1
|
Akaishi T, Tarasawa K, Matsumoto Y, Sandhya P, Misu T, Fushimi K, Takahashi T, Fujimori J, Ishii T, Fujimori K, Yaegashi N, Nakashima I, Fujihara K, Aoki M. Associations between neuromyelitis optica spectrum disorder, Sjögren's syndrome, and conditions with electrolyte disturbances. J Neurol Sci 2023; 452:120742. [PMID: 37515845 DOI: 10.1016/j.jns.2023.120742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Electrolyte disorders are among the important conditions negatively affecting the disease course of neuromyelitis optica spectrum disorder (NMOSD). Possible mechanisms may include renal tubular acidosis (RTA) accompanying Sjögren's syndrome (SS), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and central diabetes insipidus (DI). Currently, the overlap profiles between these conditions remain uncertain. METHODS This cross-sectional study collected data from the nationwide administrative Diagnosis Procedure Combination (DPC) database and evaluated the overlap profiles. RESULTS Among the 28,285,908 individuals from 1203 DPC-covered hospitals, 8477 had NMOSD, 174108 had SS, 4977 had RTA, 7640 had SIADH, and 24,789 had central DI. Of those with NMOSD, 986 (12%) had SS. The odds ratio (OR) for a diagnosis of NMOSD in those with SS compared with those without was 21 [95% confidence interval (CI), 20-23]. Overlap between NMOSD and SS was seen both in males (OR, 28 [95% CI, 23-33]) and females (OR, 16 [15-17]) and was more prominent in the younger population. Among patients with SS, the prevalence of RTA was lower in patients with NMOSD compared with those without NMOSD. Patients with NMOSD showed a higher prevalence of SIADH (OR, 11 [7.5-17]; p < 0.0001) and DI (OR, 3.7 [2.4-5.3]; p < 0.0001). Comorbid SS in NMOSD was associated with a higher prevalence of DI. CONCLUSIONS Patients with NMOSD are likely to have SS, SIADH, and central DI. RTA in SS does not facilitate the overlap between NMOSD and SS. SS in NMOSD may predispose patients to DI.
Collapse
Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuki Matsumoto
- Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuo Fujihara
- Department of Neurology, Fukushima Medical University, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Japan
| |
Collapse
|
2
|
Ortiz GG, Torres-Mendoza BMG, Ramírez-Jirano J, Marquez-Pedroza J, Hernández-Cruz JJ, Mireles-Ramirez MA, Torres-Sánchez ED. Genetic Basis of Inflammatory Demyelinating Diseases of the Central Nervous System: Multiple Sclerosis and Neuromyelitis Optica Spectrum. Genes (Basel) 2023; 14:1319. [PMID: 37510224 PMCID: PMC10379341 DOI: 10.3390/genes14071319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
Demyelinating diseases alter myelin or the coating surrounding most nerve fibers in the central and peripheral nervous systems. The grouping of human central nervous system demyelinating disorders today includes multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) as distinct disease categories. Each disease is caused by a complex combination of genetic and environmental variables, many involving an autoimmune response. Even though these conditions are fundamentally similar, research into genetic factors, their unique clinical manifestations, and lesion pathology has helped with differential diagnosis and disease pathogenesis knowledge. This review aims to synthesize the genetic approaches that explain the differential susceptibility between these diseases, explore the overlapping clinical features, and pathological findings, discuss existing and emerging hypotheses on the etiology of demyelination, and assess recent pathogenicity studies and their implications for human demyelination. This review presents critical information from previous studies on the disease, which asks several questions to understand the gaps in research in this field.
