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Wang Z, Zhang Z, Luo T, Du X, Yang M, Yao Q, Su L, Li Y, Chen X, Huang X, Zhang Y. Increased serum interleukin-41 correlates with disease severity in myasthenia gravis. Int Immunopharmacol 2024; 134:112275. [PMID: 38759373 DOI: 10.1016/j.intimp.2024.112275] [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: 02/07/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Myasthenia gravis (MG) is an autoimmune disease mediated by pathogenic antibodies produced by abnormally activated B cells, resulting in neuromuscular junction transmission dysfunction. Interleukin-41 (IL-41) is a novel immunomodulatory cytokine that has been implicated in various metabolic, inflammatory, and autoimmune diseases. The role of IL-41 in MG is still unclear up to now, our study aimed to investigate the level of IL-41 in MG patients and its correlation with clinical features and inflammatory indicators. METHODS Totally, 60 MG patients and 30 healthy controls (HC) were recruited. Baseline data and laboratory parameters were routinely recorded through electronic medical systems. IL-41 levels were measured by enzyme-linked immunosorbent assay. Proportions of T-cell and B-cell subsets and natural killer cells were analyzed by flow cytometry. The correlation between serum IL-41 and MG related parameters was investigated, and the clinical value of IL-41 in the diagnosis of MG was evaluated by receiver operator characteristic curve (ROC) analysis. RESULTS Serum IL-41 levels in MG patients were higher than in HC, and were higher in Myasthenia Gravis Foundation of America (MGFA) III + IV group than that in MGFA I + II group. Serum IL-41 was positively correlated with MG-specific activities of daily living scale (MG-ADL), MGFA classification, platelet to lymphocyte ratio (PLR), and proportion of CD19+ B cells, while it was negatively correlated with high-sensitive C-reactive protein (hs-CRP) and circulatory plasma cells in MG patients. Serum IL-41 levels increased in patients who were treated with efgartigimod during the first cycle of therapy. However, compared to disease initiation, serum IL-41 levels decreased when clinical features steadily improved. ROC analysis showed that IL-41 had a diagnostic value for MG. CONCLUSION The present findings suggested that serum IL-41 was increased in MG patients and was positively associated with the severity of the disease. IL-41 may be essential to the immunopathological mechanism of MG and a potential biomarker for MG.
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Affiliation(s)
- Zhouyi Wang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China; Central Laboratory, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhouao Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China; Central Laboratory, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Tiancheng Luo
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China; Central Laboratory, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xue Du
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Mingjin Yang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Qian Yao
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Luyao Su
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Yuting Li
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Xiao Chen
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China
| | - Xiaoyu Huang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China; Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yong Zhang
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, Jiangsu, China.
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Wylezinski LS, Sesler CL, Shaginurova GI, Grigorenko EV, Wohlgemuth JG, Cockerill FR, Racke MK, Spurlock CF. Machine Learning Analysis Using RNA Sequencing to Distinguish Neuromyelitis Optica from Multiple Sclerosis and Identify Therapeutic Candidates. J Mol Diagn 2024; 26:520-529. [PMID: 38522839 PMCID: PMC11163981 DOI: 10.1016/j.jmoldx.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
This study aims to identify RNA biomarkers distinguishing neuromyelitis optica (NMO) from relapsing-remitting multiple sclerosis (RRMS) and explore potential therapeutic applications leveraging machine learning (ML). An ensemble approach was developed using differential gene expression analysis and competitive ML methods, interrogating total RNA-sequencing data sets from peripheral whole blood of treatment-naïve patients with RRMS and NMO and healthy individuals. Pathway analysis of candidate biomarkers informed the biological context of disease, transcription factor activity, and small-molecule therapeutic potential. ML models differentiated between patients with NMO and RRMS, with the performance of certain models exceeding 90% accuracy. RNA biomarkers driving model performance were associated with ribosomal dysfunction and viral infection. Regulatory networks of kinases and transcription factors identified biological associations and identified potential therapeutic targets. Small-molecule candidates capable of reversing perturbed gene expression were uncovered. Mitoxantrone and vorinostat-two identified small molecules with previously reported use in patients with NMO and experimental autoimmune encephalomyelitis-reinforced discovered expression signatures and highlighted the potential to identify new therapeutic candidates. Putative RNA biomarkers were identified that accurately distinguish NMO from RRMS and healthy individuals. The application of multivariate approaches in analysis of RNA-sequencing data further enhances the discovery of unique RNA biomarkers, accelerating the development of new methods for disease detection, monitoring, and therapeutics. Integrating biological understanding further enhances detection of disease-specific signatures and possible therapeutic targets.
