodies in the serum of NMO patients. This finding validates, in a well-defined human disease, that synthetic, unnatural ligands for the antigen-binding site of a disease-linked antibody can be isolated by high-throughput screening.
Collapse
Affiliation(s)
- Bindu Raveendra
- Departments of Chemistry & Cancer Biology, The Scripps Research Institute, 130 Scripps Way, Jupiter, FL 33458
| | - Wu Hao
- Departments of Chemistry & Cancer Biology, The Scripps Research Institute, 130 Scripps Way, Jupiter, FL 33458
| | - Roberto Baccala
- Department of Immunology & Microbial Science, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037
| | | | | | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, University of Colorado School of Medicine, 12700 E. 19 Ave., Aurora, CO 80045
| | - Argyrios N. Theofilopoulos
- Department of Immunology & Microbial Science, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037
| | - Thomas Kodadek
- Departments of Chemistry & Cancer Biology, The Scripps Research Institute, 130 Scripps Way, Jupiter, FL 33458
| |
Collapse
|
45
|
Carroll WM, Saida T, Kim HJ, Kira J, Kermode AG, Tsai CP, Fujihara K, Kusunoki S, Tanaka M, Kim KK, Bates D. A guide to facilitate the early treatment of patients with idiopathic demyelinating disease (multiple sclerosis and neuromyelitis optica). Mult Scler 2013; 19:1371-80. [PMID: 23325588 DOI: 10.1177/1352458512471092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Definite diagnosis of inflammatory demyelinating disease (multiple sclerosis (MS) and neuromyelitis optica (NMO)) may require time, but early treatment offers the opportunity to maximize patient outcomes. The purpose of this report is to provide guidance to facilitate early treatment decisions for patients with inflammatory demyelinating disease, before definitive diagnosis. Neurology experts reviewed the existing literature and clinical evidence. A treatment decision pathway was developed, defining patients for whom first-line MS disease-modifying therapies (a) are unlikely to be effective, (b) may be effective but require careful monitoring and (c) are likely to provide benefit. This algorithm seeks to ensure that patients, particularly those in Asia, receive appropriate treatment early in inflammatory demyelinating disease.
Collapse
|
46
|
Kimbrough DJ, Fujihara K, Jacob A, Lana-Peixoto MA, Leite MI, Levy M, Marignier R, Nakashima I, Palace J, de Seze J, Stuve O, Tenembaum SN, Traboulsee A, Waubant E, Weinshenker BG, Wingerchuk DM. Treatment of Neuromyelitis Optica: Review and Recommendations. Mult Scler Relat Disord 2012; 1:180-187. [PMID: 24555176 DOI: 10.1016/j.msard.2012.06.002] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.
Collapse
Affiliation(s)
| | | | - Anu Jacob
- The Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Marco A Lana-Peixoto
- Medical School of the Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | | | | | | | | | | | | | - Olaf Stuve
- University of Texas Southwestern, Dallas, TX, USA
| | - Silvia N Tenembaum
- National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
A Japanese randomized controlled study showed that Interferon â (IFN-â1b) therapy is clinically effective in decreasing the frequency of attacks in multiple sclerosis (MS), even in optico-spinal MS (OSMS). However, recent studies have shown that IFN-â (IFN-â1a/IFN-â1b) treatment was not effective in neuromyelitis optica (NMO) patients and that the diminished benefit of IFN-â treatment in NMO may be due to different immune responses to IFN-â. We determined longitudinally the expression of CCR5, CXCR3 and CCR4 on CD4+ T and CD8+ T cells in the blood from patients with NMO and MS treated with IFN-â1b. During a 12-month period of IFN-â1b therapy, the annualized relapse rate decreased in MS patients but not in NMO patients. There was no significant difference in the expression of the chemokine receptors between NMO and MS at baseline. The percentages of CD4+CCR5+ and CD4+CXCR3+ T cells, representative of the Th1 response, were decreased in both NMO and MS after treatment. The percentage of CD4+CCR4+ T cells, representative of the Th2 response, was decreased in MS, but those for NMO was significantly increased compared with the pretreatment levels. Our results indicate that IFN-â1b-induced up-modulation of the Th2 response in NMO patients may be the source of differences in the therapeutic response to IFN-â1b therapy. In the present study, Th2 predominance is involved in the pathogenesis of NMO.