Collapse
Affiliation(s)
- Genaro Gabriel Ortiz
- Department of Philosophical and Methodological Disciplines and Service of Molecular Biology in Medicine Hospital, Civil University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Department of Neurology, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44329, Jalisco, Mexico
| | - Blanca M G Torres-Mendoza
- Department of Philosophical and Methodological Disciplines and Service of Molecular Biology in Medicine Hospital, Civil University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
- Neurosciences Division, Western Biomedical Research Center, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Javier Ramírez-Jirano
- Neurosciences Division, Western Biomedical Research Center, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Guadalajara 44340, Jalisco, Mexico
| | - Jazmin Marquez-Pedroza
- Neurosciences Division, Western Biomedical Research Center, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Guadalajara 44340, Jalisco, Mexico
- Coordination of Academic Activities, Western Biomedical Research Center, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS), Guadalajara 44340, Jalisco, Mexico
| | - José J Hernández-Cruz
- Department of Neurology, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44329, Jalisco, Mexico
| | - Mario A Mireles-Ramirez
- Department of Neurology, High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44329, Jalisco, Mexico
| | - Erandis D Torres-Sánchez
- Department of Medical and Life Sciences, University Center of la Cienega, University of Guadalajara, Ocotlan 47820, Jalisco, Mexico
| |
Collapse
|
3
|
Ong J, Mortensen P, Raviskanthan S, Pakravan M, Charoenkijkajorn C, Davila-Siliezar P, Laylani NA, Lee AG. Delayed Visual Improvement in Neuromyelitis Optica Spectrum Disorder With Severe Optic Atrophy. J Neuroophthalmol 2023:00041327-990000000-00346. [PMID: 37171884 DOI: 10.1097/wno.0000000000001877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Joshua Ong
- Michigan Medicine (JO), University of Michigan, Ann Arbor, Michigan; Department of Ophthalmology (PM, SR, MP, CC, PD-S, NAL, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Neurology (AGL) and Ophthalmology (AGL), Baylor College of Medicine, Houston, Texas; The Houston Methodist Research Institute (AGL), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; University of Texas MD Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Aliyu M, Zohora FT, Anka AU, Ali K, Maleknia S, Saffarioun M, Azizi G. Interleukin-6 cytokine: An overview of the immune regulation, immune dysregulation, and therapeutic approach. Int Immunopharmacol 2022; 111:109130. [PMID: 35969896 DOI: 10.1016/j.intimp.2022.109130] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 12/19/2022]
Abstract
Several studies have shown that interleukin 6 (IL-6) is a multifunctional cytokine with both pro-inflammatory and anti-inflammatory activity, depending on the immune response context. Macrophages are among several cells that secrete IL-6, which they express upon activation by antigens, subsequently inducing fever and production of acute-phase proteins from the liver. Moreover, IL-6 induces the final maturation of B cells into memory B cells and plasma cells as well as an adaptive role for short-term energy allocation. Activation of IL-6 receptors results in the intracellular activation of the JAK/STAT pathway with resultant production of inflammatory cytokines. Several mechanisms-controlled IL-6 expression, but aberrant production was shown to be crucial in the pathogenesis of many diseases, which include autoimmune and chronic inflammatory diseases. IL-6 in combination with transforming growth factor β (TGF-β) induced differentiation of naïve T cells to Th17 cells, which is the cornerstone in autoimmune diseases. Recently, IL-6 secretion was shown to form the backbone of hypercytokinemia seen in the Coronavirus disease 2019 (COVID-19)-associated hyperinflammation and multiorgan failure. There are two classes of approved IL-6 inhibitors: anti-IL-6 receptor monoclonal antibodies (e.g., tocilizumab) and anti-IL-6 monoclonal antibodies (i.e., siltuximab). These drugs have been evaluated in patients with rheumatoid arthritis, juvenile idiopathic arthritis, cytokine release syndrome, and COVID-19 who have systemic inflammation. JAK/STAT pathway blockers were also successfully used in dampening IL-6 signal transduction. A better understanding of different mechanisms that modulate IL-6 expression will provide the much-needed solution with excellent safety and efficacy profiles for the treatment of autoimmune and inflammatory diseases in which IL-6 derives their pathogenesis.
Collapse
Affiliation(s)
- Mansur Aliyu
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, International Campus, TUMS-IC, Tehran, Iran; Department of Medical Microbiology, Faculty of Clinical Science, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Fatema Tuz Zohora
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Malaysia
| | - Abubakar Umar Anka
- Department of Medical Laboratory Science, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Kashif Ali
- Department of Pharmacy Abdul Wali, Khan University Mardan, Pakistan
| | - Shayan Maleknia
- Biopharmaceutical Research Center, AryoGen Pharmed Inc., Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Saffarioun
- Biopharmaceutical Research Center, AryoGen Pharmed Inc., Alborz University of Medical Sciences, Karaj, Iran
| | - Gholamreza Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| |
Collapse
|
5
|
Furuya K, Itoh N. A Rare Case of Neuromyelitis Optica Spectrum Disorders With Unknown Fever and Subacute Cognitive Decline With Normal Images. Cureus 2022; 14:e24950. [PMID: 35698698 PMCID: PMC9188466 DOI: 10.7759/cureus.24950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 12/04/2022] Open
Abstract
We report the case of a 69-year-old Japanese man who came to our hospital with a chief complaint of fever and cognitive decline for three weeks. There were no neurological abnormalities other than the decreased level of consciousness. He developed urinary retention after admission, so we performed a lumbar puncture, although his head and neck magnetic resonance imaging (MRI) showed no abnormal findings. The cerebrospinal fluid (CSF) examination showed albuminocytologic dissociation and the anti-aquaporin 4 antibody was positive. Thus, we diagnosed him with neuromyelitis optica spectrum disorder (NMOSD). NMOSD is an autoimmune disease that causes demyelination. The clue to diagnosing NMOSD is demyelinating findings on MRI. Therefore, it is difficult to diagnose NMOSD if there are no abnormalities on the images. However, abnormal MRI findings are not necessary for the diagnosis of NMOSD. Thus, NMOSD cannot be ruled out even if MRI findings are normal and the real clue to diagnosing NMOSD is the anti-aquaporin 4 antibody.