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Affiliation(s)
- Lukasz S Wylezinski
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Jay G Wohlgemuth
- Quest Diagnostics, Secaucus, New Jersey; Trusted Health Advisors, San Juan Capistrano, California
| | - Franklin R Cockerill
- Decode Health, Inc., Nashville, Tennessee; Trusted Health Advisors, San Juan Capistrano, California; Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | | | - Charles F Spurlock
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Wagner School of Public Service, New York University, New York, New York.
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Rodin RE, Chitnis T. Soluble biomarkers for Neuromyelitis Optica Spectrum Disorders: a mini review. Front Neurol 2024; 15:1415535. [PMID: 38817544 PMCID: PMC11137173 DOI: 10.3389/fneur.2024.1415535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024] Open
Abstract
The Neuromyelitis Optica Spectrum Disorders (NMOSD) constitute a spectrum of rare autoimmune diseases of the central nervous system characterized by episodes of transverse myelitis, optic neuritis, and other demyelinating attacks. Previously thought to be a subtype of multiple sclerosis, NMOSD is now known to be a distinct disease with unique pathophysiology, clinical course, and treatment options. Although there have been significant recent advances in the diagnosis and treatment of NMOSD, the field still lacks clinically validated biomarkers that can be used to stratify disease severity, monitor disease activity, and inform treatment decisions. Here we review many emerging NMOSD biomarkers including markers of cellular damage, neutrophil-to-lymphocyte ratio, complement, and cytokines, with a focus on how each biomarker can potentially be used for initial diagnosis, relapse surveillance, disability prediction, and treatment monitoring.
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Affiliation(s)
- Rachel E. Rodin
- Department of Neurology, Brigham MS Center, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Tanuja Chitnis
- Department of Neurology, Brigham MS Center, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Yan H, Wang Y, Li Y, Shen X, Ma L, Wang M, Du J, Chen W, Xi X, Li B. Combined platelet-to-lymphocyte ratio and blood-brain barrier biomarkers as indicators of disability in acute neuromyelitis optica spectrum disorder. Neurol Sci 2024; 45:709-718. [PMID: 37676374 DOI: 10.1007/s10072-023-07058-3] [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: 06/09/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a complex neuroinflammatory disease characterized by severe disability. In this study, we investigated the relationship between cerebrospinal fluid (CSF)/serum albumin quotient (Qalb) and platelet to lymphocyte ratio (PLR) in assessing disease severity. METHOD A retrospective analysis of 72 NMOSD patients and 72 healthy controls was conducted, and patients were divided into two groups based on their Expanded Disability Status Scale (EDSS) scores. RESULTS NMOSD patients had significantly higher levels of serum PLR, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein (CRP) compared to healthy controls (all P<0.01). Patients in the EDSS≥4 group exhibited significantly elevated levels of Qalb, QIgG, QIgA, QIgM, and PLR (P=0.000, P<0.0001, P=0.0019, P=0.0001, respectively). Spearman's correlation test revealed significant positive associations between Qalb, QIgG, QIgA, QIgM, PLR, and EDSS score. Specifically, Qalb (r=0.571; P<0.001), QIgG (r=0.551; P<0.001), QIgA (r=0.519; P<0.001), and QIgM (r=0.541; P<0.001) demonstrated significant positive correlations with EDSS score, while PLR exhibited a moderate positive correlation (r=0.545; P<0.001) with EDSS score and a mild positive association (r=0.387; P<0.001) with Qalb. The increase of Qalb was positively correlated with the increased EDSS score (r=0.528, P=0.001), as well as the increase of QIgG (r=0.509, P=0.001), and the increase of QIgA (r=0.4989, P=0.03). ROC analysis indicated that Qalb, QIgG, QIgA, QIgM, and PLR levels could effectively serve as indicators of NMOSD severity (all P<0.0001). Multivariate analysis confirmed the independent significance of Qalb and PLR in assessing disease severity (P=0.000). CONCLUSION These findings provide valuable insights into the risk and pathogenesis of NMOSD and highlight the potential of Qalb and PLR as independent markers for disease severity assessment in NMOSD patients.
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Affiliation(s)
- Hongjing Yan
- Department of Neurology, Handan First Hospital, Handan, China.
