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Preziosa P, Amato MP, Battistini L, Capobianco M, Centonze D, Cocco E, Conte A, Gasperini C, Gastaldi M, Tortorella C, Filippi M. Moving towards a new era for the treatment of neuromyelitis optica spectrum disorders. J Neurol 2024; 271:3879-3896. [PMID: 38771385 DOI: 10.1007/s00415-024-12426-w] [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: 03/21/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) include a rare group of autoimmune conditions that primarily affect the central nervous system. They are characterized by inflammation and damage to the optic nerves, brain and spinal cord, leading to severe vision impairment, locomotor disability and sphynteric disturbances. In the majority of cases, NMOSD arises due to specific serum immunoglobulin G (IgG) autoantibodies targeting aquaporin 4 (AQP4-IgG), which is the most prevalent water-channel protein of the central nervous system. Early diagnosis and treatment are crucial to manage symptoms and prevent long-term disability in NMOSD patients. NMOSD were previously associated with a poor prognosis. However, recently, a number of randomized controlled trials have demonstrated that biological therapies acting on key elements of NMOSD pathogenesis, such as B cells, interleukin-6 (IL-6) pathway, and complement, have impressive efficacy in preventing the occurrence of clinical relapses. The approval of the initial drugs marks a revolutionary advancement in the treatment of NMOSD patients, significantly transforming therapeutic options and positively impacting their prognosis. In this review, we will provide an updated overview of the key immunopathological, clinical, laboratory, and neuroimaging aspects of NMOSD. Additionally, we will critically examine the latest advancements in NMOSD treatment approaches. Lastly, we will discuss key aspects regarding optimization of treatment strategies and their monitoring.
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Affiliation(s)
- Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Amato
- Department Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Luca Battistini
- Neuroimmunology Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Binaghi Hospital, ASL Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonella Conte
- Unit of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Claudio Gasperini
- MS Center, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Carla Tortorella
- MS Center, Department of Neuroscience, San Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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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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Wang X, Qu Y, Fan J, Ren H. Serum NfL and EGFR/NfL ratio mRNAs as biomarkers for phenotype and disease severity of myelin oligodendrocyte glycoprotein IgG-associated disease. Front Immunol 2024; 15:1388734. [PMID: 38807603 PMCID: PMC11130348 DOI: 10.3389/fimmu.2024.1388734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Background and purpose Myelin oligodendrocyte glycoprotein (MOG) IgG is frequently elevated in pediatric patients with acquired demyelinating syndrome (ADS). However, no specific biomarkers exist for phenotype classification, symptom severity, prognosis, and treatment guidance of MOG-IgG-associated disease (MOGAD). This study evaluated neurofilament light chain (NfL) and endothelial growth factor receptor (EGFR) mRNA expression levels in serum and cerebrospinal fluid (CSF) as potential biomarkers for MOGAD in Chinese children. Methods This was a cross-sectional and single-center study. We enrolled 22 consecutive pediatric patients hospitalized with MOGAD and 20 control pediatric patients hospitalized for noninflammatory neurological diseases in Hebei Children's Hospital. Serum and CSF were collected from MOGAD patients within 3 days before immunotherapy. The mRNA levels of NfL and EGFR in serum and CSF were measured by real-time polymerase chain reaction (qPCR), and the EGFR/NfL ratio mRNA was calculated. These measurement values were then compared between disease groups and among MOGAD phenotypes. In addition, the correlations between the mRNAs of three markers (NfL, EGFR, EGFR/NfL ratio), extended disability status scale (EDSS) scores, and clinical phenotypes were analyzed. Results Serum and CSF NfL mRNA levels were significantly higher of acute-stage MOGAD patients than those of control patients (p< 0.05 and p< 0.01, respectively), while the mRNA levels of serum EGFR and EGFR/NfL ratio were significantly lower of MOGAD patients than those of controls (p < 0.05, p < 0.0001). Serum NfL mRNA was significantly correlated with mRNA of serum EGFR (r =0.480, p < 0.05). Serum and CSF NfL mRNA levels in MOGAD patients with the ADEM-like phenotype were also significantly higher than those in control patients (p < 0.01, p < 0.01) and optic neuritis (ON) phenotype (p < 0.05, p < 0.05). Both mRNAs of NfL in CSF and EGFR/NfL ratio in serum were correlated with EDSS scores (p < 0.05, r = 0.424; p < 0.05, r= -0.521). Conclusion The mRNA levels of elevated NfL in serum and CSF as well as lower EGFR and EGFR/NfL ratio in serum could help distinguish acute-phase MOGAD. Higher mRNA levels of NfL in serum and CSF of MOGAD patients help distinguish ADEM-like phenotype. In addition, serum EGFR/NfL mRNA ratio is indicative of disease severity in pediatric patients with MOGAD. Further investigations are warranted to elucidate the pathological mechanisms underlying these associations.
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Affiliation(s)
- Xin Wang
- Second Department of Neurology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Yi Qu
- Department of Science and Education, Hebei Children’s Hospital, Shijiazhuang, China
| | - Jiayu Fan
- Second Department of Neurology, Hebei Children’s Hospital, Shijiazhuang, China
| | - Huiqiang Ren
- Department of Pathology, Hebei Children’s Hospital, Shijiazhuang, China
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Khalil M, Teunissen CE, Lehmann S, Otto M, Piehl F, Ziemssen T, Bittner S, Sormani MP, Gattringer T, Abu-Rumeileh S, Thebault S, Abdelhak A, Green A, Benkert P, Kappos L, Comabella M, Tumani H, Freedman MS, Petzold A, Blennow K, Zetterberg H, Leppert D, Kuhle J. Neurofilaments as biomarkers in neurological disorders - towards clinical application. Nat Rev Neurol 2024; 20:269-287. [PMID: 38609644 DOI: 10.1038/s41582-024-00955-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
Neurofilament proteins have been validated as specific body fluid biomarkers of neuro-axonal injury. The advent of highly sensitive analytical platforms that enable reliable quantification of neurofilaments in blood samples and simplify longitudinal follow-up has paved the way for the development of neurofilaments as a biomarker in clinical practice. Potential applications include assessment of disease activity, monitoring of treatment responses, and determining prognosis in many acute and chronic neurological disorders as well as their use as an outcome measure in trials of novel therapies. Progress has now moved the measurement of neurofilaments to the doorstep of routine clinical practice for the evaluation of individuals. In this Review, we first outline current knowledge on the structure and function of neurofilaments. We then discuss analytical and statistical approaches and challenges in determining neurofilament levels in different clinical contexts and assess the implications of neurofilament light chain (NfL) levels in normal ageing and the confounding factors that need to be considered when interpreting NfL measures. In addition, we summarize the current value and potential clinical applications of neurofilaments as a biomarker of neuro-axonal damage in a range of neurological disorders, including multiple sclerosis, Alzheimer disease, frontotemporal dementia, amyotrophic lateral sclerosis, stroke and cerebrovascular disease, traumatic brain injury, and Parkinson disease. We also consider the steps needed to complete the translation of neurofilaments from the laboratory to the management of neurological diseases in clinical practice.
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Affiliation(s)
- Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria.
| | - Charlotte E Teunissen
- Neurochemistry Laboratory Department of Laboratory Medicine, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Sylvain Lehmann
- LBPC-PPC, Université de Montpellier, INM INSERM, IRMB CHU de Montpellier, Montpellier, France
| | - Markus Otto
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Samir Abu-Rumeileh
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Simon Thebault
- Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Abdelhak
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Ari Green
- Weill Institute for Neurosciences, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Manuel Comabella
- Neurology Department, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hayrettin Tumani
- Department of Neurology, CSF Laboratory, Ulm University Hospital, Ulm, Germany
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Axel Petzold
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Centre and Neuro-ophthalmology Expertise Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery and the Queen Square Institute of Neurology, UCL, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Paris Brain Institute, ICM, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Neurodegenerative Disorder Research Center, Division of Life Sciences and Medicine, and Department of Neurology, Institute on Aging and Brain Disorders, University of Science and Technology of China and First Affiliated Hospital of USTC, Hefei, P. R. China
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - David Leppert
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.