Collapse
|
48
|
Makino T, Ito S, Mori M, Yonezu T, Ogawa Y, Kuwabara S. Diffuse and heterogeneous T2-hyperintense lesions in the splenium are characteristic of neuromyelitis optica. Mult Scler 2012; 19:308-15. [DOI: 10.1177/1352458512454772] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Callosal lesions in multiple sclerosis (MS) are usually focal, involving the inferior aspect of the corpus callosum on brain magnetic resonance imaging (MRI), but little is known about callosal lesions in neuromyelitis optica (NMO). Objective: To clarify MRI abnormalities in callosal lesions of NMO. Methods: Japanese patients with NMO ( n=28) or MS ( n=22) were assessed. The distributions and appearances of callosal lesions were evaluated on a brain mid-sagittal T2-weighted image (T2WI) or a fluid-attenuated inversion recovery image with a 1.5T MRI scanner. Logistic regression analysis identified which characteristics of the callosal lesions were useful for discriminating NMO from MS. Results: Callosal lesions were present in 79% of NMO and 82% of MS patients. Callosal abnormalities of NMO, including splenial lesions (57% in NMO versus 27% in MS, odds ratio (OR)=4.23, p=0.04), diffusely spreading lesions from the lower to upper edges of the corpus callosum (71% versus 23%, OR=7.18, p=0.0024), and heterogeneous T2 hyperintense lesions (71% versus 9%, OR=44.3, p=0.0006), were feasible for discriminating NMO from MS. Conclusion: Diffuse and heterogeneous T2 hyperintense splenial lesions were characteristic of NMO. These findings could help distinguish NMO from MS on MRI.
Collapse
Affiliation(s)
| | - Shoichi Ito
- Department of Neurology, Chiba University, Japan
- Office of Medical Education, Chiba University, Japan
| | | | | | | | | |
Collapse
|
49
|
Abstract
In multiple sclerosis, type I interferon (IFN) is considered immune-modulatory, and recombinant forms of IFN-β are the most prescribed treatment for this disease. This is in contrast to most other autoimmune disorders, because type I IFN contributes to the pathologies. Even within the relapsing-remitting multiple sclerosis (RRMS) population, 30-50% of MS patients are non-responsive to this treatment, and it consistently worsens neuromyelitis optica, a disease similar to RRMS. In this article, we discuss the recent advances in the field of autoimmunity and introduce the theory explain how type I IFNs can be pro-inflammatory in disease that is predominantly driven by a Th17 response and are therapeutic when disease is predominantly Th1.
Collapse
Affiliation(s)
- Robert C Axtell
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA 94305-5316, USA.
| | | |
Collapse
|
50
|
Fujihara K, Misu T, Nakashima I, Takahashi T, Bradl M, Lassmann H, Takano R, Nishiyama S, Takai Y, Suzuki C, Sato D, Kuroda H, Nakamura M, Fujimori J, Narikawa K, Sato S, Itoyama Y, Aoki M. Neuromyelitis optica should be classified as an astrocytopathic disease rather than a demyelinating disease. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1759-1961.2012.00030.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Ichiro Nakashima
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | | | - Monika Bradl
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Hans Lassmann
- Center for Brain Research; Medical University Vienna; Vienna; Austria
| | - Rina Takano
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Shuhei Nishiyama
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Yoshiki Takai
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Chihiro Suzuki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Douglas Sato
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Hiroshi Kuroda
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Masashi Nakamura
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Juichi Fujimori
- Department of Neurology; Tohoku Welfare Pension Hospital; Sendai; Japan
| | - Koichi Narikawa
- Department of Neurology; National Hospital Organization Sendai Medical Center; Sendai; Japan
| | - Shigeru Sato
- Department of Neurology; Kohnan Hospital; Sendai; Japan
| | - Yasuto Itoyama
- National Center Hosptial; National Center of Neurology and Psychiatry; Tokyo; Japan
| | - Masashi Aoki
- Department of Neurology; Tohoku University Graduate School of Medicine; Sendai; Japan
| |
Collapse
|