| | - Yining Wang
- Department of Neurology, Handan First Hospital, Handan, China
| | - Yanmei Li
- Department of Neurology, Handan First Hospital, Handan, China
| | - Xiaoling Shen
- Department of Neurology, Handan First Hospital, Handan, China
| | - Lifen Ma
- Department of Neurology, Handan First Hospital, Handan, China
| | - Min Wang
- Department of Neurology, Handan First Hospital, Handan, China
| | - Juan Du
- Department of Neurology, Handan First Hospital, Handan, China
| | - Weifeng Chen
- Department of Neurosurgery, The Central Hospital of Handan, Handan, China
| | - Xutao Xi
- Department of Orthopedics, Handan First Hospital, Handan, Hebei, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical, University, Shijiazhuang, China
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Guo RY, Wang WY, Huang JY, Jia Z, Sun YF, Li B. Deciphering prognostic indicators in AQP4-IgG-seropositive neuromyelitis optica spectrum disorder: An integrative review of demographic and laboratory factors. Mult Scler 2024; 30:7-15. [PMID: 37982449 DOI: 10.1177/13524585231212832] [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] [Indexed: 11/21/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a group of inflammatory diseases affecting the central nervous system, characterized by optic neuritis and myelitis. The complex nature of NMOSD and varied patient response necessitates personalized treatment and efficient patient stratification strategies. OBJECTIVE To provide a comprehensive review of recent advances in clinical and biomarker research related to aquaporin-4 (AQP4)-immunoglobulin G (IgG)-seropositive NMOSD prognosis and identify key areas for future research. METHODS A comprehensive review and synthesis of recent literature were conducted, focusing on demographic factors and laboratory investigations. RESULTS Demographic factors, such as age, ethnicity, and sex, influence NMOSD prognosis. Key biomarkers for NMOSD prognosis include homocysteine, antinuclear antibodies, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, thyroid hormone levels, neurofilament light chain levels, and serum glial fibrillary acidic protein might also predict NMOSD attack prognosis. CONCLUSION Further investigation is required to understand sex-related disparities and biomarker inconsistencies. Identification and understanding of these factors can aid in the development of personalized therapeutic strategies, thereby improving outcomes for NMOSD patients. Future studies should focus on unifying research design for consistent results.
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Affiliation(s)
- Ruo-Yi Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Wen-Ya Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Jing-Ying Huang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Ya-Fei Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- The Key Laboratory of Neurology, Hebei Medical University, Ministry of Education, Shijiazhuang, China
- The Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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7
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Zhang L, Xue Y, Yuan C, Du X, Wang X, Guo L, Li B. Decreased SIRT1 mRNA expression in peripheral blood mononuclear cells from patients with neuromyelitis optica spectrum disorders. Acta Neurol Belg 2023; 123:2287-2294. [PMID: 37294424 DOI: 10.1007/s13760-023-02300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Sirtuin (SIRT)1, as a molecular link between immunity and metabolic pathways, is a key immune response regulator. The significance of SIRT1 in peripheral blood mononuclear cells (PBMCs) of neuromyelitis optica spectrum disorder (NMOSD) has not been investigated. Here, we aimed to evaluate the SIRT1 mRNA level in PBMCs of patients with NMOSD and its clinical relevance and explore the potential mechanism of SIRT1 action. METHODS A total of 65 patients with NMOSD and 60 normal controls from North China were enrolled. Using real-time fluorescence quantitative-polymerase chain reaction, mRNA levels were detected in PBMCs, and protein levels were detected using western blotting. RESULTS Compared to the healthy controls and chronic-phase patients with NMOSD, SIRT1 mRNA and protein levels in PBMCs of NMOSD patients with acute attack were significantly downregulated (p < 0.0001). ∆EDSS scores (EDSS scores in the acute phase-EDSS scores before the recent attack) were higher in NMOSD patients with low SIRT1 mRNA level than in patients with high SIRT1 expression (p = 0.042). SIRT1 mRNA level in patients with acute-phase NMSOD was positively correlated with lymphocyte and monocyte counts and negatively correlated with neutrophil counts and the neutrophil-to-lymphocyte ratio. Furthermore, the transcription factor FOXP3 mRNA level was significantly positively correlated with the SIRT1 mRNA level in PBMCs of patients with acute-phase NMOSD. CONCLUSIONS Our study indicated that SIRT1 mRNA expression was downregulated in the PBMCs of patients with acute-phase NMOSD, and its level was correlated with the clinical parameters of the patients, suggesting a potential role of SIRT1 in NMOSD.
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Affiliation(s)
- Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Yumei Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
- Department of Pharmacy, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Congcong Yuan
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
- Department of Neurology, Baoding First Central Hospital, Baoding, China
| | - Xiaochen Du
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Xuan Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China.
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China.
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215, Hepingxi Road, Shijiazhuang, 050000, China.
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, China.