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Kim S, Lee JJ, Park JS, Kang M, Seok HY. Neurofilament light chain as a biomarker in neuromyelitis optica spectrum disorder: a comprehensive review and integrated analysis with glial fibrillary acidic protein. Neurol Sci 2024; 45:1255-1261. [PMID: 38141119 DOI: 10.1007/s10072-023-07277-8] [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: 09/24/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND In the context of neuromyelitis optica spectrum disorder (NMOSD), there are several measures that serve as a biomarker. However, each of the methods has the intrinsic limitations. While neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have emerged as an additional biomarker for NMOSD, a thorough investigation of their role remains incomplete. Our aim is to provide a comprehensive review of the current literature regarding NfL and GFAP as a biomarker and explore their potential utility in NMOSD. METHODS We performed a comprehensive search using PubMed and Google Scholar to identify peer-reviewed articles investigating NfL and GFAP as a biomarker in NMOSD. RESULTS Our search identified 13 relevant studies. NfL consistently showed promise in distinguishing NMOSD patients from healthy individuals, although it had limited specificity in distinguishing NMOSD from other demyelinating diseases. NfL offered certain advantages over GFAP, notably its ability to predict disability worsening during attacks. In contrast, GFAP provided valuable insight, particularly in distinguishing NMOSD from multiple sclerosis and identifying clinical relapses. In addition, GFAP showed predictive potential for future attacks. Some studies even suggested that NfL may serve as an indicator of treatment response in NMOSD. CONCLUSIONS NfL and GFAP hold promise as biomarkers for NMOSD, demonstrating their usefulness in distinguishing patients from healthy individuals, assessing disease severity, and possibly reflecting treatment response. However, it is important to recognize that NfL and GFAP may, at some point, have different roles.
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Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Jae-Joon Lee
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
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Carta S, Dinoto A, Capobianco M, Valentino P, Montarolo F, Sala A, Reindl M, Lo Re M, Chiodega V, Branger P, Audoin B, Aboab J, Papeix C, Collongues N, Kerschen P, Zephir H, Créange A, Bourre B, Schanda K, Flanagan EP, Redenbaugh V, Villacieros-Álvarez J, Arrambide G, Cobo-Calvo A, Ferrari S, Marignier R, Mariotto S. Serum Biomarker Profiles Discriminate AQP4 Seropositive and Double Seronegative Neuromyelitis Optica Spectrum Disorder. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200188. [PMID: 38134369 PMCID: PMC10753928 DOI: 10.1212/nxi.0000000000200188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) serum levels are useful to define disease activity in different neurologic conditions. These biomarkers are increased in patients with aquaporin-4 antibody-positive NMOSD (AQP4+NMOSD) during clinical attacks suggesting a concomitant axonal and glial damage. However, there are contradictory results in double seronegative NMOSD (DS-NMOSD). The aim of this study was to characterize the neuronal, axonal, and glial damage of DS-NMOSD in comparison with AQP4+NMOSD. METHODS Patients with DS-NMOSD (i.e., for AQP4 and myelin oligodendrocyte glycoprotein antibodies-MOG-Abs) and age-matched AQP4+NMOSD diagnosed according to the latest diagnostic criteria and with available serum samples obtained within 3 months from onset/relapse were retrospectively enrolled from 14 international centers. Clinical and radiologic data were collected. Serum NfL, GFAP, tau, and UCH-L1 levels were determined using an ultrasensitive paramagnetic bead-based ELISA (SIMOA). Statistical analysis was performed using nonparametric tests and receiver-operating characteristic (ROC) curve analysis. RESULTS We included 25 patients with AQP4+NMOSD and 26 with DS-NMOSD. The median age at disease onset (p = 0.611) and female sex predominance (p = 0.072) were similar in the 2 groups. The most common syndromes at sampling in both AQP4+NMOSD and DS-NMOSD were myelitis (56% vs 38.5%) and optic neuritis (34.6% vs 32%), with no statistical differences (p = 0.716). Median EDSS at sampling was 3.2 (interquartile range [IQR] 2-7.7) in the AQP4+NMOSD group and 4 (IQR [3-6]) in the DS-NMOSD group (p = 0.974). Serum GFAP, tau, and UCH-L1 levels were higher in patients with AQP4+NMOSD compared with those with DS-NMOSD (median 308.3 vs 103.4 pg/mL p = 0.001; median 1.2 vs 0.5 pg/mL, p = 0.001; and median 61.4 vs 35 pg/mL, p = 0.006, respectively). The ROC curve analysis showed that GFAP, tau, and UCH-L1, but not NfL, values were able to discriminate between AQP4+ and DS-NMOSD (area under the curve (AUC) tau: 0.782, p = 0.001, AUC GFAP: 0.762, p = 0.001, AUC UCH-L1: 0.723, p = 0.006). NfL levels were associated with EDSS at nadir only in patients with AQP4+NMOSD. DISCUSSION Serum GFAP, tau, and UCH-L1 levels discriminate between AQP4+NMOSD and DS-NMOSD. The different biomarker profile of AQP4+NMOSD vs DS-NMOSD suggests heterogeneity of diseases within the latter category and provides useful data to improve our understanding of this disease.
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Affiliation(s)
- Sara Carta
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alessandro Dinoto
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Marco Capobianco
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Paola Valentino
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Francesca Montarolo
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Arianna Sala
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Markus Reindl
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Marianna Lo Re
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Vanessa Chiodega
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Pierre Branger
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Bertrand Audoin
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Jennifer Aboab
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Caroline Papeix
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Nicolas Collongues
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Philippe Kerschen
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Helene Zephir
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alain Créange
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Bertrand Bourre
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Kathrin Schanda
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Eoin P Flanagan
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Vyanka Redenbaugh
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Javier Villacieros-Álvarez
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Georgina Arrambide
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alvaro Cobo-Calvo
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Sergio Ferrari
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Romain Marignier
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Sara Mariotto
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
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7
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Chu F, Shi M, Liu C, Zhu J. Discrepancy in clinical and laboratory profiles of NMOSD patients between AQP4 antibody positive and negative: can NMOSD be diagnosed without AQP4 antibody? Clin Exp Immunol 2023; 213:363-370. [PMID: 37161978 PMCID: PMC10570998 DOI: 10.1093/cei/uxad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/02/2023] [Accepted: 05/09/2023] [Indexed: 05/11/2023] Open
Abstract
AQP4-IgG has been considered as the pathogenic factor leading to NMOSD. However, about 20-30% of patients lack AQP4-IgG. So far, all therapeutic medicines are ineffective for NMOSD patients without AQP4 IgG. Thus AQP4-IgG is the pathogenic factor of NMOSD has been suspected and challenged. In addition, lack of efficacy of immunotherapy in NMOSD without AQP4 IgG has been a serious problem in the neurology. Identifying the clinical and laboratory characteristics and diversities between NMOSD patients with and without AQP4-IgG can be helpful to further explore the pathogenesis of NMOSD and guide clinical treatment. This is a single-centre retrospective study in The First Hospital of Jilin University, China including 92 patients diagnosed as NMOSD from January 2013 to January 2015. The characteristics of clinic, blood, cerebrospinal fluid (CSF), and image between AQP4-IgG negative (AQP4-IgG-) and AQP4-IgG positive (AQP4-IgG+) NMOSDs were compared. Our results showed that in the AQP4-IgG+ group, the ratio of women to men was 5.55, while in AQP4-IgG- group was 1.54 (P = 0.0092). In the AQP4-IgG+ patients, the expanded disability status scale (EDSS) was from 0 to 8.5, with an average of 5.550 ± 0.25, and the AQP4-IgG- patients had the EDSS score from 0 to 9, with an average of 4.032 ± 0.36 (P = 0.0006), which mainly affected movement system (P < 0.05) and superficial sensory impairment (P < 0.05). In the AQP4-IgG+ group, the blood brain barrier (BBB) permeability (P = 0.0210) and myelin basic protein (MBP) were increased (P = 0.0310) when compared to AQP4-IgG- group. Higher level IL-17 was seen in AQP4-IgG+ group than AQP4-IgG- group (P= 0.0066). Our results demonstrated that the NMOSD with AQP4-IgG more likely occurred in women and presented more severe clinical symptoms as well as significant BBB damage and increased MBP and IL-17 in CSF and blood, respectively compared with NMOSD without AQP4-IgG group. The differences in clinical and laboratory profiles between NMOSD with and without AQP4-IgG indicate the heterogeneity of NMOSD, in which AQP4-IgG may not be the only pathogenic molecule. It is necessary to find more pathogenic factors and to explore the new pathogenesis of NMOSD and therapeutic methods in the future.
