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Chen B, Gomez-Figueroa E, Redenbaugh V, Francis A, Satukijchai C, Wu Y, Messina S, Sa M, Woodhall M, Paul F, Robertson NP, Lim M, Wassmer E, Kneen R, Huda S, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin RJ, Dobson R, Cooper SA, Williams V, Waters P, Chen JJ, Pittock SJ, Ramdas S, Leite MI, Flanagan EP, Geraldes R, Palace J. Do Early Relapses Predict the Risk of Long-Term Relapsing Disease in an Adult and Paediatric Cohort with MOGAD? Ann Neurol 2023; 94:508-517. [PMID: 37394961 DOI: 10.1002/ana.26731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD. METHODS A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. "Early relapses" were defined as attacks within the first 12 months from onset, with "very early relapses" defined within 30 to 90 days from onset and "delayed early relapses" defined within 90 to 365 days. "Long-term relapses" were defined as relapses beyond 12 months. Cox regression modeling and Kaplan-Meier survival analysis were used to estimate the long-term relapse risk and rate. RESULTS Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any "early relapses" were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026). INTERPRETATION The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508-517.
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Affiliation(s)
- Bo Chen
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Enrique Gomez-Figueroa
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Mexico
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Anna Francis
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | | | - Yan Wu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Mario Sa
- Department of Paediatric Neurology, Oxford University NHS Foundation Trust, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Neil P Robertson
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Ming Lim
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK
- Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Evangeline Wassmer
- Women and Children's Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Kneen
- Department of Paediatric Neurology, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Saif Huda
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Camilla Blain
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher Halfpenny
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Southampton General Hospital, Southampton, UK
| | - Eoin O'Sullivan
- Department of Paediatric Neurology, Great Ormond St. Hospital for Children, London, UK
| | - Jeremy Hobart
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Leonora K Fisniku
- Department of Neurology, University Hospitals Plymouth National Health Service Foundation Trust, Devon, UK
| | - Roswell J Martin
- Department of Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Dobson
- Department of Neurology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | - Sarah A Cooper
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Victoria Williams
- Department of Neurology, University Hospitals Sussex National Health Service Foundation Trust, Brighton, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John J Chen
- Department of Neurology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Sean J Pittock
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN
| | - Sithara Ramdas
- Centre MS and Autoimmune Neurology, Department Neurology, Mayo Clinic, Rochester, MN
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Eoin P Flanagan
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
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Ingelfinger F, Kramer M, Lutz M, Widmer CC, Piccoli L, Kreutmair S, Wertheimer T, Woodhall M, Waters P, Sallusto F, Lanzavecchia A, Mundt S, Becher B, Schreiner B. Antibodies Produced by CLL Phenotype B Cells in Patients With Myasthenia Gravis Are Not Directed Against Neuromuscular Endplates. Neurol Neuroimmunol Neuroinflamm 2023; 10:10/2/e200087. [PMID: 36754834 PMCID: PMC9909583 DOI: 10.1212/nxi.0000000000200087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/28/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Myasthenia gravis (MG) can in rare cases be an autoimmune phenomenon associated with hematologic malignancies such as chronic lymphocytic leukemia (CLL). It is unclear whether in patients with MG and CLL, the leukemic B cells are the ones directly driving the autoimmune response against neuromuscular endplates. METHODS We identified patients with acetylcholine receptor antibody-positive (AChR+) MG and CLL or monoclonal B-cell lymphocytosis (MBL), a precursor to CLL, and described their clinical features, including