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Baek SI, Ro S, Chung YH, Ju H, Kwon S, Park KA, Min JH. Novel index, neutrophil percentage (%) is a useful marker for disease activity in MOG antibody-associated disease. Mult Scler Relat Disord 2023; 76:104796. [PMID: 37320937 DOI: 10.1016/j.msard.2023.104796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a CNS autoimmune disease affecting the brain, spinal cord, and optic nerve. The neutrophil-to-lymphocyte ratio (NLR) is related to autoimmune disease activity. However, the clinical implication of index ratios such as the NLR is unclear in patients with MOGAD. OBJECTIVES We investigated the relationship between index ratios such as the NLR and disease activity and disability to discover the index that best correlates with an attack in MOGAD. METHODS Using a CNS demyelinating disease cohort, we reviewed 39 patients with MOGAD (age 37.4 ± 12.0 years; F:M = 20:19) who had 390 blood samples available for cell count analysis. We calculated the NLR, eosinophil-to-lymphocyte-ratio (ELR), platelet-to-lymphocyte-ratio (PLR), monocyte-to-lymphocyte ratio (MLR), basophil-to-lymphocyte ratio (BLR), and neutrophil percentage (N%) [neutrophil count (/mm3) / WBC (/mm3) x 100 (%)]. We investigated the associations between each index ratio and disease activity and disability using the receiver operating characteristic (ROC) curve, machine learning program (kNN algorithm), and generalized estimating equations (GEE) analysis. RESULTS In patients with MOGAD, the NLR, PLR, and N% were higher and ELR was lower during an attack than in remission (all p<0.001). The areas under the ROC curve for the NLR, ELR, PLR, and N% were 0.68, 0.69, 0.61, and 0.68, respectively, with the highest sensitivity of 76.0% in the ELR and the highest specificity of 76.3% in the N%. The classification accuracy scores of the kNN machine learning algorithm were 71% for the NLR, 62% for the ELR, 63% for the PLR, and 72% for the N%. In the GEE analysis of attack samples, both the NLR and treatment-naive had positive associations with the Expanded Disability Status Scale (EDSS) score (β=0.137, p = 0.008 and β=1.142, p = 0.003, respectively), and the PLR was negatively associated with the EDSS score (β=-0.004, p = 0.022). DISCUSSION Our study suggests that the novel index, neutrophil% is the simplest and the most useful marker to differentiate between attack and remission and shows comparable reliability with NLR in MOGAD. Moreover, the NLR and PLR could be used as supportive biomarkers for disease disability during an attack in patients with MOGAD.
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Affiliation(s)
- Song-Ik Baek
- Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suho Ro
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, Graduate School of Medicine, Sungkyunkwan University, South Korea
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Hyunjin Ju
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Soonwook Kwon
- Department of Neurology, Inha university Hospital, Inchon, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.
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Devlin L, Gombolay G. The Neutrophil-to-Lymphocyte Ratio and the Monocyte-to-Lymphocyte Ratio Predict Expanded Disability Status Scale Score at One Year in Pediatric Neuromyelitis Optica Spectrum Disorder but not in Multiple Sclerosis. Pediatr Neurol 2023; 143:84-88. [PMID: 37044044 PMCID: PMC10205676 DOI: 10.1016/j.pediatrneurol.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are inflammatory biomarkers that may predict disease course in neuroinflammatory diseases. We examine whether NLR or MLR at the time of the first attack predicts longitudinal disease outcomes in pediatric neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). METHODS Clinical data were collected retrospectively at a single institution. NLR (ratio of percent neutrophils to percent lymphocytes) and MLR (ratio of percent monocytes to percent lymphocytes) were calculated in the complete blood cell count at the time of presentation before treatments. Expanded Disability Status Scale (EDSS) score and time to next relapse were used as the outcome assessments. RESULTS Twenty-eight patients with MS and eight patients with aquaporin-4-positive NMOSD were included. For NMOSD, NLR at presentation associated with EDSS at six months (P = 0.003) and one year (P = 0.032) even when adjusting for age at presentation. MLR associated with EDSS at six months (P = 0.0203) and EDSS at one year (P = 0.0079). However, NLR and MLR did not predict EDSS scores in MS. MLR and NLR did not predict time to next relapse or did not associate with magnetic resonance imaging activity in MS and NMOSD. Changes in MLR and NLR were observed with disease-modifying therapies but did not predict disease activity. CONCLUSIONS NLR and MLR associated with six-month and one-year EDSS in children with NMOSD but not in MS. Future studies should explore whether changes in NLR and MLR could predict disease activity or treatment efficacy.
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Affiliation(s)
- Lily Devlin
- Emory University School of Medicine, Atlanta, Georgia
| | - Grace Gombolay
- Division of Pediatric Neurology, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia.