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Affiliation(s)
- Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Canyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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8
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Plantone D, Sabatelli E, Locci S, Marrodan M, Laakso SM, Mateen FJ, Feresiadou A, Buelens T, Bianco A, Fiol MP, Correale J, Tienari P, Calabresi P, De Stefano N, Iorio R. Clinically relevant increases in serum neurofilament light chain and glial fibrillary acidic protein in patients with Susac syndrome. Eur J Neurol 2023; 30:3256-3264. [PMID: 37335505 DOI: 10.1111/ene.15939] [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: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND AND PURPOSE Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are promising neuro-axonal damage and astrocytic activation biomarkers. Susac syndrome (SS) is an increasingly recognized neurological condition and biomarkers that can help assess and monitor disease evolution are highly needed for the adequate management of these patients. sNfL and sGFAP levels were evaluated in patients with SS and their clinical relevance in the relapse and remission phase of the disease was assessed. METHODS As part of a multicentre study that enrolled patients diagnosed with SS from six international centres, sNfL and sGFAP levels were assessed in 22 SS patients (nine during a relapse and 13 in remission) and 59 age- and sex-matched healthy controls using SimoaTM assay Neurology 2-Plex B Kit. RESULTS Serum NfL levels were higher than those of healthy controls (p < 0.001) in SS patients and in both subgroups of patients in relapse and in remission (p < 0.001 for both), with significantly higher levels in relapse than in remission (p = 0.008). sNfL levels showed a negative correlation with time from the last relapse (r = -0.663; p = 0.001). sGFAP levels were slightly higher in the whole group of patients than in healthy controls (p = 0.046) and were more pronounced in relapse than in remission (p = 0.013). CONCLUSION In SS patients, both sNFL and sGFAP levels increased compared with healthy controls. Both biomarkers had higher levels during clinical relapse and much lower levels in remission. sNFL was shown to be time sensitive to clinical changes and can be useful to monitor neuro-axonal damage in SS.
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Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Eleonora Sabatelli
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
| | - Sara Locci
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Sini M Laakso
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amalia Feresiadou
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Section of Neurology, Uppsala University, Uppsala, Sweden
| | - Tom Buelens
- Department of Ophthalmology, CHU St Pierre and Brugmann, Brussels, Belgium
| | - Assunta Bianco
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
| | | | - Jorge Correale
- Neurology Department, Fleni, Buenos Aires, Argentina
- Institute of Biological Chemistry and Biophysics (IQUIFIB) CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - Pentti Tienari
- Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
- Research Program of Translational Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Aktas O, Hartung HP, Smith MA, Rees WA, Fujihara K, Paul F, Marignier R, Bennett JL, Kim HJ, Weinshenker BG, Pittock SJ, Wingerchuk DM, Cutter G, She D, Gunsior M, Cimbora D, Katz E, Cree BA. Serum neurofilament light chain levels at attack predict post-attack disability worsening and are mitigated by inebilizumab: analysis of four potential biomarkers in neuromyelitis optica spectrum disorder. J Neurol Neurosurg Psychiatry 2023; 94:757-768. [PMID: 37221052 PMCID: PMC10447388 DOI: 10.1136/jnnp-2022-330412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/03/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate relationships between serum neurofilament light chain (sNfL), ubiquitin C-terminal hydrolase L1 (sUCHL1), tau (sTau) and glial fibrillary acidic protein (sGFAP) levels and disease activity/disability in neuromyelitis optica spectrum disorder (NMOSD), and the effects of inebilizumab on these biomarkers in N-MOmentum. METHODS N-MOmentum randomised participants to receive inebilizumab or placebo with a randomised controlled period (RCP) of 28 weeks and an open-label follow-up period of ≥2 years. The sNfL, sUCHL1, sTau and sGFAP were measured using single-molecule arrays in 1260 scheduled and attack-related samples from N-MOmentum participants (immunoglobulin G (IgG) autoantibodies to aquaporin-4-positive, myelin oligodendrocyte glycoprotein-IgG-positive or double autoantibody-negative) and two control groups (healthy donors and patients with relapsing-remitting multiple sclerosis). RESULTS The concentration of all four biomarkers increased during NMOSD attacks. At attack, sNfL had the strongest correlation with disability worsening during attacks (Spearman R2=0.40; p=0.01) and prediction of disability worsening after attacks (sNfL cut-off 32 pg/mL; area under the curve 0.71 (95% CI 0.51 to 0.89); p=0.02), but only sGFAP predicted upcoming attacks. At RCP end, fewer inebilizumab-treated than placebo-treated participants had sNfL>16 pg/mL (22% vs 45%; OR 0.36 (95% CI 0.17 to 0.76); p=0.004). CONCLUSIONS Compared with sGFAP, sTau and sUCHL1, sNfL at attack was the strongest predictor of disability worsening at attack and follow-up, suggesting a role for identifying participants with NMOSD at risk of limited post-relapse recovery. Treatment with inebilizumab was associated with lower levels of sGFAP and sNfL than placebo. TRIAL REGISTRATION NUMBER NCT02200770.
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Affiliation(s)
- Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Medical University Vienna, Vienna, Austria
- Department of Neurology, Palacky University in Olomouc, Olomouc, Czech Republic
| | | | | | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Koriyama, Fukushima, Japan
- Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Romain Marignier
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hopital Neurologique et Neurochirurgical Pierre Wertheimer Centre de reference des syndromes neurologiques paraneoplasiques et encephalites auto-immun, Lyon, Auvergne-Rhône-Alpes, France
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Brian G Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Sean J Pittock
- Department of Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dewei She
- Horizon Therapeutics plc, Gaithersburg, Maryland, USA
| | | | | | - Eliezer Katz
- Horizon Therapeutics plc, Gaithersburg, Maryland, USA
| | - Bruce A Cree
- Department of Neurology, UCSF, Weill Institute for Neurosciences, University California of San Francisco, San Francisco, California, USA
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10
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Varley JA, Strippel C, Handel A, Irani SR. Autoimmune encephalitis: recent clinical and biological advances. J Neurol 2023; 270:4118-4131. [PMID: 37115360 PMCID: PMC10345035 DOI: 10.1007/s00415-023-11685-3] [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: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
In 2015, we wrote a review in The Journal of Neurology summarizing the field of autoantibody-associated neurological diseases. Now, in 2023, we present an update of the subject which reflects the rapid expansion and refinement of associated clinical phenotypes, further autoantibody discoveries, and a more detailed understanding of immunological and neurobiological pathophysiological pathways which mediate these diseases. Increasing awareness around distinctive aspects of their clinical phenotypes has been a key driver in providing clinicians with a better understanding as to how these diseases are best recognized. In clinical practice, this recognition supports the administration of often effective immunotherapies, making these diseases 'not to miss' conditions. In parallel, there is a need to accurately assess patient responses to these drugs, another area of growing interest. Feeding into clinical care are the basic biological underpinnings of the diseases, which offer clear pathways to improved therapies toward enhanced patient outcomes. In this update, we aim to integrate the clinical diagnostic pathway with advances in patient management and biology to provide a cohesive view on how to care for these patients in 2023, and the future.
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Affiliation(s)
- James A Varley
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - Christine Strippel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK.
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK.
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11
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Ziaei A, Nasr Z, Hart J, Francisco C, Rutatangwa A, Leppert D, Kuhle J, Flanagan E, Waubant E. High serum neurofilament levels are observed close to disease activity events in pediatric-onset MS and MOG antibody-associated diseases. Mult Scler Relat Disord 2023; 74:104704. [PMID: 37031551 DOI: 10.1016/j.msard.2023.104704] [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: 06/10/2022] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Serum neurofilament light chain (sNfL) is an emerging multiple sclerosis (MS) biomarker which measures neuro-axonal damage. However, understanding its temporal association with disease activity in pediatric-onset MS (POMS) and Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) remains limited. OBJECTIVE To investigate the association of sNfL levels and time from disease activity in children with MS and MOGAD. METHODS POMS and MOGAD cases with onset before 18 years of age were enrolled at the University of California San Francisco (UCSF) Regional Pediatric MS Center. Frequency-matched healthy subjects were recruited from general pediatric clinics. Serum samples were tested for MOG-IgG at Mayo Clinic using a live cell-based fluorescent activated cell sorting assay. sNfL levels were measured using single-molecule array (Simoa) technology measured in pg/mL. Data on demographics, clinical features, MRI, CSF, and treatment data were collected by chart review. RESULTS We included 201 healthy controls healthy controls, 142 POMS, and 20 confirmed MOGAD cases with available sNfL levels. The median (IQR) age at the time of sampling was 15.6 (3.9), 15.5 (3.1), and 8.8 (4.1) years for controls, POMS, and MOGAD, respectively. Median sNfL levels (pg/ml) were higher in POMS (19.6) and MOGAD (32.7) cases compared to healthy controls (3.9) (p<0.001). sNfL levels ≥100 pg/ml were only detected within four months of a clinical event or MRI activity in both POMS and MOGAD cases. In addition, sNfL levels were higher in POMS patients with new/enlarged T2 and gadolinium-enhanced lesions than those without MRI activity within four months of sampling in POMS cases. CONCLUSION High sNfL levels were observed close to clinical or MRI events in POMS and MOGAD. Our findings support sNfL as a biomarker of disease activity in pediatric demyelinating disorders.