treatment responses. We generated recombinant monoclonal antibodies (mAbs) corresponding to the B-cell receptors of the CLL phenotype B cells and screened them for autoantigen binding. RESULTS A computational immune cell screen revealed a subgroup of 5/38 patients with MG and 0/21 healthy controls who displayed a CLL-like B-cell phenotype. In follow-up hematologic flow cytometry, 2 of these 5 patients were diagnosed with an MBL. An additional patient with AChR+ MG as a complication of manifest CLL presented at our neuromuscular clinic and was successfully treated with the anti-CD20 therapy obinutuzumab plus chlorambucil. We investigated the specificities of expanding CLL-like B-cell clones to assess a direct causal link between the 2 diseases. However, we observed no reactivity of the clones against the AChR, antigens at the neuromuscular junction, or other common autoantigens. DISCUSSION Our study suggests that AChR autoantibodies are produced by nonmalignant, polyclonal B cells The new anti-CD20 treatment obinutuzumab might be considered in effectively treating AChR+ MG. CLASSIFICATION OF EVIDENCE This is a single case study and provides Class IV evidence that obinutuzumab is safe to use in patients with MG.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Burkhard Becher
- From the Institute of Experimental Immunology (F.I., M.L., S.K., T.W., S.M., B.S., B.B.), University of Zurich, Switzerland; Department of Neurology (F.I., B.S.), University Hospital Zurich, Switzerland; Institute for Research in Biomedicine (M.K., L.P., F.S., A.L.), Università Della Svizzera Italiana, Bellinzona, Switzerland; Institute of Microbiology (M.K., F.S.), ETH Zurich, Switzerland; Department of Medical Oncology and Hematology (C.C.W.), University Hospital Zurich and University of Zurich, Switzerland; and Nuffield Department of Clinical Neurosciences (M.W., P.W.), University of Oxford, United Kingdom.
| | - Bettina Schreiner
- From the Institute of Experimental Immunology (F.I., M.L., S.K., T.W., S.M., B.S., B.B.), University of Zurich, Switzerland; Department of Neurology (F.I., B.S.), University Hospital Zurich, Switzerland; Institute for Research in Biomedicine (M.K., L.P., F.S., A.L.), Università Della Svizzera Italiana, Bellinzona, Switzerland; Institute of Microbiology (M.K., F.S.), ETH Zurich, Switzerland; Department of Medical Oncology and Hematology (C.C.W.), University Hospital Zurich and University of Zurich, Switzerland; and Nuffield Department of Clinical Neurosciences (M.W., P.W.), University of Oxford, United Kingdom.
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Kwon YN, Woodhall M, Sung JJ, Kim KK, Lim YM, Kim H, Kim JE, Baek SH, Kim BJ, Park JS, Seok HY, Kim DS, Kwon O, Park KH, Sohn E, Bae JS, Yoon BN, Kim NH, Ahn SW, Choi K, Oh J, Park HJ, Shin KJ, Lee S, Park J, Kim SH, Seok JI, Bae DW, An JY, Joo IS, Choi SJ, Nam TS, Kim S, Park KJ, Kwon KH, Waters P, Hong YH. Clinical pitfalls and serological diagnostics of MuSK myasthenia gravis. J Neurol 2023; 270:1478-1486. [PMID: 36396811 PMCID: PMC9971039 DOI: 10.1007/s00415-022-11458-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to evaluate the diagnostic accuracy of enzyme-linked immunosorbent assay (ELISA) for anti-muscle specific tyrosine kinase (MuSK) antibody (Ab) in a large cohort of anti-acetylcholine receptor (AChR) Ab-negative generalized myasthenia gravis (MG), and also to investigate clinical contexts for the diagnosis of MuSK MG. METHODS A retrospective study of 160 patients with a clinical suspicion of AChR Ab-negative generalized MG was performed. The serum samples were tested for anti-clustered AChR Ab by cell-based assay (CBA), anti-MuSK Ab by ELISA, CBA and/or radioimmunoprecipitation assay (RIPA). Clinical data were compared between anti-MuSK Ab-positive MG and double seronegative (AChR and MuSK) MG groups. RESULTS After excluding non-MG and clustered AChR Ab-positive patients, we identified 89 patients as a cohort of AChR Ab-negative generalized MG. Anti-MuSK Ab was positive by ELISA in 22 (24.7%) patients. While CBA identified five additional anti-MuSK Ab-positive patients, the results of ELISA were mostly consistent with CBA and RIPA with Cohen's kappa of 0.80 and 0.90, respectively (p < 0.001). The most frequent differential diagnosis was motor neuron disease particularly of bulbar onset which showed remarkably overlapping clinical and electrophysiological features with MuSK MG at presentation. CONCLUSION While confirming the highest sensitivity of CBA for detecting anti-MuSK Ab, our results highlight the clinical pitfalls in making a diagnosis of MuSK MG and may support a diagnostic utility of MuSK-ELISA in clinical practice.