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Lin L, Ji M, Wu Y, Hang H, Lu J. Neutrophil to lymphocyte ratio may be a useful marker in distinguishing MOGAD and MS and platelet to lymphocyte ratio associated with MOGAD activity. Mult Scler Relat Disord 2023; 71:104570. [PMID: 36827875 DOI: 10.1016/j.msard.2023.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/19/2022] [Accepted: 02/12/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical overlap is observed between multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein immunoglobulin-G (MOG-IgG) associated disease (MOGAD) and the difficulty in distinguishing between the two diseases. Here, we measured and compared the readily available neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) to determine whether these three biomarkers can help to distinguish MOGAD and MS at disease onset. The impact of these three biomarkers on MOGAD and MS relapse also needs to be explored. METHODS In this retrospective analysis, we obtained clinical and paraclinical data from the first attacks of MOGAD (N = 31) and MS (N = 50). Electronic medical records were used to collect demographic data (gender, age at onset), clinical symptoms, EDSS at onset, and medical treatments. The primary outcome was relapse within one year of onset. Four hematological parameters were recorded, including neutrophil count, platelet count, lymphocyte count, and monocyte count. NLR, PLR, and MLR were calculated and compared between MOGAD, MS, and HC. Receiver operator curve (ROC) analysis was performed to assess the ability of NLR, PLR, and MLR to distinguish between MOGAD and MS, MOGAD and HC, respectively. A logistic regression analysis was performed to determine the impact of NLR/PLR/MLR on MOGAD/MS relapse within one year of onset. RESULTS Compared to HC, NLR is significantly higher in MOGAD and MS (p<0.001, p = 0.04, respectively). The PLR and MLR are elevated in MOGAD compared to HC (p<0.001, p<0.001, respectively), and MLR in MS are also statistically higher than in HC (p = 0.023). It is worth noting that NLR and PLR were much higher in MOGAD compared to MS (p<0.001, p = 0.001, respectively), but a significant difference regarding MLR has not been found between MOGAD and MS. Based on ROC curve analyses, we found that using NLR, PLR, and MLR to discriminate between MOGAD and MS yielded a ROC-plot area under the curve (AUC) value of 0.794, 0.727, and 0.681, respectively. Meanwhile, the AUC of NLR, PLR, and MLR to discriminate between MOGAD and HC were 0.926, 0.772, and 0.786. Furthermore, the logistics analysis revealed a significant positive association between PLR and MOGAD relapse. CONCLUSION NLR helps differentiate MOGAD and MS in disease onset, and higher PLR was related to MOGAD relapse.
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Affiliation(s)
- Liuyu Lin
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Meihua Ji
- Department of Neurology, Huai'an Hospital of Huai'an City, Huai'an, Jiangsu 223001, China
| | - Yuqing Wu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hailun Hang
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jie Lu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Fazlinejad N, Hosseini S, Yaghoobpoor S, Dehghani M, Bazrafshan H, Khanzadeh S, Lucke-Wold B. The Diagnostic Value of Neutrophil to Lymphocyte Ratio as an Effective Biomarker for Neuromyelitis Optica Spectrum Disorder. JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION (WILMINGTON, DEL.) 2023; 5:16-25. [PMID: 37654690 PMCID: PMC10469024 DOI: 10.33696/rehabilitation.5.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background Neuromyelitis Optica (NMO) is a serious condition associated with inflammation. Early diagnosis and detection are critical for early intervention. In this systematic review, we investigate the role of the neutrophil to lymphocyte ratio (NLR) as an important biomarker for NMO. Methods Ten studies were selected that were sufficiently high quality and then checked for quality. The studies were organized by English language and selective inclusion criteria. Results NLR was significantly increased in NMO patients compared to controls. The ratio was specifically proportional to severity of disease. More severe disease had a higher ratio. Conclusion NLR offers a reliable and affordable method for early detection of disease severity. This can help guide appropriate treatment selection and monitor treatment response.
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Affiliation(s)
| | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Yaghoobpoor
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mina Dehghani
- School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hanieh Bazrafshan
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Brandon Lucke-Wold
- Endovascular Fellow, University of Florida, Department of Neurosurgery, Gainesville, FL, USA
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12
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Huang X, Xu M, Wang Y, Zhang Z, Li F, Chen X, Zhang Y. The systemic inflammation markers as possible indices for predicting respiratory failure and outcome in patients with myasthenia gravis. Ann Clin Transl Neurol 2022; 10:98-110. [PMID: 36453129 PMCID: PMC9852395 DOI: 10.1002/acn3.51706] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to explore the relationship between systemic inflammation markers and clinical activity, respiratory failure, and prognosis in patients with myasthenia gravis (MG). METHODS One hundred and seventeen MG patients and 120 controls were enrolled in this study. Differences in the four immune-related markers of two groups based on blood cell counts: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), and systemic immune-inflammation index (SII) were measured. The stability of the associations between systemic inflammation markers and respiratory failure in MG patients was confirmed by adjusted logistic regression analysis. Moreover, Kaplan-Meier curve and multivariate COX regression models were applied to assess the factors affecting the outcome of MG. RESULTS NLR, PLR, and SII were higher in MG patients than those in controls and were positively associated with MGFA classification, but not LMR. Adjusted logistic regression analysis showed that PLR was an independent predictor of MG with respiratory failure. The ROC curve demonstrated that PLR showed good sensitivity and specificity for the diagnosis of MG with respiratory failure. Kaplan-Meier curve showed that GMG, positive AchR-Ab, respiratory failure, high NLR, PLR, SII, and IVIg exposure correlated with the risk for poor outcomes in MG patients. The multivariate COX regression models indicated that GMG and high SII was a risk factor for poor outcome of MG. INTERPRETATION The systemic inflammation markers expressed abnormally in MG patients, in which PLR may be an independent predictor of respiratory failure, and high SII and GMG were predictive risk factors for poor outcomes in MG patients.