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Affiliation(s)
- Amin Ziaei
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Zahra Nasr
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Janace Hart
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Carla Francisco
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Alice Rutatangwa
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - David Leppert
- Neurology, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Jens Kuhle
- Neurology, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel, Switzerland
| | - Eoin Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emmanuelle Waubant
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
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12
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Bian J, Sun J, Chang H, Wei Y, Cong H, Yao M, Xiao F, Wang H, Zhao Y, Liu J, Zhang X, Yin L. Profile and potential role of novel metabolite biomarkers, especially indoleacrylic acid, in pathogenesis of neuromyelitis optica spectrum disorders. Front Pharmacol 2023; 14:1166085. [PMID: 37324490 PMCID: PMC10263123 DOI: 10.3389/fphar.2023.1166085] [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: 02/14/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory and demyelinating disorder that can lead to serious disability and mortality. Humoral fluid biomarkers with specific, convenient, and efficient profiles that could characterize and monitor disease activity or severity are very useful. We aimed to develop a sensitive and high-throughput liquid chromatography-tandem mass spectrometry (LC-MS)/MS-based analytical method for novel biomarkers finding in NMOSD patients and verified its function tentatively. Methods: Serum samples were collected from 47 NMOSD patients, 18 patients with other neurological disorders (ONDs), and 35 healthy controls (HC). Cerebrospinal fluid (CSF) samples were collected from 18 NMOSD and 17 OND patients. Three aromatic amino acids (phenylalanine, tyrosine, and tryptophan) and nine important metabolites that included phenylacetylglutamine (PAGln), indoleacrylic acid (IA), 3-indole acetic acid (IAA), 5-hydroxyindoleacetic acid (HIAA), hippuric acid (HA), I-3-carboxylic acid (I-3-CA), kynurenine (KYN), kynurenic acid (KYNA), and quinine (QUIN) were analyzed by using the liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based method. The profile of IA was further analyzed, and its function was verified in an astrocyte injury model stimulated by NMO-IgG, which represents important events in NMOSD pathogenesis. Results: In the serum, tyrosine and some of the tryptophan metabolites IA and I-3-CA decreased, and HIAA increased significantly in NMOSD patients. The CSF levels of phenylalanine and tyrosine showed a significant increase exactly during the relapse stage, and IA in the CSF was also increased markedly during the relapse and remission phases. All conversion ratios had similar profiles with their level fluctuations. In addition, the serum IA levels negatively correlated with glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) levels in the serum of NMOSD patients were measured by using ultra-sensitive single-molecule arrays (Simoa). IA showed an anti-inflammatory effect in an in vitro astrocyte injury model. Conclusion: Our data suggest that essential aromatic amino acid tryptophan metabolites IA in the serum or CSF may serve as a novel promising biomarker to monitor and predict the activity and severity of NMOSD disease. Supplying or enhancing IA function can promote anti-inflammatory responses and may have therapeutic benefits.
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Affiliation(s)
- Jiangping Bian
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiali Sun
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haoxiao Chang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuzhen Wei
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hengri Cong
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengyuan Yao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fuyao Xiao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Huabing Wang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaobo Zhao
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianghong Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xinghu Zhang
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linlin Yin
- Department of Neuroinfection and Neuroimmunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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13
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Al-Ani A, Chen JJ, Costello F. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): current understanding and challenges. J Neurol 2023:10.1007/s00415-023-11737-8. [PMID: 37154894 PMCID: PMC10165591 DOI: 10.1007/s00415-023-11737-8] [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: 03/07/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
New diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have recently been proposed, distinguishing this syndrome from other inflammatory diseases of the central nervous system. Seropositivity status for MOG-IgG autoantibodies is important for diagnosing MOGAD, but only in the context of robust clinical characterization and cautious interpretation of neuroimaging. Over the last several years, access to cell-based assay (CBA) techniques has improved diagnostic accuracy, yet the positive predictive value of serum MOG-IgG values varies with the prevalence of MOGAD in any given patient population. For this reason, possible alternative diagnoses need to be considered, and low MOG-IgG titers need to be carefully weighted. In this review, cardinal clinical features of MOGAD are discussed. Key challenges to the current understanding of MOGAD are also highlighted, including uncertainty regarding the specificity and pathogenicity of MOG autoantibodies, the need to identify immunopathologic targets for future therapies, the quest to validate biomarkers that facilitate diagnosis and detect disease activity, and the importance of deciphering which patients with MOGAD require long-term immunotherapy.
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Affiliation(s)
- Abdullah Al-Ani
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - Fiona Costello
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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14
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Kim HJ, Lee EJ, Kim SY, Kim H, Kim KW, Kim S, Kim H, Seo D, Lee BJ, Lim HT, Kim KK, Lim YM. Serum proteins for monitoring and predicting visual function in patients with recent optic neuritis. Sci Rep 2023; 13:5609. [PMID: 37019946 PMCID: PMC10076295 DOI: 10.1038/s41598-023-32748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
It is unclear whether serum proteins can serve as biomarkers to reflect pathological changes and predict recovery in inflammation of optic nerve. We evaluated whether serum proteins could monitor and prognosticate optic neuritis (ON). We prospectively recruited consecutive patients with recent ON, classified as ON with anti-aquaporin-4 antibody (AQP4-ON), ON with anti-myelin oligodendrocyte glycoprotein antibody (MOG-ON), and double-seronegative ON (DSN-ON). Using ultrasensitive single-molecule array assays, we measured serum neurofilament light chain and glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF). We analyzed the markers according to disease group, state, severity, and prognosis. We enrolled 60 patients with recent ON (15 AQP4-ON; 14 MOG-ON; 31 DSN-ON). At baseline, AQP4-ON group had significantly higher serum GFAP levels than did other groups. In AQP4-ON group, serum GFAP levels were significantly higher in the attack state than in the remission state and correlated with poor visual acuity. As a prognostic indicator, serum BDNF levels were positively correlated with follow-up visual function in the AQP4-ON group (r = 0.726, p = 0.027). Serum GFAP reflected disease status and severity, while serum BDNF was identified as a prognostic biomarker in AQP4-ON. Serum biomarkers are potentially helpful for patients with ON, particularly those with AQP4-ON.
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Affiliation(s)
- Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Meidcal Center, Seoul, South Korea.
| | - Sang-Yeob Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seungmi Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunji Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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15
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Disease characteristics of idiopathic transverse myelitis with serum neuronal and astroglial damage biomarkers. Sci Rep 2023; 13:3988. [PMID: 36894677 PMCID: PMC9998854 DOI: 10.1038/s41598-023-30755-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
Despite its close association with CNS inflammatory demyelinating disorders (CIDDs), pathogenic characteristics of idiopathic transverse myelitis (ITM) remain largely unknown. Here, we investigated serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) in patients with ITM to unravel the disease characteristics of ITM. We prospectively recruited 70 patients with ITM, 62 with AQP4 + NMOSD and 85 with RRMS-including 31 patients with acute TM attacks-along with 30 HCs. We measured sNfL and sGFAP levels using single-molecular arrays and compared these levels per lesion volume between the disease groups during attacks. Compared to HCs, ITM patients showed higher sNfL and sGFAP during acute attacks (sNfL: p < 0.001, sGFAP: p = 0.024), while those in remission (sNfL: p = 0.944, sGFAP: p > 0.999) did not, regardless of lesion extents and presence of multiple attacks. ITM patients demonstrated lower sGFAP/volume (p = 0.011) during acute attacks and lower sGFAP (p < 0.001) in remission compared to AQP4 + NMOSD patients. These findings suggest that both neuronal and astroglial damages occur in patients with acute ITM attacks at a similar level to those with RRMS, distinct from AQP4 + NMOSD. However, active neuroinflammatory process was not remarkable during remission in this cohort.