Collapse
|
6
|
A Case of Neuromyelitis Optica: Puerto Rican Woman with an Increased Time Lag to Diagnosis and a High Response to Eculizumab Therapy. Case Rep Neurol Med 2022; 2022:4311382. [PMID: 35223117 PMCID: PMC8881169 DOI: 10.1155/2022/4311382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
A link between intractable hiccups, as the initial symptom, and a possible neuromyelitis optica spectrum disorder (NMOSD) diagnosis is confusing but vital and may not be made by health care providers (HCPs) if they are not aware of the 2015 NMOSD criteria. Early diagnosis and adequate treatment are essential to prevent disease progression. We report the case of a 46-year-old Puerto Rican female who presented intractable hiccups when she was 31 (in 2004). Almost 15 years passed since the initial symptom, and after two severe relapses, she received a formal NMOSD diagnosis in March 2019. Treatment started with rituximab 1000 mg IV in April 2019. However, a lack of response to treatment led to a switch to eculizumab therapy in August 2019. The patient had cervical and brain magnetic resonance imaging (MRI) conducted in June 2020, which depicted a remarkable decrease in swelling and hyperintensity within the cervical spinal cord with no enhancing lesions when compared with the first MRI from February 2019. In addition, the patient suffered no new relapses, an improvement regarding disability, and a reduction of the cervical spinal cord lesion size. Nonetheless, this substantial decrease does not occur on all NMOSD patients, but more awareness of the disease is needed, especially in Puerto Rico. This case illustrates the efficacy of eculizumab therapy and the importance of differentiating the clinical, histopathological, and neuroimaging characteristics that separate demyelinating autoimmune inflammatory disorders, such as NMOSD and multiple sclerosis (MS).
Collapse
|
7
|
NASEHI MM, GHOFRANI M, TABRIZI A, Abdollah GORJI F, KHOSRAVI B. The preventive Effectiveness of Rituximab in Pediatric Autoimmune and Inflammatory CNS Diseases Relapse: an Iranian Experience. IRANIAN JOURNAL OF CHILD NEUROLOGY 2022; 16:167-182. [PMID: 36204433 PMCID: PMC9531201 DOI: 10.22037/ijcn.v16i3.29322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/05/2022] [Indexed: 11/20/2022]
Abstract
Objectives To determine the effectiveness of Rituximab (RTX) therapy as the first therapeutic choice for the long-term prevention of secondary relapse in children with AIND that had relapse after primary treatment with immunosuppressive agents other than RTX. Materials & Methods We conducted a single-center retrospective study of 9 consecutive pediatric patients (≤ 18 years old) registered on Autoimmune and Demyelinating Disorders Database (ADDD) of Mofid Children Hospital, from 2012 to 2016 and experienced relapse following therapeutic interventions with immunosuppressive agents other than RTX. Result A remarkable reduction of 94.13% (p=0.015) occurred in annualized relapse rate (ARR) as a clinical indicator of therapeutic efficacy comparing before and after initiating RTX therapy. Conclusion Rituximab is an effective drug in relapse prevention of AIND when administrated to patients for whom initial treatment with other immunosuppressive agents fail.POWER OF EVIDENCE: This study represents Class IV evidence that RTX therapy significantly reduces ARR in pediatric AIND including DDCNS.