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Affiliation(s)
- Young Nam Kwon
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, University of Oxford, John Radcliffe Hospital, Level 5, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Jung-Joon Sung
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Sung Park
- 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, Daegu, Republic of Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Kee Hong Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyomin Choi
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sanggon Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jinseok Park
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Dae Woong Bae
- Department of Neurology, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Young An
- Department of Neurology, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - In Soo Joo
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sunyoung Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ki-Jong Park
- Department of Neurology, College of Medicine, Gyeongsang National University, Gyeonsang Institute of Health Science, Jinju, Republic of Korea
| | - Ki-Han Kwon
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, University of Oxford, John Radcliffe Hospital, Level 5, West Wing, Headley Way, Oxford, OX3 9DU, UK.
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea.
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Binks S, Crawford AH, Woodhall M, Fower A, Syme H, Kennedy LJ, Waters P, Davison L, Irani S, Pakozdy A. 067 One Health: Clinical characteristics of spontaneously-arising feline LGI1- autoantibody limbic encephalitis in a large international cohort. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionLeucine-rich glioma-inactivated 1 (LGI1) is one of the most common surface neuronal autoantigens associated with autoimmune limbic encephalitis (LE) in humans, with hallmarks of personality change, amnesia and seizures. Recently, these autoantibodies were described in domestic cats with LE, likewise with a distinctive phenotype of behavioural change and orofacial seizures.MethodsUsing a feline-specific cell-based assay for LGI1-autoantibodies, we tested serum from 123 cats with neurological signs, submitted by veterinary surgeons across Europe. Clinical presentation, investiga- tions, management and outcomes were captured by questionnaire and review of medical records.Results56 samples were positive for LGI1-autoantibodies. The median age was 45 months and 34/54 (63%) were female. Most (44/56, 79%) had LE but other clinical syndromes included epilepsy, encephalopathy and feline hyperesthesia syndrome. Focal seizures without generalisation were reported in 42/51 (82%) compared to 25/47 (53%) in seronegative cats (p=0.02). Among seropositive cats, MRI abnormalities were identified in 23/42 (55%), adverse drug reactions in 7/50 (14%), and 8/51 (16%) were euthanised due to refractory seizures or status epilepticus.ConclusionMany features are common to humans and cats with LGI1-autoantibodies. Feline patients represent a naturally-occurring disease model and an opportunity to benefit health in both species via a bi-directional translational model.
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Yapp N, Clayton L, Eriksson S, Sathyamoorthy T, Lunn M, Woodhall M, Walters P, Skelly D, Bogdanovic M, Irani S. 130 IgLON5-antibody disease: a case series. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IgLON5-antibody disease is a rare disorder first described in 2014 with features which interfaces both autoimmune and neurodegenerative pathophysiological processes. It has a strong HLA association, and the diagnosis is confirmed by the presence of antibodies which bind the extracellular domain of a neuronal cell adhesion protein, Iglon5. Post-mortem findings reveal this correlates with a tauopathy and subsequent neurodegeneration affecting the hypothalamus and tegmental brainstem. We present three cases and describe their history, disease progression, management and treatment responses. We found a remarkably consistent clinical phenotype which was characterised by REM and NREM parasomnias, bulbar dysfunction causing distinctive inspiratory noises, and mixed movement disorders. Our cases were diagnosed between 1.5-2 years from symptom onset. One patient died following treatment with IVIg, whilst two have been diagnosed within the last month and started on plasma exchange and immunotherapy. We will report their clinical follow up. IgLON5-antibody disease is often diagnosed late, it is thought after irreversible neurodegeneration has occurred and symptoms are advanced. We hope to raise awareness of the classical myriad of presenting symptoms and lead to earlier diagnosis, within which a window of opportunity may exist to instigate immunotherapy and arrest ongoing autoimmune processes.