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Wang J, Wang J, Xie W, Liu J, Feng J, Wei W, Li M, Wu L, Wang C, Li R. Decipher potential biomarkers of diagnosis and disease activity for NMOSD with AQP4 using LC-MS/MS and Simoa. Int Immunopharmacol 2023; 116:109761. [PMID: 36709595 DOI: 10.1016/j.intimp.2023.109761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune demyelinating disease, leading recurrently relapses and severe disability. There is a need for new biomarkers to meet clinical needs in diagnosis and monitoring. METHODS Through liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) analysis, brain lesions from NMO animal models were analyzed to identify potential biomarkers. Then, we assessed the levels of serum glial fibrillary acidic protein (sGFAP), neurofilament light chain (sNfL), Tau protein (sTau) and Ubiquitin C-terminal hydrolase L1 (sUCHL1) using an ultrasensitive single molecule array (Simoa) of AQP4-IgG + NMOSD patients, myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) patients, multiple sclerosis (MS) patients and healthy controls (HCs). Additionally, we further explored the early diagnosis value of these proteins. RESULTS There were 72 differentially expressed proteins between the NMO and control groups. NfL abundance was elevated when GFAP, UCHL1, and Tau abundance was decreased in the NMO group. Then, we observed that the sGFAP and sUCHL1 levels in patients with NMOSD in the early stage were significantly increased compared to those in control participants. Combined ROCs of the sGFAP, sNfL, and sUCHL1 levels to better predict NMOSD with relapse stages was optimal. Notably, univariate and multivariate analyses demonstrated that the sGFAP and sNfL levels were higher in patients with brain lesions, while the sUCHL1 levels were higher in those with spinal cord lesions during recent relapse. CONCLUSIONS These findings suggested that sGFAP, sNfL, and sUCHL1 displayed good diagnostic performance in AQP4-IgG + NMOSD and could be novel candidates for early discrimination.
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Affiliation(s)
- Jinyang Wang
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; School of Laboratory Medicine, Weifang Medical College, Weifang, Shandong 261053, China
| | - Jianan Wang
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; Medical School of Chinese PLA, Beijing 100853, China
| | - Wei Xie
- Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
| | - Jiayu Liu
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
| | - Jie Feng
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
| | - Wenbin Wei
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
| | - Mianyang Li
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China
| | - Lei Wu
- Department of Neurology, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China.
| | - Chengbin Wang
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China; School of Laboratory Medicine, Weifang Medical College, Weifang, Shandong 261053, China; Medical School of Chinese PLA, Beijing 100853, China.
| | - Ruibing Li
- Department of Laboratory Medicine, the First Medical Centre of Chinese PLA General Hospital, Beijing 100853, China.
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Schindler P, Aktas O, Ringelstein M, Wildemann B, Jarius S, Paul F, Ruprecht K. Glial fibrillary acidic protein as a biomarker in neuromyelitis optica spectrum disorder: a current review. Expert Rev Clin Immunol 2023; 19:71-91. [PMID: 36378751 DOI: 10.1080/1744666x.2023.2148657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, often debilitating neuroinflammatory disease, whose predominant clinical manifestations are longitudinally extensive transverse myelitis and optic neuritis. About 80% of the patients with an NMOSD phenotype have pathogenic autoantibodies against the astrocyte water channel aquaporin-4 (AQP4-IgG). While therapeutic options for NMOSD have greatly expanded in recent years, well-established biomarkers for prognosis or treatment response are still lacking. Glial fibrillary acidic protein (GFAP) is mainly expressed in astrocytes and can be detected in cerebrospinal fluid (CSF) and blood of patients with NMOSD. AREAS COVERED Here, we comprehensively review the current knowledge on GFAP as a biomarker in NMOSD. EXPERT OPINION In patients with AQP4-IgG+ NMOSD, GFAP levels are elevated in CSF and serum during acute attacks and correlate with disability, consistent with the pathophysiology of this antibody-mediated astrocytopathy. Serum GFAP levels tend to be higher in AQP4-IgG+ NMOSD than in its differential diagnoses, multiple sclerosis, and myelin oligodendrocyte antibody-associated disease. Importantly, serum GFAP levels in AQP4-IgG+ NMOSD during remission may be predictive of future disease activity. Serial serum GFAP measurements are emerging as a biomarker to monitor disease activity in AQP4-IgG+ NMOSD and could have the potential for application in clinical practice.
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Affiliation(s)
- Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Wingerchuk DM, Weinshenker BG, McCormick D, Barron S, Simone L, Jarzylo L. Aligning payer and provider strategies with the latest evidence to optimize clinical outcomes for patients with neuromyelitis optica spectrum disorder. J Manag Care Spec Pharm 2022; 28:S3-S27. [DOI: 10.18553/jmcp.2022.28.12-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tybirk L, Hviid CVB, Knudsen CS, Parkner T. Serum GFAP - reference interval and preanalytical properties in Danish adults. Clin Chem Lab Med 2022; 60:1830-1838. [PMID: 36067832 DOI: 10.1515/cclm-2022-0646] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) is a promising biomarker that could potentially contribute to diagnosis and prognosis in neurological diseases. The biomarker is approaching clinical use but the reference interval for serum GFAP remains to be established, and knowledge about the effect of preanalytical factors is also limited. METHODS Serum samples from 371 apparently healthy reference subjects, 21-90 years of age, were measured by a single-molecule array (Simoa) assay. Continuous reference intervals were modelled using non-parametric quantile regression and compared with traditional age-partitioned non-parametric reference intervals established according to the Clinical and Laboratory Standards Institute (CLSI) guideline C28-A3. The following preanalytical conditions were also examined: stability in whole blood at room temperature (RT), stability in serum at RT and -20 °C, repeated freeze-thaw cycles, and haemolysis. RESULTS The continuous reference interval showed good overall agreement with the traditional age-partitioned reference intervals of 25-136 ng/L, 34-242 ng/L, and 5-438 ng/L for the age groups 20-39, 40-64, and 65-90 years, respectively. Both types of reference intervals showed increasing levels and variability of serum GFAP with age. In the preanalytical tests, the mean changes from baseline were 2.3% (95% CI: -2.4%, 6.9%) in whole blood after 9 h at RT, 3.1% (95% CI: -4.5%, 10.7%) in serum after 7 days at RT, 10.4% (95% CI: -6.0%, 26.8%) in serum after 133 days at -20 °C, and 10.4% (95% CI: 9.5%, 11.4%) after three freeze-thaw cycles. CONCLUSIONS The study establishes age-dependent reference ranges for serum GFAP in adults and demonstrates overall good stability of the biomarker.
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Affiliation(s)
- Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Costello F, Burton JM. Contemporary management challenges in seropositive NMOSD. J Neurol 2022; 269:5674-5681. [PMID: 35816205 PMCID: PMC9272395 DOI: 10.1007/s00415-022-11241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory disorder of the central nervous system that presents unique management challenges. Neurologic disability in NMOSD is directly linked to acute attacks, therefore, relapse prevention is an overarching goal of care. To this end, identifying effective biomarkers that predict relapse onset and severity is of critical importance. As treatment becomes more precision-based and patient-centred, clinicians will need to be familiar with managing circumstances of particular vulnerability for patients with NMOSD, including infection, pregnancy, and the post-partum phase. The discovery of the pathogenic aquaporin-4 Immunoglobulin G (AQP4 IgG) autoantibody almost 20 years ago ultimately distinguished NMOSD as an autoimmune astrocytopathy and helped spearhead recent therapeutic advancements. Targeted therapies, including eculizumab, satralizumab, and inebilizumab, approved for use in aquaporin-4 immunoglobulin G (AQP4 IgG) seropositive patients with NMOSD will likely improve outcomes, but there are formidable costs involved. Importantly, seronegative patients continue to have limited therapeutic options. Moving forward, areas of research exploration should include relapse prevention, restorative therapies, and initiatives that promote equitable access to approved therapies for all people living with NMOSD.