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Affiliation(s)
- Xiaoyu Huang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina,Department of NeurologyTianjin Neurological Institute, Tianjin Medical University General HospitalTianjinChina
| | - Mingming Xu
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Yingying Wang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Zhouao Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Fengzhan Li
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Xiao Chen
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
| | - Yong Zhang
- Department of NeurologyAffiliated Hospital of Xuzhou Medical UniversityNo. 99 Huaihai West Road, Quanshan DistrictXuzhouJiangsuChina
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13
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Duan Z, Jia A, Cui W, Feng J. Correlation between neutrophil-to-lymphocyte ratio and severity of myasthenia gravis in adults: A retrospective study. J Clin Neurosci 2022; 106:117-121. [DOI: 10.1016/j.jocn.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
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14
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Zhai M, Cao S, Wang X, Liu Y, Tu F, Xia M, Li Z. Increased neutrophil-to-lymphocyte ratio is associated with unfavorable functional outcomes in acute pontine infarction. BMC Neurol 2022; 22:445. [PMID: 36447170 PMCID: PMC9707260 DOI: 10.1186/s12883-022-02969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is positively associated with unfavorable outcomes in patients with cerebral infarction. This study aimed to investigate the relationship between the NLR and the short-term clinical outcome of acute pontine infarction. METHODS Patients with acute pontine infarction were consecutively included. Clinical and laboratory data were collected. All patients were followed up at 3 months using modified Rankin Scale (mRS) scores. An unfavorable outcome was defined as an mRS score ≥ 3. Receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cutoff values for patients with acute pontine infarction. risk factors can be predictive factors for an unfavorable outcome after acute pontine infarction. RESULTS Two hundred fifty-six patients with acute pontine infarction were included in this study. The NLR was significantly higher in the unfavorable outcome group than in the favorable outcome group (P < 0.05). Additionally, the infarct size was significantly higher in the high NLR tertile group than in the low NLR tertile group (P < 0.05). Multivariate logistic regression analysis revealed that the baseline National Institutes of Health Stroke Scale (NIHSS) score, NLR, platelet count, and fasting blood glucose (FBG) level were significantly associated with unfavorable outcomes 3 months after acute pontine infarction. The optimal cutoff value of the NLR for predicting the 3-month outcome of acute pontine infarction was 3.055. The negative and positive predictive values of NLR were 85.7% and 61.3%, respectively, and the sensitivity and specificity of NLR were 69.2% and 80.9%. CONCLUSIONS We found that the NLR may be an independent predictive factor for the outcome of acute pontine infarction.
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Affiliation(s)
- Mingfeng Zhai
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China
| | - Shugang Cao
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Hefei Hospital of Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, China
| | - Xinlin Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Liu
- grid.252957.e0000 0001 1484 5512Department of Neurology, The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang, China
| | - Feng Tu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China
| | - Mingwu Xia
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Hefei Hospital of Anhui Medical University, The Second People’s Hospital of Hefei, Hefei, China
| | - Zongyou Li
- grid.186775.a0000 0000 9490 772XDepartment of Neurology, The Affiliated Fuyang People’s Hospital of Anhui Medical University, The People’s Hospital of Fuyang, Fuyang, 236300 China ,grid.252957.e0000 0001 1484 5512Department of Neurology, The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang, China
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15
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Kashyap N, Morris M, Loerinc LB, Benoit M, Blackwell L, Howarth R, Gombolay G. The neutrophil-to-lymphocyte ratio is associated with intubation in pediatric anti-NMDA receptor encephalitis: A retrospective study. J Neuroimmunol 2022; 370:577931. [PMID: 35872506 PMCID: PMC9675910 DOI: 10.1016/j.jneuroim.2022.577931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/02/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) may predict poor outcomes in adult anti-NMDAR encephalitis (NMDARE). The association of NLR with outcomes in pediatric NMDARE was examined. Methods Pediatric NMDARE patients (N = 36) were retrospectively studied. Results High NLR (>6) had a higher proportion of tumors (43% versus 7%) and higher intubation rates (100% versus 38%, p = 0.008). Multivariate analyses showed that high NLR did not correlate with one-year outcomes, inpatient length of stay (LOS), or with tumor, but was associated with intubation and rehabilitation LOS. Conclusion NLR is associated with intubation and rehabilitation LOS. Further investigation is needed for prognostic biomarkers in NMDARE.