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Damato V, Spagni G, Monte G, Woodhall M, Jacobson L, Falso S, Smith T, Iorio R, Waters P, Irani SR, Vincent A, Evoli A. Clinical value of cell-based assays in the characterisation of seronegative myasthenia gravis. J Neurol Neurosurg Psychiatry 2022; 93:995-1000. [PMID: 35835469 DOI: 10.1136/jnnp-2022-329284] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Patients with myasthenia gravis without acetylcholine receptor (AChR) or muscle-specific kinase (MuSK) antibodies detected by radioimmunoprecipitation assays (RIAs) are classified as seronegative myasthenia gravis (SNMG). Live cell-based assays (l-CBAs) can detect additional antibodies to clustered AChR, MuSK and low-density lipoprotein receptor-related protein 4 (LRP4), but positivity rates are variable and both clinical relevance and utility of CBA platforms remain unclear. METHODS Sera from 82 patients with SNMG were tested by l-CBAs. Human embryonic kidney cells were transfected to individually express clustered AChR, MuSK or LRP4; or transfected to jointly express both clustered adult AChR and MuSK. Sera from 30 and 20 patients positive by RIA for AChR or MuSK antibodies were used as comparators. RESULTS 53 of 82 (72%) patients with SNMG had generalised and 29 (28%) had ocular disease. The clustered AChR CBA detected antibodies in 16 of 82 patients (19.5%; including 4 patients with solely fetal AChR antibodies), while 7 of 82 (8.5%) patients had MuSK antibodies. A novel exploratory combined adult AChR-MuSK l-CBA efficiently detected all these antibodies in a subset of the SNMG cohort. No LRP4 antibodies were identified. Overall, patients with SNMG with clustered AChR antibodies, CBA-positive MuSK-MG or triple seronegative were younger, had less severe disease than patients with RIA-positive MG and had a better clinical outcome when immunotherapy was started soon after disease onset, although the time interval from onset to immunotherapy was not different when compared with patients with RIA-positive MG. CONCLUSION Around one-third of patients with SNMG had AChR or MuSK antibodies by l-CBAs, which were efficiently detected with a combined l-CBA. The results in this large and unselected cohort of patients with MG demonstrate the diagnostic usefulness of performing CBAs and the importance of making these tests more widely available.