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Affiliation(s)
- Fiona Costello
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
- Department of Surgery, University of Calgary, Calgary, Canada.
| | - Jodie M Burton
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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21
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Sechi E, Cacciaguerra L, Chen JJ, Mariotto S, Fadda G, Dinoto A, Lopez-Chiriboga AS, Pittock SJ, Flanagan EP. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol 2022; 13:885218. [PMID: 35785363 PMCID: PMC9247462 DOI: 10.3389/fneur.2022.885218] [Citation(s) in RCA: 92] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is the most recently defined inflammatory demyelinating disease of the central nervous system (CNS). Over the last decade, several studies have helped delineate the characteristic clinical-MRI phenotypes of the disease, allowing distinction from aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) and multiple sclerosis (MS). The clinical manifestations of MOGAD are heterogeneous, ranging from isolated optic neuritis or myelitis to multifocal CNS demyelination often in the form of acute disseminated encephalomyelitis (ADEM), or cortical encephalitis. A relapsing course is observed in approximately 50% of patients. Characteristic MRI features have been described that increase the diagnostic suspicion (e.g., perineural optic nerve enhancement, spinal cord H-sign, T2-lesion resolution over time) and help discriminate from MS and AQP4+NMOSD, despite some overlap. The detection of MOG-IgG in the serum (and sometimes CSF) confirms the diagnosis in patients with compatible clinical-MRI phenotypes, but false positive results are occasionally encountered, especially with indiscriminate testing of large unselected populations. The type of cell-based assay used to evaluate for MOG-IgG (fixed vs. live) and antibody end-titer (low vs. high) can influence the likelihood of MOGAD diagnosis. International consensus diagnostic criteria for MOGAD are currently being compiled and will assist in clinical diagnosis and be useful for enrolment in clinical trials. Although randomized controlled trials are lacking, MOGAD acute attacks appear to be very responsive to high dose steroids and plasma exchange may be considered in refractory cases. Attack-prevention treatments also lack class-I data and empiric maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the presenting attack. A variety of empiric steroid-sparing immunosuppressants can be considered and may be efficacious based on retrospective or prospective observational studies but prospective randomized placebo-controlled trials are needed to better guide treatment. In summary, this article will review our rapidly evolving understanding of MOGAD diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Fadda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eoin P. Flanagan
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22
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Pathomechanisms in demyelination and astrocytopathy: autoantibodies to AQP4, MOG, GFAP, GRP78 and beyond. Curr Opin Neurol 2022; 35:427-435. [PMID: 35674086 DOI: 10.1097/wco.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the recently emerging pathomechanisms of diseases associated with autoantibodies to AQP4, MOG, GFAP, GRP78 and further novel targets. We discuss novel biomarkers and therapeutic approaches. RECENT FINDINGS Although complement-mediated cytotoxicity (CDC) is regarded as the major effector mechanism for AQP4-IgG in neuromyelitis optica spectrum disorders (NMOSD), recent studies helped to understand the relevance of complement-independent effector mechanisms. For MOG-IgG mediated diseases the role of CDC is less clear. MOG-IgG may trigger a tightly controlled FcR and BTK-driven microglia proliferative response in MOG-antibody-associated diseases. Differences of antibody-mediated tissue damage may reflect differential response to therapy. In addition, antibodies to GFAP, GRP78 and further novel targets have been implicated in demyelination and astrocytopathy. SUMMARY Elucidating the whole spectrum of effector functions in diseases mediated by AQP4-IgG and MOG-IgG and understanding the role of additional novel autoantibodies involved in demyelination and astrocytopathy may guide further novel treatment decisions.
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23
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Serum NfL associated with anti-NMDA receptor encephalitis. Neurol Sci 2022; 43:3893-3899. [DOI: 10.1007/s10072-021-05838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
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Traub J, Otto M, Sell R, Homola GA, Steinacker P, Oeckl P, Morbach C, Frantz S, Pham M, Störk S, Stoll G, Frey A. Serum glial fibrillary acidic protein indicates memory impairment in patients with chronic heart failure. ESC Heart Fail 2022; 9:2626-2634. [PMID: 35611842 PMCID: PMC9288738 DOI: 10.1002/ehf2.13986] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/28/2022] [Accepted: 05/06/2022] [Indexed: 12/12/2022] Open
Abstract
Aims Cognitive dysfunction occurs frequently in patients with heart failure (HF), but early detection remains challenging. Serum glial fibrillary acidic protein (GFAP) is an emerging biomarker of cognitive decline in disorders of primary neurodegeneration such as Alzheimer's disease. We evaluated the utility of serum GFAP as a biomarker for cognitive dysfunction and structural brain damage in patients with stable chronic HF. Methods and results Using bead‐based single molecule immunoassays, we quantified serum levels of GFAP in patients with HF participating in the prospective Cognition.Matters‐HF study. Participants were extensively phenotyped, including cognitive testing of five separate domains and magnetic resonance imaging (MRI) of the brain. Univariable and multivariable models, also accounting for multiple testing, were run. One hundred and forty‐six chronic HF patients with a mean age of 63.8 ± 10.8 years were included (15.1% women). Serum GFAP levels (median 246 pg/mL, quartiles 165, 384 pg/mL; range 66 to 1512 pg/mL) did not differ between sexes. In the multivariable adjusted model, independent predictors of GFAP levels were age (T = 5.5; P < 0.001), smoking (T = 3.2; P = 0.002), estimated glomerular filtration rate (T = −4.7; P < 0.001), alanine aminotransferase (T = −2.1; P = 0.036), and the left atrial end‐systolic volume index (T = 3.4; P = 0.004). NT‐proBNP but not serum GFAP explained global cerebral atrophy beyond ageing. However, serum GFAP levels were associated with the cognitive domain visual/verbal memory (T = −3.0; P = 0.003) along with focal hippocampal atrophy (T = 2.3; P = 0.025). Conclusions Serum GFAP levels are affected by age, smoking, and surrogates of the severity of HF. The association of GFAP with memory dysfunction suggests that astroglial pathologies, which evade detection by conventional MRI, may contribute to memory loss beyond ageing in patients with chronic HF.
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Affiliation(s)
- Jan Traub
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, University Würzburg, Würzburg, Germany
| | - Markus Otto
- Department of Neurology, University Hospital Ulm, Ulm, Germany.,Department of Neurology, University Hospital Halle-Wittenberg, Halle, Germany
| | - Roxane Sell
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | - György A Homola
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Petra Steinacker
- Department of Neurology, University Hospital Ulm, Ulm, Germany.,Department of Neurology, University Hospital Halle-Wittenberg, Halle, Germany
| | - Patrick Oeckl
- Department of Neurology, University Hospital Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE e.V.), Ulm, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Mirko Pham
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Guido Stoll
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Anna Frey
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
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25
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Gomes ABAGR, Adoni T. Differential diagnosis of demyelinating diseases: what's new? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:137-142. [PMID: 35976299 PMCID: PMC9491438 DOI: 10.1590/0004-282x-anp-2022-s109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acquired demyelinating disorders lead to overlapping visual, pyramidal, sensory, autonomic, and cerebellar deficits and may lead to severe disability. Early diagnosis and start of treatment are fundamental towards preventing further attacks and halting disability. OBJECTIVE In this paper we provide an updated overview of the differential diagnoses of acquired demyelinating disorders. METHODS We performed a critical targeted review of the diagnoses of the most prevalent demyelinating disorders: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). RESULTS We discuss the workup, diagnostic criteria and new biomarkers currently being used for the diagnosis of these disease entities taking into account the particularities of the Brazilian population and healthcare system. CONCLUSION A comprehensive analysis of medical history, physical examination, biomedical and imaging data should be performed to obtain differential diagnosis. Diagnostic criteria should be mindfully employed considering ethnic and environmental particularities of each patient.
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Affiliation(s)
| | - Tarso Adoni
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo SP, Brazil
- Hospital Sírio-Libanês, Centro de Esclerose Múltipla, São Paulo SP, Brazil
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26
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Hanson BA, Visvabharathy L, Ali ST, Kang AK, Patel TR, Clark JR, Lim PH, Orban ZS, Hwang SS, Mattoon D, Batra A, Liotta EM, Koralnik IJ. Plasma Biomarkers of Neuropathogenesis in Hospitalized Patients With COVID-19 and Those With Postacute Sequelae of SARS-CoV-2 Infection. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/3/e1151. [PMID: 35256481 PMCID: PMC8901169 DOI: 10.1212/nxi.0000000000001151] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/24/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Although patients hospitalized with COVID-19 frequently present with encephalopathy, those with mild initial COVID-19 disease who never required hospitalization also often develop neurologic symptoms as part of postacute sequelae of severe acute respiratory coronavirus type 2 (SARS-CoV-2) infection (neuro-PASC). The pathogenic mechanisms of COVID-19 encephalopathy and neuro-PASC are unknown. We sought to establish biochemical evidence of CNS injury in those patients and their association with neuropsychiatric manifestations and SARS-CoV-2 antigenemia. METHODS We recruited hospitalized, posthospitalized, and nonhospitalized patients with confirmed diagnosis of COVID-19 with neurologic symptoms in addition to healthy control (HC) subjects. Plasma neurofilament light chain (pNfL), plasma glial fibrillary acidic protein (pGFAP), and plasma SARS-CoV-2 Nucleocapsid antigen (pN Ag) were measured by HD-X Simoa analyzer (Quanterix) and compared with neuropsychiatric symptoms, patient-reported quality-of-life measures, and standardized cognitive assessments. Neuroglial scores (pGFAP/pNfL) were calculated to estimate the relative contribution of astroglial and neuronal involvement. RESULTS We enrolled a total of 64 study participants, including 9 hospitalized patients with COVID-19 encephalopathy (CE), 9 posthospitalization neuro-PASC (PNP) patients, 38 nonhospitalized neuro-PASC (NNP) patients, and 8 HC subjects. Patients with CE were older, had higher pNfL and pGFAP concentrations, and more frequent pN Ag detection than all neuro-PASC groups. PNP and NNP patients exhibited similar PASC symptoms, decreased quality-of-life measures, and cognitive dysfunction, and 1 of the 38 (2.6%) NNP patients had pN Ag detectable 3 weeks postsymptoms onset. Patients with neuro-PASC presenting with anxiety/depression had higher neuroglial scores, which were correlated with increased anxiety on quality-of-life measures. DISCUSSION pNfL, pGFAP, and pN Ag measurements indicate neuronal dysfunction and systemic involvement in hospitalized COVID-19 patients with encephalopathy. Detection of SARS-CoV-2 N Ag in blood 3 weeks after symptoms onset in a nonhospitalized patient suggests that prolonged antigenic stimulation, or possibly latent infection, may occur. Anxiety was associated with evidence of astroglial activation in patients with neuro-PASC. These data shed new light on SARS-Cov-2 neuropathogenesis and demonstrate the value of plasma biomarkers across the COVID-19 disease spectrum.