Collapse
Affiliation(s)
- Mohammad Mahdi NASEHI
- Pediatric Neurology Research Center, Pediatric Neurology center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran,Pediatric Neurology Department, Mofid Children’s Hospital, Faculty of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad GHOFRANI
- Pediatric Neurology Research Center, Pediatric Neurology center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran,Pediatric Neurology Department, Mofid Children’s Hospital, Faculty of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Aydin TABRIZI
- Pediatric Neurology Research Center, Pediatric Neurology center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Tehran, Iran
| | - Fatemeh Abdollah GORJI
- Pediatric Neurology Department, Mofid Children’s Hospital, Faculty of Medicine, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Bakhtyar KHOSRAVI
- Pediatric Neurology, Department of Pediatrics, School of Medicine, Besat Hospital, Kurdistan University of Medical Sciences, Kurdistan,Iran
| |
Collapse
|
8
|
Identification of Novel Serum Proteins Associated with Myelination and Cholesterol Transport in Neuromyelitis Optica Spectrum Disorders by Mass Spectrometry. Indian J Clin Biochem 2021; 37:275-284. [DOI: 10.1007/s12291-021-01004-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
|
9
|
Fujikawa P, Shah FA, Braford M, Patel K, Madey J. Neuromyelitis Optica in a Healthy Female After Severe Acute Respiratory Syndrome Coronavirus 2 mRNA-1273 Vaccine. Cureus 2021; 13:e17961. [PMID: 34660149 PMCID: PMC8516014 DOI: 10.7759/cureus.17961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/05/2022] Open
Abstract
Neuromyelitis optica spectrum disorder is an autoimmune demyelinating disease with high relative prevalence in the East Asian population. Clinical manifestations include optic neuritis, longitudinally extensive transverse myelitis, area postrema syndrome, brainstem syndromes, and diencephalic syndromes. In this case report, we present a case of neuromyelitis optica spectrum disorder that developed 10 days after the first dose of the severe acute respiratory syndrome coronavirus 2 mRNA-1273 vaccine. The patient was a previously healthy White female, completely independent and functional at baseline. She presented with bilateral lower-extremity numbness/tingling, weakness, and urinary retention. Although her neuromyelitis optica IgG was negative, the MRI was consistent with neuromyelitis optica involving and spanning longitudinally the C6-T2 vertebrae. She was treated with IV steroids and her symptoms improved. Given the novelty of the COVID-19 vaccines and the paucity of literature regarding their adverse effects, case reports such as ours provide unique information that aids healthcare providers in accurately diagnosing and treating patients, ultimately minimizing long-term neurologic deficits.
Collapse
Affiliation(s)
| | - Farhan A Shah
- Internal Medicine, Lewis Gale Medical Center, Salem, USA
| | - Michalla Braford
- Internal Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Kashyap Patel
- Internal Medicine, Lewis Gale Medical Center, Salem, USA
| | - Jason Madey
- Neurology, Lewis Gale Medical Center, Salem, USA
| |
Collapse
|
10
|
Burden and cost of comorbidities in patients with neuromyelitis optica spectrum disorder. J Neurol Sci 2021; 427:117530. [PMID: 34111762 DOI: 10.1016/j.jns.2021.117530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/11/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is associated with various comorbidities, including non-autoimmune and autoimmune conditions. The burden and cost of illness for NMOSD are unclear, particularly in the context of comorbidities. METHODS Claims data from IBM MarketScan Commercial and Medicare Supplemental Databases between 2014 and 2018 were analyzed. Patients with NMOSD were specified as having inpatient or outpatient claims for NMOSD diagnosis or specific NMOSD symptoms claims and no subsequent claims for multiple sclerosis (MS) or use of MS disease-modifying therapy (DMT). Continuous enrollment ≥ 6 months before and ≥ 1 year after the first claim (index date) was required for study inclusion. Total costs stratified by comorbidities within 12 months post-index date were calculated per patient and compared 1:5 with matched non-NMOSD controls. RESULTS A total of 162 patients with NMOSD and 810 non-NMOSD controls were evaluated. A significantly higher proportion of NMOSD patients had comorbidities than non-NMOSD controls (66.7% vs 41.5%; P < 0.001). Concomitant autoimmune disease occurred in 19.1% vs 4.9% (P < 0.001) of patients with NMOSD vs non-NMOSD controls. NMOSD patients incurred significantly higher total median (interquartile range) healthcare costs per patient ($68,386.48 [$23,373.54-$160,862.70]) than matched non-NMOSD controls with autoimmune disease ($17,215.13 [$6715.48-$31,441.93]; P < 0.001) or patients with NMOSD without autoimmune comorbidity ($23,905.42 [$8632.82-$67,251.54]; P = 0.022). Similarly, patients with NMOSD and non-autoimmune comorbidities incurred higher median healthcare costs than matched controls. CONCLUSIONS Patients with NMOSD experience significant disease burden and cost that are amplified by comorbidities. Effective therapies are needed, particularly for patients with concomitant autoimmune disease.