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Affiliation(s)
- Valentina Damato
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy .,Department of Neurosciences, Drugs and Child Health, University of Florence, Florence, Italy.,Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Gregorio Spagni
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy.,Neurology Institute, Fondazione Policlinico Gemelli IRCSS, Rome, Italy
| | - Gabriele Monte
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy.,Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Falso
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas Smith
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Raffaele Iorio
- Neurology Institute, Fondazione Policlinico Gemelli IRCSS, Rome, Italy
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amelia Evoli
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy.,Neurology Institute, Fondazione Policlinico Gemelli IRCSS, Rome, Italy
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Fadda G, Waters P, Woodhall M, Brown RA, O'Mahony J, Castro DA, Longoni G, Yeh EA, Marrie RA, Arnold DL, Banwell B, Bar-Or A. Serum MOG-IgG in children meeting multiple sclerosis diagnostic criteria. Mult Scler 2022; 28:1697-1709. [PMID: 35581944 PMCID: PMC9442635 DOI: 10.1177/13524585221093789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is now recognized as distinct from multiple sclerosis (MS). Objective: To evaluate the importance of considering myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin-G (IgG) serology when applying MS diagnostic criteria in children. Methods: Within a prospective cohort of children meeting MS criteria (median follow-up = 6 years, interquartile range (IQR) = 4–9), we measured MOG-IgG in serial archived serum obtained from presentation, and compared imaging and clinical features between seropositive and seronegative participants. Results: Of 65 children meeting MS criteria (median age = 14.0 years, IQR = 10.9–15.1), 12 (18%) had MOG-IgG at disease onset. Seropositive participants were younger, had brain magnetic resonance imaging (MRI) features atypical for MS, rarely had cerebrospinal fluid (CSF) oligoclonal bands (2/8, 25%), and accumulated fewer T2 lesions over time. On serial samples, 5/12 (42%) were persistently seropositive, 5/12 (42%) became seronegative, and 2/12 (17%) had fluctuating results. All 12 children experienced a disease course different from typical MS. Conclusion: While children with MOG-IgG can have clinical, CSF, and MRI features conforming to MS criteria, the presence of MOG-IgG is associated with atypical features and predicts a non-MS disease course. Given MOG-IgG seropositivity can wane over time, testing at first attack is of considerable importance for the diagnosis of MOGAD.
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Affiliation(s)
- Giulia Fadda
- Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA/Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Julia O'Mahony
- Institute of Health Policy, Management and Evaluation, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Denise A Castro
- Department of Diagnostic Imaging, Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada/Department of Diagnostic Radiology, Queen's University, Kingston, ON, Canada
| | - Giulia Longoni
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Division of Neuroscience and Mental Health, SickKids Research Institute, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Division of Neuroscience and Mental Health, SickKids Research Institute, University of Toronto, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Brenda Banwell
- Division of Child Neurology, Department of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Chow KL, Waters PJ, Woodhall M, O’Donnell JL. Fixed myelin oligodendrocyte glycoprotein (MOG) autoantibody cell-based assays (CBA): A cautionary tale. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Pace S, Orrell M, Woodhall M, Palace J, Leite MI, Irani SR, Waters P, Handel AE. Frequency of MOG-IgG in cerebrospinal fluid versus serum. J Neurol Neurosurg Psychiatry 2022; 93:334-335. [PMID: 34261747 PMCID: PMC8862025 DOI: 10.1136/jnnp-2021-326779] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/26/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Samuel Pace
- Medical School, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Orrell
- Medical School, University of Oxford, Oxford, Oxfordshire, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Adam E Handel
- Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK .,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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10
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Clarke L, Bukhari W, O'Gorman CM, Khalilidehkordi E, Arnett S, Woodhall M, Prain KM, Parratt JDE, Barnett MH, Marriott MP, McCombe PA, Sutton I, Boggild M, Brownlee W, Carroll WM, Hodgkinson S, Macdonell RAL, Mason DF, Pereira J, Slee M, Das C, Henderson APD, Kermode AG, Lechner-Scott J, Waters P, Sun J, Broadley SA. Response to treatment in NMOSD: the Australasian experience. Mult Scler Relat Disord 2022; 58:103408. [PMID: 35216788 DOI: 10.1016/j.msard.2021.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD. METHODS This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores. RESULTS Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]). CONCLUSIONS These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; St Vincent's Hospital Melbourne, Fitzroy VIC 3065, AustraliA
| | - Cullen M O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia; Department of Neurology, Mater Hospital Brisbane, South Brisbane QLD, 4101, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford OX3 9DU, UK
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown NSW 2006, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2006, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3052, Australia
| | - Pamela A McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia; Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston QLD 4029, AustraliA
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst NSW 2010, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas QLD 4814, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand; Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8140, New Zealand
| | - Jennifer Pereira
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park SA 5042, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran ACT 2605, Australia
| | | | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA; Institute for Immunology and Infectious Disease, Murdoch University, Murdoch WA 6150, AustraliA
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights NSW 2305, AustralIA
| | | | - Patrick Waters
- Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia.