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Affiliation(s)
- Barbara A Hanson
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Lavanya Visvabharathy
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Sareen T Ali
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Anthony K Kang
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Tulsi R Patel
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Jeffrey R Clark
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Patrick H Lim
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Zachary S Orban
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Soyoon S Hwang
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Dawn Mattoon
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Ayush Batra
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Eric M Liotta
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA
| | - Igor J Koralnik
- From the Ken and Ruth Davee Department of Neurology (B.A.H., L.V., S.T.A., A.K.K., T.R.P., J.R.C., P.H.L., Z.S.O., A.B., E.M.L., I.J.K.), Feinberg School of Medicine, Northwestern University; Rush Medical College (B.A.H.), Chicago IL; and Quanterix Corporation (S.S.H., D.M.), Billerica, MA.
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27
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Huang W, Wang L, Xia J, Li W, Wang M, Yu J, Li Q, Wang B, Pan J, Du L, Ma J, Tan H, Chang X, Lu C, Zhao C, Lu J, Zhou L, ZhangBao J, Quan C. Efficacy and safety of azathioprine, mycophenolate mofetil and reduced dose of rituximab in neuromyelitis optica spectrum disorder. Eur J Neurol 2022; 29:2343-2354. [PMID: 35398950 DOI: 10.1111/ene.15355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Wenjuan Huang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Liang Wang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Junhui Xia
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Wenyu Li
- Department of Neurology Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou Zhejiang Province China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Qinying Li
- Department of Rehabilitation Medicine Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Bei Wang
- Department of Neurology Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Juyuan Pan
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Lei Du
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Jianhua Ma
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Hongmei Tan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Xuechun Chang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chuanzhen Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chongbo Zhao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jiahong Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Lei Zhou
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jingzi ZhangBao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chao Quan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
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28
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Dinoto A, Sechi E, Flanagan EP, Ferrari S, Solla P, Mariotto S, Chen JJ. Serum and Cerebrospinal Fluid Biomarkers in Neuromyelitis Optica Spectrum Disorder and Myelin Oligodendrocyte Glycoprotein Associated Disease. Front Neurol 2022; 13:866824. [PMID: 35401423 PMCID: PMC8983882 DOI: 10.3389/fneur.2022.866824] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022] Open
Abstract
The term neuromyelitis optica spectrum disorder (NMOSD) describes a group of clinical-MRI syndromes characterized by longitudinally extensive transverse myelitis, optic neuritis, brainstem dysfunction and/or, less commonly, encephalopathy. About 80% of patients harbor antibodies directed against the water channel aquaporin-4 (AQP4-IgG), expressed on astrocytes, which was found to be both a biomarker and a pathogenic cause of NMOSD. More recently, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), have been found to be a biomarker of a different entity, termed MOG antibody-associated disease (MOGAD), which has overlapping, but different pathogenesis, clinical features, treatment response, and prognosis when compared to AQP4-IgG-positive NMOSD. Despite important refinements in the accuracy of AQP4-IgG and MOG-IgG testing assays, a small proportion of patients with NMOSD still remain negative for both antibodies and are called “seronegative” NMOSD. Whilst major advances have been made in the diagnosis and treatment of these conditions, biomarkers that could help predict the risk of relapses, disease activity, and prognosis are still lacking. In this context, a number of serum and/or cerebrospinal fluid biomarkers are emerging as potentially useful in clinical practice for diagnostic and treatment purposes. These include antibody titers, cytokine profiles, complement factors, and markers of neuronal (e.g., neurofilament light chain) or astroglial (e.g., glial fibrillary acidic protein) damage. The aim of this review is to summarize current evidence regarding the role of emerging diagnostic and prognostic biomarkers in patients with NMOSD and MOGAD.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Solla
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- *Correspondence: Sara Mariotto
| | - John J. Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
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Kim H, Lee EJ, Lim YM, Kim KK. Glial Fibrillary Acidic Protein in Blood as a Disease Biomarker of Neuromyelitis Optica Spectrum Disorders. Front Neurol 2022; 13:865730. [PMID: 35370870 PMCID: PMC8968934 DOI: 10.3389/fneur.2022.865730] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Glial fibrillary acidic protein (GFAP) is a type III intermediate filament protein found in astrocytes in the brain. Damaged astrocytes release GFAP into cerebrospinal fluid and blood. Thus, GFAP levels in these body fluids may reflect the disease state of neuromyelitis optica spectrum disorder (NMOSD), which includes astrocytopathy, characterized by pathogenic antibodies against aquaporin 4 located on astrocytes. Recently, single-molecule array technology that can detect these synaptic proteins in blood, even in the subfemtomolar range, has been developed. Emerging evidence suggests that GFAP protein is a strong biomarker candidate for NMOSD. This mini-review provides basic information about GFAP protein and innovative clinical data that show the potential clinical value of blood GFAP levels as a biomarker for NMOSD.
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Affiliation(s)
- Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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30
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Wendel EM, Bertolini A, Kousoulos L, Rauchenzauner M, Schanda K, Wegener-Panzer A, Baumann M, Reindl M, Otto M, Rostásy K. Serum neurofilament light-chain levels in children with monophasic myelin oligodendrocyte glycoprotein-associated disease, multiple sclerosis, and other acquired demyelinating syndrome. Mult Scler 2022; 28:1553-1561. [DOI: 10.1177/13524585221081090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To assess the diagnostic and prognostic potential of serum neurofilament light chain (sNfL) in children with first acquired demyelinating syndrome (ADS). Methods: We selected 129 children with first ADS including 19 children with myelin oligodendrocyte glycoprotein (MOG)-antibody associated disease (MOGAD), 36 MOG/AQP4-seronegative ADS, and 74 with multiple sclerosis (MS) from the BIOMARKER study cohort. All children had a complete set of clinical, radiological, laboratory data and serum for NfL measurement using a highly sensitive digital ELISA (SIMOA). A control group of 35 children with non-inflammatory neurological diseases was included. sNfL levels were compared across patient groups according to clinical, laboratory, neuroradiological features and outcome after 2 years. Results: sNfL levels were significantly increased in MOGAD, seronegative ADS and MS compared to controls ( p-value < 0.001), in particular in children with an acute disseminated encephalomyelitis (ADEM)-like magnetic resonance imaging (MRI) pattern ( p < 0.001) or longitudinally extensive myelitis ( p < 0.01). In pediatric MS, elevated sNfL levels were significantly associated with higher numbers of cerebral ( p < 0.001) and presence of spinal ( p < 0.05) MRI lesions at baseline and predicted a higher number of relapses ( p < 0.05). Conclusion: sNfL levels are significantly elevated in all three studied pediatric ADS subtypes indicating neuroaxonal injury. In pediatric MS high levels of sNfL are associated with risk factors for disease progression.