Collapse
|
11
|
Kishk NA, Abdelfattah W, Shalaby NM, Shehata HS, Hassan A, Hegazy MI, Abokrysha NT, Abdellatif D, Shawky SM, Abdo SS, Taha N, Fouad AM, Elmazny A, Ragab AH. The aquaporin4-IgG status and how it affects the clinical features and treatment response in NMOSD patients in Egypt. BMC Neurol 2021; 21:53. [PMID: 33535985 PMCID: PMC7860192 DOI: 10.1186/s12883-021-02083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
Background In Egypt, the characterization of Neuromyelitis Optica Spectrum Disorder (NMOSD) is lacking. Objectives To determine the demographics, clinical features, aquaporin4 antibodies (AQP4-IgG) status, and neuroimaging of Egyptian NMOSD patients. Methods Retrospective analysis of 70 NMOSD patients’ records from the MS clinic, Kasr Alainy hospital, between January 2013 and June 2018. Results Patients’ mean age was 34.9 ± 9.2 years, and the mean at disease onset was 28.9 ± 10.5 years. Fifty-nine patients had an initial monosymptomatic presentation. AQP4-IgG was measured using either enzyme-linked immunosorbent assay (ELISA) (22 patients) or cell-based assay (CBA) (34 patients). Six and 29 patients had positive results, respectively (p < 0.001). 84% had typical NMOSD brain lesions. Longitudinally extensive myelitis was detected in 49 patients, and 9 had either short segments or normal cords. Treatment failure was higher in seropositive patients. Rituximab significantly reduced the annualized relapse rate (ARR) compared to Azathioprine with a percentage reduction of (76.47 ± 13.28) and (10.21 ± 96.07), respectively (p = 0.04). Age at disease onset was the only independent predictor for disability (p < 0.01). Conclusion Treatment failure was higher in seropositive patients. However, there was no difference in clinical or radiological parameters between seropositive and seronegative patients. Patients, who are polysymptomatic or with older age of onset, are predicted to have higher future disability regardless of the AQP4-IgG status. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02083-1.
Collapse
Affiliation(s)
- Nirmeen A Kishk
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Walaa Abdelfattah
- Department of Clinical Pathology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin M Shalaby
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Hatem S Shehata
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Amr Hassan
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Mohamed I Hegazy
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Noha T Abokrysha
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Doaa Abdellatif
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Shereen M Shawky
- Department of Clinical Pathology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sarah S Abdo
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Noha Taha
- Department of Internal Medicine, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr M Fouad
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Alaa Elmazny
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt
| | - Amany H Ragab
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, 7 Emtedad al Ikhaa, Maadi, Nile Corniche, Cairo, Egypt.
| |
Collapse
|
12
|
Potential role of the gut microbiota in neuromyelitis optica spectrum disorder: Implication for intervention. J Clin Neurosci 2020; 82:193-199. [PMID: 33257156 DOI: 10.1016/j.jocn.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/19/2022]
Abstract
The gut microbiota plays an important role in the occurrence and development of neuroimmunological diseases. Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system that is characterized by the peripheral production of the disease-specific serum autoantibody aquaporin-4 (AQP4)-IgG. Recently, accumulating evidence has provided insights into the associations of gut microbiota dysbiosis and intestinal mucosal barrier destruction with NMOSD, but the underlying pathogenesis remains unclear. Thus, a microbiota intervention might be a potential therapeutic strategy for NMOSD by regulating the gut microbiota, repairing the intestinal mucosal barrier, and modulating intestinal immunity and peripheral immunity.