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11
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Woodhall M, Mgbachi V, Fox H, Irani S, Waters P. Utility of Live Cell-Based Assays for Autoimmune Neurology Diagnostics. J Appl Lab Med 2022; 7:391-393. [PMID: 34996083 PMCID: PMC8741325 DOI: 10.1093/jalm/jfab133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/07/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Victor Mgbachi
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Hannah Fox
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Sarosh Irani
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, UK,Address correspondence to this author at: Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. E-mail
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12
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Chang T, Moloney T, Jacobson L, Malavige N, Lohitharajah J, Wanigasinghe J, Peach S, Woodhall M, Berretta A, Waters P, Vincent A. Significance of neuronal autoantibodies in comparison to infectious etiologies among patients presenting with encephalitis in a region with a high prevalence of infections. Ann Indian Acad Neurol 2022; 25:473-478. [PMID: 35936609 PMCID: PMC9350781 DOI: 10.4103/aian.aian_280_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/19/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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13
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Huda S, Whittam D, Jackson R, Karthikeayan V, Kelly P, Linaker S, Mutch K, Kneen R, Woodhall M, Murray K, Hunt D, Waters P, Jacob A. Predictors of relapse in MOG antibody associated disease: a cohort study. BMJ Open 2021; 11:e055392. [PMID: 34848526 PMCID: PMC8634280 DOI: 10.1136/bmjopen-2021-055392] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify factors predictive of relapse risk and disability in myelin oligodendrocyte glycoprotein associated disease (MOGAD). SETTING Patients were seen by the neuromyelitis optica spectrum disorders (NMOSD) service in Liverpool, UK, a national referral centre for adult patients with MOGAD, NMOSD and related conditions. PARTICIPANTS Patients with MOGAD=76 from England, Northern Ireland and Scotland were included in this cohort study. RESULTS Relapsing disease was observed in 55% (42/76) of cases. Steroid treatment >1 month (OR 0.2, 95% CI 0.05 to 0.80; p=0.022), transverse myelitis (TM) at first attack (OR 0.03, 95% CI 0.004 to 0.23; p=0.001) and male sex (OR 0.16, 95% CI 0.04 to 0.68; p=0.014) were associated with monophasic disease (area under the curve=0.85). Male sex (HR 0.46, 95% CI 0.24 to 0.89; p=0.011) and TM at disease onset (HR 0.42, 95% CI 0.22 to 0.82; p=0.011) were also associated with an increased latency to first relapse. 45% (32/71) of patients became MOG-antibody negative and in relapsing patients negative seroconversion was associated with a lower relapse risk (relative risk 0.11 95% CI 0.05 to 0.26; p<0.001). No specific factors were predictive of visual or overall disability. CONCLUSIONS Male patients with spinal cord involvement at disease onset have a lower risk of relapsing disease and longer latency to first relapse. Steroid treatment for at least 1 month at first attack was also associated with a monophasic disease course. MOG-antibody negative seroconversion was associated with a lower risk of relapse and may help inform treatment decisions and duration.