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Affiliation(s)
- Eva-Maria Wendel
- Department of Pediatrics, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Annikki Bertolini
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Lampros Kousoulos
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Markus Rauchenzauner
- Department of Pediatrics and Neonatology, Kliniken Ostallgäu-Kaufbeuren, Kaufbeuren, Germany/Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Wegener-Panzer
- Department of Pediatric Radiology, Children`s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Matthias Baumann
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Otto
- Department of Neurology, University Hospital of Ulm, Ulm, Germany; Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Kevin Rostásy
- Department of Pediatric Neurology, Children’s Hospital Datteln, University Witten/Herdecke, Datteln, Germany
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Hyun JW, Kim SY, Kim Y, Park NY, Kim KH, Kim SH, Kim HJ. Absence of attack-independent neuroaxonal injury in MOG antibody-associated disease: Longitudinal assessment of serum neurofilament light chain. Mult Scler 2021; 28:993-999. [PMID: 34965770 DOI: 10.1177/13524585211063756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To evaluate the occurrence of attack-independent neuroaxonal and astrocytic damage in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) levels were longitudinally measured in 102 sera using a single-molecule array assay. Sera from 15 adults with relapsing MOGAD with available longitudinal samples for the median 24-month follow-up and 26 age-/sex-matched healthy controls were analyzed. sNfL levels were significantly elevated in all clinical attacks, where the levels decreased below or close to cut-off value within 6 months after attacks. sNfL levels were consistently low during inter-attack periods. In contrast, sGFAP levels did not increase in most clinical attacks and remained low during follow-up. Significant neuroaxonal damage was observed at clinical attacks, while attack-independent neuroaxonal and astrocytic injury was absent in MOGAD.
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Affiliation(s)
- Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - So Yeon Kim
- Division of Clinical Research, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Yeseul Kim
- Division of Clinical Research, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Na Young Park
- Division of Clinical Research, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea/Division of Clinical Research, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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Luo W, Chen Y, Mao S, Jin J, Liu C, Zhong X, Sun X, Kermode AG, Qiu W. Serum neurofilament light chain in adult and pediatric patients with myelin oligodendrocyte glycoprotein antibody-associated disease: Correlation with relapses and seizures. J Neurochem 2021; 160:568-577. [PMID: 34839538 DOI: 10.1111/jnc.15549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) causes major disability as a consequence of recurrent demyelinating events and neuronal loss. Biomarkers identifying different phenotypes of recurrence or tissue damage might be useful to guide individualized therapy. Herein, we evaluated serum neurofilament light chain (sNfL) as a potential biomarker in both adult and pediatric MOGAD patients. Forty-nine patients with MOGAD (37 adults, 12 children) and 71 healthy controls (HCs) (56 adults, 15 children) were enrolled prospectively from September 2019 to April 2021 at the Third Affiliated Hospital of Sun Yat-sen University and the Children's Hospital, Zhejiang University School of Medicine. sNfL levels were determined using ultrasensitive single-molecule array assay and correlated with clinical parameters. The sNfL levels in MOGAD adults in a relapsed state (median: 31.0 pg/ml) were higher than those in a remission state (8.1 pg/ml, p = 0.001) and in HC adults (10.3 pg/ml, p = 0.004). Similar results were observed in children (relapse: 46.8 pg/ml vs. remission: 13.1 pg/ml, p = 0.001; and vs. HCs: 8.2 pg/ml, p = 0.007) sNfL levels were correlated with recent relapses within 60 days (multivariate: β = 2.02, p = 0.003), seizures (multivariate: β = 2.50, p = 0.021) and brain lesions on magnetic resonance imaging (MRI) of a recent relapse (multivariate: β = 1.72, p = 0.012). Our study showed that sNfL levels are beneficial for identifying recent relapses and seizures and suggest that adult and pediatric MOGAD patients had similar sNfL levels.
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Affiliation(s)
- Wenjing Luo
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yashuang Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianing Jin
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perth, Western Australia, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Zhang TX, Chen JS, Du C, Zeng P, Zhang H, Wang X, Liu Y, Huang Z, Yuan M, Li YL, Jia D, Shi FD, Zhang C. Longitudinal treatment responsiveness on plasma neurofilament light chain and glial fibrillary acidic protein levels in neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord 2021; 14:17562864211054952. [PMID: 34777577 PMCID: PMC8573482 DOI: 10.1177/17562864211054952] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/02/2021] [Indexed: 01/25/2023] Open
Abstract
Background Neurofilament light chain (NfL) and glial fibrilliary acidic protein (GFAP) have been suggested to be biomarkers of the pathophysiological process of neuromyelitis optica spectrum disorders (NMOSD), but the relationship between the plasma levels of these molecules with disease activity and treatment is incompletely understood. Objective To investigate the treatment effects of disease-modifying drugs on plasma neurofilament light chain (pNfL) and plasma glial fibrillary acidic protein (pGFAP) and explore the predictive value of pNfL and pGFAP in the activity of NMOSD. Methods pNfL and pGFAP levels were measured using single-molecule arrays in 72 patients with NMOSD and 38 healthy controls (HCs). Patients with NMOSD received tocilizumab (n = 29), rituximab (n = 23), oral prednisone (n = 16), and oral azathioprine or mycophenolate mofetil (n = 4). Results NMOSD patients had significantly higher pNfL and pGFAP levels than HCs (pNfL, 18.3 (11.2-39.3) versus 11.5 (7.0-23.3) pg/mL; p = 0.001; pGFAP, 149.7 (88.6-406.5) versus 68.7 (59.4-80.8) pg/mL; p < 0.001). Multivariable regression analyses indicated that baseline pNfL concentration was associated with age (p = 0.017), Expanded Disability Status Scale (EDSS) score (p = 0.002), and recent relapses (p < 0.001). Baseline pGFAP concentration was also associated with EDSS (p < 0.001) and recent relapses (p < 0.001). Compared with prednisone, tocilizumab and rituximab significantly reduced pNfL [tocilizumab, exp(β), 0.65; 95% confidence interval (CI), 0.56-0.75; p < 0.001; rituximab, exp(β), 0.79; 95% CI = 0.68-0.93; p = 0.005] and pGFAP levels [tocilizumab, exp(β), 0.64; 95% CI, 0.51-0.80; p < 0.001; rituximab, exp(β), 0.77; 95% CI, 0.61-0.98; p = 0.041] at the end of the study. The pNfL levels in the tocilizumab and rituximab groups were reduced to those of HCs [tocilizumab, 8.5 (7.06-17.90) pg/mL; p = 0.426; rituximab, 14.0 (9.94-21.80) pg/mL; p = 0.216]. However, the pGFAP levels did not decrease to those of HCs in NMOSD patients at the end of study [tocilizumab, 88.9 (63.4-131.8) pg/mL; p = 0.012; rituximab, 141.7 (90.8-192.7) pg/mL; p < 0.001]. Conclusion pNfL and pGFAP may serve as biomarkers for NMOSD disease activity and treatment effects.
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Affiliation(s)
- Tian-Xiang Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Jing-Shan Chen
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Chen Du
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Pei Zeng
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Huiming Zhang
- Department of Neurology, The Third People's Hospital of Datong, Datong, China
| | - Xuejiao Wang
- Department of Neurology, The Third People's Hospital of Datong, Datong, China
| | - Ye Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Zhenning Huang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Meng Yuan
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Yu-Lin Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Dongmei Jia
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin, P.R. China
| | - Chao Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin Neurological Institute, Tianjin 300052, P.R. China
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Molazadeh N, Filippatou AG, Vasileiou ES, Levy M, Sotirchos ES. Evidence for and against subclinical disease activity and progressive disease in MOG antibody disease and neuromyelitis optica spectrum disorder. J Neuroimmunol 2021; 360:577702. [PMID: 34547512 DOI: 10.1016/j.jneuroim.2021.577702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) are generally considered to be relapsing disorders, without clinical progression or subclinical disease activity outside of clinical relapses, in contrast to multiple sclerosis (MS). With advances in the diagnosis and treatment of these conditions, prolonged periods of remission without relapses can be achieved, and the question of whether progressive disease courses can occur has re-emerged. In this review, we focus on studies exploring evidence for and against relapse-independent clinical progression and/or subclinical disease activity in patients with MOGAD and AQP4-IgG+ NMOSD.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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Contentti EC, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Carnero Contentti E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Liguori NF, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina. Mult Scler J Exp Transl Clin 2021; 7:20552173211032334. [PMID: 34434560 PMCID: PMC8381444 DOI: 10.1177/20552173211032334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine treatment interventions implemented in patients experiencing
neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and
response).
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Affiliation(s)
| | | | | | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Buenos Aires, Argentina
| | | | | | | | - Felisa Leguizamon
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
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