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Affiliation(s)
- Nisha Kashyap
- Children's Healthcare of Atlanta, Division of Neurology, Atlanta, GA, United States of America
| | - Morgan Morris
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, United States of America
| | - Leah B Loerinc
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Macarthur Benoit
- Children's Healthcare of Atlanta, Division of Neurology, Atlanta, GA, United States of America
| | - Laura Blackwell
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, United States of America; Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta 30322, Georgia
| | - Robyn Howarth
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, United States of America; Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta 30322, Georgia
| | - Grace Gombolay
- Children's Healthcare of Atlanta, Division of Neurology, Atlanta, GA, United States of America; Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA.
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16
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Xu L, Gao TX, Chang SH, Jiang SM, Zhang LJ, Yang L. Role of lymphocyte-related immune-inflammatory biomarkers in detecting early progression of Guillain-Barré syndrome. J Clin Neurosci 2022; 105:31-36. [PMID: 36063751 DOI: 10.1016/j.jocn.2022.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study aimed to investigate the role of peripheral neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR) in the progression and severity of the Guillain-Barré syndrome (GBS). METHODS 47 GBS patients and 50 age and sex-matched healthy controls (HC) were retrospectively included. Demographic and clinical assessment data were reviewed and abstracted. NLR, MLR, and PLR were calculated based on the peripheral blood tests by reviewing clinical data. The relationship between the Hughes' score and NLR, MLR, PLR levels was investigated. RESULTS The GBS patients had higher NLR levels (P < 0.001), MLR levels (P = 0.001) and PLR levels (P < 0.001) than those in HC. And patients with severe disability score (Hughes' score ≥ 3) had significantly higher NLR (P = 0.007), MLR (P = 0.04), PLR (P = 0.013). Spearman correlation analysis indicated that NLR was positively associated with the Hughes' score (r = 0.331, P = 0.023). In the patients with acute inflammatory demyelinating polyneuropathy (AIDP), Spearman correlation analysis indicated that NLR, MLR and PLR were positively associated to the Hughes' score (r = 0.825, P = 0.001 for NLR, r = 0.727, P = 0.005 for MLR, and r = 0.723, P = 0.005 for PLR). CONCLUSIONS NLR, MLR, and PLR may be indicators of disease activity in patients with GBS or AIDP. These parameters may benefit the active treatment of GBS patients with a high degree of disability.
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Affiliation(s)
- Lu Xu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Tian-Xiao Gao
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Sheng-Hui Chang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Shu-Min Jiang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.
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Duan Z, Feng J. Comparison of neutrophil-to-lymphocyte ratio between myelin oligodendrocyte glycoprotein antibody-associated disease and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders in adults. J Clin Neurosci 2022; 101:89-93. [PMID: 35569419 DOI: 10.1016/j.jocn.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/30/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a biomarker for evaluating disease activity in systemic autoimmune diseases. However, few studies have discussed NLR changes in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). This study aimed to explore the NLR difference between MOGAD, aquaporin-4 antibody (AQP4-Ab)-positive neuromyelitis optica spectrum disorders (NMOSD), and healthy controls (HCs) and evaluate the clinical value of NLR in the differential diagnosis. We included 15 patients with MOGAD, 28 patients with AQP4-Ab-positive NMOSD, and 68 HCs. Their NLRs were calculated, and statistical analysis was performed, with statistical significance set at P < 0.05. In pairwise comparisons between three groups, P < 0.017 was considered statistically significant under Bonferroni correction. NLR was higher during the acute attack in MOGAD patients than HCs but lower than in AQP4-Ab-positive NMOSD patients. NLR was correlated with Expanded Disability Status Scale (EDSS) in MOGAD and AQP4-Ab-positive NMOSD patients. Also, there were no statistical differences in intracranial pressure between MOGAD and AQP4-Ab-positive NMOSD patients and HCs. The cut-off value was 2.86, and the sensitivity and specificity were 0.750 and 0.867, respectively. In conclusion, our results suggest that NLR may be a helpful marker to evaluate disease severity and differentiate between both diseases at a cut-off value of > 2.86 when patients have clinical symptoms like optic neuritis or myelitis.
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Affiliation(s)
- Zhenghao Duan
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, China.