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Affiliation(s)
- Saif Huda
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Whittam
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Salford Royal Hospital, Salford, UK
| | - Richard Jackson
- Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, Merseyside, UK
| | | | - Patricia Kelly
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sam Linaker
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kerry Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rachel Kneen
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, Scotland
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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14
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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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15
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Cross H, Sabiq F, Ackermans N, Mattar A, Au S, Woodhall M, Sun B, Devonshire V, Carruthers R, Sayao AL, Bhan V, Schabas A, Chan J, Fritzler M, Waters P, Traboulsee A. Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Positive Patients in a Multi-Ethnic Canadian Cohort. Front Neurol 2021; 11:525933. [PMID: 33510701 PMCID: PMC7835710 DOI: 10.3389/fneur.2020.525933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease is a recently described central nervous system (CNS) inflammatory disorder with phenotypic overlap with Neuromyelitis Optica Spectrum Disorder (NMOSD). NMOSD seronegative patients, and those with limited forms of the disorder, become suspects for MOG antibody-associated disease. We describe a multi-ethnic population with MOG antibody seropositivity from the University of British Columbia MS/NMO clinic. Methods: AQP4-antibody seronegative patients presenting 2005-2016 with CNS inflammatory disease suspicious for NMOSD, as well as 20 MS controls, were retrospectively tested for MOG-IgG1 antibodies by live cell-based assay at Oxford Autoimmune Neurology Diagnostic Laboratory (UK) and by a commercial fixed cell-based assay at MitogenDx (Calgary, Canada). Additional MOG seropositive cases were identified through routine clinical interaction (2016-2018) using one of these laboratories. Clinical data was reviewed retrospectively. Results: Retrospective testing identified 21 MOG seropositives (14 by live assay only, 3 by fixed assay only and 4 by both) representing 14% of the "NMOSD suspects" cohort. One multiple sclerosis (MS) control serum was MOG seropositive. Twenty additional MOG positive cases were identified prospectively. Of 42 patients (27 female), median disease onset age was 29 years (range 3-62; 9 pediatric cases), 20 (47%) were non-Caucasian, and 3 (7%) had comorbid autoimmune disease. Most common onset phenotypes were optic neuritis (23, 55%; 8 bilateral) and myelitis (9, 21%; 6 longitudinally extensive) Three of the patients in our cohort experienced cortical encephalitis; two presented with seizures. Onset was moderate-severe in 64%, but 74% had good response to initial steroid therapy. Cumulative relapse probability for the MOG positive group at 1 year was 0.428 and at 4 years was 0.628. Most had abnormal brain imaging, including cortical encephalitis and poorly demarcated subcortical and infratentorial lesions. Few "classic MS" lesions were seen. Optic nerve lesions (frequently bilateral) were long and predominantly anterior, but 5 extended to the chiasm. Spinal cord lesions were long and short, with involvement of multiple spinal regions simultaneously, including the conus medullaris. Conclusions: Our MOG seropositive patients display phenotypes similar to previous descriptions, including cortical lesions with seizures and conus medullaris involvement. Many patients relapsed, predominantly in a different CNS location from onset. Serologic data from two different cell-based antibody assays highlight the discrepancies between live and fixed testing for MOG antibodies.
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Affiliation(s)
- Helen Cross
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Farahna Sabiq
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Nathalie Ackermans
- Department of Neurology, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Andrew Mattar
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Shelly Au
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Mark Woodhall
- Autoimmune Neurology Diagnostic Laboratory, University of Oxford, Oxford, United Kingdom
| | - Bo Sun
- Autoimmune Neurology Diagnostic Laboratory, University of Oxford, Oxford, United Kingdom
| | | | - Robert Carruthers
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Ana Luiza Sayao
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Virender Bhan
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Alice Schabas
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Jillian Chan
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
| | | | - Patrick Waters
- Autoimmune Neurology Diagnostic Laboratory, University of Oxford, Oxford, United Kingdom
| | - Anthony Traboulsee
- UBC MS/NMO Clinic, University of British Columbia, Vancouver, BC, Canada
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16
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Woodhall M, Mitchell JW, Gibbons E, Healy S, Waters P, Huda S. Case Report: Myelin Oligodendrocyte Glycoprotein Antibody-Associated Relapse With COVID-19. Front Neurol 2020; 11:598531. [PMID: 33324337 PMCID: PMC7724101 DOI: 10.3389/fneur.2020.598531] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023] Open
Abstract
A 39-year-old lady with relapsing myelin oligodendrocyte glycoprotein antibody (MOG-IgG) associated disease developed coryzal symptoms, malaise, sweating, and postural dizziness. Six days later she presented with painful progressive right visual loss consistent with optic neuritis. COVID-19 was confirmed by nasopharyngeal swab and MOG-IgG serological reversion was noted. Visual function improved following steroids and plasma exchange. This case highlights a possible causal association between inflammation due to COVID-19 and a relapse of MOG-IgG associated disease. It also highlights the clinical relevance of reporting MOG-IgG titers in MOG-IgG associated disease.