Collapse
|
13
|
Is Fertility Affected in Women of Childbearing Age with Multiple Sclerosis or Neuromyelitis Optica Spectrum Disorder? J Mol Neurosci 2020; 70:1829-1835. [PMID: 32740781 DOI: 10.1007/s12031-020-01576-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/30/2020] [Indexed: 01/05/2023]
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system (CNS), which is more prevalent among women of childbearing age. Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disease of the CNS with similar prevalence features to MS and has recently been considered a different entity from MS. Measuring ovarian reserve is one way of evaluating fertility. Anti-Müllerian hormone (AMH) is a peptide hormone produced by ovarian granulosa cells of early follicles and is considered to be a marker for ovarian reserve. With MS and NMOSD predominance in young women, the present study aimed to address the possibility of these diseases affecting fertility by measuring AMH levels in MS and NMOSD patients and comparing it with healthy controls. The present study included 23 relapsing-remitting MS (RRMS) patients, 23 seronegative NMOSD patients, and 23 healthy age-matched controls between 18 and 45 years of age. Serum samples of the three groups were collected, and the AMH levels were measured with AMH Gen II Enzyme-Linked Immunosorbent Assay, Beckman Coulter kit. In the present study, the AMH levels did not differ significantly between the groups (p = 0.996). The mean AMH in the RRMS group was 3.59 ± 0.55 ng/ml compared with the mean of 3.60 ± 0.50 ng/ml in healthy controls. The mean AMH levels in the NMOSD group were 3.66 ± 0.61 ng/ml. Lower levels of AMH were found to be negatively associated with annualized relapse rate (in both groups of patients) and MS severity score. However, the difference was not significant. In NMOSD patients, the serum levels of AMH were negatively associated with disease duration (r = - 0.42, p = 0.023). There had been a significant negative correlation between mean AMH serum levels with Expanded Disability Status Scale (EDSS) at the time of diagnosis and at the time of study in the NMOSD group (r = - 0.402, p = 0.03 and r = - 0.457, p = 0.014, respectively). There was not a significant difference in mean serum AMH levels between RRMS and NMOSD patients compared with that of healthy controls. Further studies with larger sample sizes should be conducted, which take more variables affecting fertility in women with either RRMS or NMOSD into account to put an end to the controversial issue of fertility in this area.
Collapse
|
14
|
Huang YJ, Lee JJ, Fan WL, Hsu CW, Tsai NW, Lu CH, Chang WN, Tsai MH. A CD33 frameshift variant is associated with neuromyelitis optica spectrum disorders. Biomed J 2020; 44:S93-S100. [PMID: 35735085 PMCID: PMC9038945 DOI: 10.1016/j.bj.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/09/2020] [Accepted: 07/22/2020] [Indexed: 01/21/2023] Open
|
15
|
Gomes NA, Silva PC, Teixeira YT, Eufrazio P, Souza AD, Rojas H, Brant R, Gomes Neto A, Christo PP, Simões RT, Fernandes KS. HLA-G Ins/Del polymorphism and +3142C/G SNP are not related to neuromyelitis optica spectrum disorder (NMOSD) development, disability status or anti-aquaporin 4 presence in Brazilian patients. J Neuroimmunol 2020; 339:577112. [PMID: 31765953 DOI: 10.1016/j.jneuroim.2019.577112] [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: 08/09/2018] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
Abstract
We analyzed the association of polymorphisms from the 3' untranslated region of the HLA-G gene in 70 neuromyelitis optica spectrum disorder (NMOSD) patients and 162 healthy controls. No associations were found between the polymorphisms in NMOSD when compared to healthy controls, serology of the anti-AQP4 NMOSD biomarker and Expanded Disability Status Scale (EDSS). In conclusion, the 3' untranslated region 14 bp Ins/Del and +3142C/G polymorphisms seem not to be associated with NMOSD susceptibility, autoantibody production, nor a neurological deficit in patients.
Collapse
Affiliation(s)
- Nathália Augusta Gomes
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Pollyanna Cristina Silva
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Ygor Tiago Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Patrícia Eufrazio
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Alessandra D Souza
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Hugo Rojas
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Renata Brant
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Antônio Gomes Neto
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Paulo Pereira Christo
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Renata Toscano Simões
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Karla Simone Fernandes
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil.
| |
Collapse
|
16
|
Zarei S, Maldonado I, Franqui-Dominguez L, Rubi C, Rosa YT, Diaz-Marty C, Coronado G, Nieves MCR, Akhlaghipour G, Chinea A. Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients. Surg Neurol Int 2019; 10:200. [PMID: 31768280 PMCID: PMC6826276 DOI: 10.25259/sni_252_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.
Collapse
Affiliation(s)
- Sara Zarei
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Irvin Maldonado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | - Yanibel Tapia Rosa
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Cristina Diaz-Marty
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Guadalupe Coronado
- Department of Neurology, San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | | | | |
Collapse
|