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18
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Liu F, Zhang B, Huang T, Wang B, Wang C, Hao M, Guo S. Influential Factors, Treatment and Prognosis of Autoimmune Encephalitis Patients With Poor Response to Short-Term First-Line Treatment. Front Neurol 2022; 13:861988. [PMID: 35493830 PMCID: PMC9046540 DOI: 10.3389/fneur.2022.861988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study was performed to assess the potential factors for poor short-term first-line treatment response, the appropriate further treatment options, and the prognosis in patients with autoimmune encephalitis (AE). Methods This retrospective study consisted of 135 patients with AE. According to their short-term first-line treatment response, patients were divided into the response group and the non-response group. The demographics, clinical characteristics, main accessory examinations, immunotherapy, and outcomes of patients were compared between the two groups. Univariate and multivariate logistic regression models were used to analyze whether non-responders have poor long-term outcomes. Further treatment and prognosis of non-responders were also analyzed. Results Of the 128 patients who were treated with first-line immunotherapy, 59 (46.1%) were non-responders. Patients in the non-response group had more symptoms and exhibited a higher proportion of mental behavior disorder, central hypoventilation, and autonomic nervous dysfunction. The modified Rankin scale (mRS) scores and neutrophil-to-lymphocyte ratio (NLR) levels were significantly higher and albumin, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A (apoA) levels were significantly lower in the non-response group (p < 0.05, all). Multivariate logistic regression analysis showed that the number of clinical symptoms, mental behavior disorder, central hypoventilation, maximum mRS score, and albumin level was independently associated with non-response to short-term first-line treatment. Non-responders had poor long-term outcomes compared with the responders at all times of followed-up (p < 0.05, all). In multivariable analysis, initial first-line treatment response was independently associated with the long-term prognosis, both at 12-month [odds ratio (OR), 4.74, 95% CI, 1.44–15.59, and p=0.010] and 24-month follow-ups (OR, 8.81, 95% CI, 1.65–47.16; and p = 0.011). Among the non-responders, a higher improvement of mRS scores was observed in those who received second-line treatment than those who had no further treatment or repetition of first-line immunotherapy in the follow-up. However, the rate of a good outcome and median mRS scores were not significantly different among the three groups. Conclusion Disease severity, clinical features, anti-N-methyl-D-aspartate receptor subtypes, antibody titers, NLR, albumin, HDL-C, and apoA levels were all associated with non-response to short-term first-line treatment. The short-term first-line treatment response is a valuable predictor of long-term outcomes in patients with AE. Second-line immunotherapy may be a more aggressive treatment option for patients who failed short-term first-line immunotherapy.
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Affiliation(s)
- Fei Liu
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bingbing Zhang
- Department of Resident Trainint, Qilu Hospital of Shandong University, Jinan, China
| | - Teng Huang
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Baojie Wang
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Chunjuan Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Maolin Hao
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Shougang Guo
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Neurology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
- *Correspondence: Shougang Guo
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Deng S, Lei Q, Lu W. Pregnancy-Related Attack in Neuromyelitis Optica Spectrum Disorder With AQP4-IgG: A Single-Center Study and Meta-Analysis. Front Immunol 2022; 12:800666. [PMID: 35069584 PMCID: PMC8767555 DOI: 10.3389/fimmu.2021.800666] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to investigate the demographic characteristic of pregnancy-related attacks (PRAs) in neuromyelitis optica spectrum disorder (NMOSD). In addition, we investigated the predictors of PRAs as well as the effect of immunosuppressive (IS) therapy in patients with pregnancy-related NMOSD. Method We retrospectively analyzed data on clinical and diagnostic characteristics, therapeutic management, and pregnancy outcomes for PRAs in AQP4-IgG-positive NMOSD patients admitted to the Second Xiangya Hospital of Central South University. Moreover, we searched the literature (without any temporal restriction) to identify all such similar cohorts and performed a meta-analysis to evaluate the effectiveness and safety of IS therapy on NMOSD patients with PRAs. Result We collected clinical data on 117 women with AQP4 antibody-positive NMOSD; we ultimately included 33 patients (34 pregnancies). Ten patients were relapse-free during pregnancy, and 23 (69.7%) had PRA; attacks were most common during the first trimester of the postpartum period. Maintenance of IS treatment during pregnancy was found to greatly reduce PRAs in patients with NMOSD. PRAs were associated with a higher neutrophil-to-lymphocyte ratio (NLR) at relapse during pregnancy and shorter time interval between the last relapse and conception. The meta-analysis suggested that maintenance of IS treatment during pregnancy can significantly reduce the RR of NMOSD (95%CI=0.35-0.62; z=5.18, p<0.0001) and had no adverse effect on the miscarriage rate. However, the unhealthy newborn occurrence among those receiving IS treatment was 3.73 times higher than that of those not receiving treatment during pregnancy (95%CI=1.40–9.91; z=2.64, p=0.008). Conclusion Our study results demonstrates that pregnancy can induce the onset or relapse of attacks in NMOSD patients. The increased NLR value and disease activity may be a predictor for PRAs in patients with NMOSD. Moreover, administration of IS treatment during pregnancy can reduce the relapse rate. However, the dosage of drugs and risks of adverse effects to the fetus need to be considered. Future prospective studies with larger sample sizes are needed to confirm and extend our findings.
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Affiliation(s)
- Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Lei
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
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