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Affiliation(s)
- Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - James W Mitchell
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Emily Gibbons
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Healy
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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17
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Waters P, Fadda G, Woodhall M, O'Mahony J, Brown RA, Castro DA, Longoni G, Irani SR, Sun B, Yeh EA, Marrie RA, Arnold DL, Banwell B, Bar-Or A. Serial Anti-Myelin Oligodendrocyte Glycoprotein Antibody Analyses and Outcomes in Children With Demyelinating Syndromes. JAMA Neurol 2020; 77:82-93. [PMID: 31545352 PMCID: PMC6763982 DOI: 10.1001/jamaneurol.2019.2940] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question Are antibodies to myelin oligodendrocyte glycoprotein (MOG) associated with relapses in children with acquired demyelination? Findings In this cohort study including 274 children with acquired demyelinating syndrome, anti-MOG antibodies were found in approximately 30% of children at presentation; they were more frequent in children with acute disseminated encephalomyelitis or younger than 11 years and were rarely present in children meeting multiple sclerosis diagnostic criteria. Neither presence of anti-MOG antibodies at onset nor their subsequent persistence were strongly associated with relapsing disease. Meaning While common in children with demyelination, anti-MOG antibodies should not be used to adjudicate long-term immunomodulatory therapy in the absence of clinical relapsing disease. Importance Identifying the course of demyelinating disease associated with myelin oligodendrocyte glycoprotein (MOG) autoantibodies is critical to guide appropriate treatment choices. Objective To characterize serial anti-MOG antibody serologies and clinical and imaging features at presentation and during follow-up in an inception cohort of prospectively monitored children with acquired demyelination. Design, Setting, and Participants In this prospective cohort study, study participants were recruited from July 2004 to February 2017 through the multicenter Canadian Pediatric Demyelinating Disease Study. Inclusion criteria included (1) incident central nervous system demyelination, (2) at least 1 serum sample obtained within 45 days from onset, and (3) complete clinical information. Of 430 participants with acquired demyelinating syndrome recruited, 274 were included in analyses. Of 156 excluded participants, 154 were excluded owing to missing baseline samples and 2 owing to incomplete clinical information. Data were analyzed from May to October 2018. Main Outcomes and Measures Presence of anti-MOG antibodies was blindly assessed in serial samples collected over a median of 4 years. Clinical, magnetic resonance imaging, and cerebrospinal fluid features were characterized at presentation, and subsequent disease course was assessed by development of new brain magnetic resonance imaging lesions, total lesion volume at last evaluation, annualized relapse rates, Expanded Disability Status Scale score and visual functional score at 4 years, and any disease-modifying treatment exposure. Results Of the 274 included participants, 140 (51.1%) were female, and the median (interquartile range) age of all participants was 10.8 (6.2-13.9) years. One-third of children were positive for anti-MOG antibodies at the time of incident demyelination. Clinical presentations included a combination of optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis for 81 of 84 anti-MOG antibody–positive children (96%). Brain lesions were present in 51 of 76 anti-MOG antibody–positive participants (67%), but magnetic resonance imaging characteristics differed with age at presentation. Complete resolution of baseline lesions was observed in 26 of 49 anti-MOG antibody–positive participants (53%). On serial serum analysis, 38 of 67 participants (57%) who were seropositive at onset became seronegative (median time to conversion, 1 year). Among all participants who were positive for anti-MOG antibodies at presentation, clinical relapses occurred in 9 of 24 children (38%) who remained persistently seropositive and in 5 of 38 children (13%) who converted to seronegative status. Conclusions and Relevance Myelin oligodendrocyte glycoprotein antibodies are common in children with acquired demyelinating syndrome and are transient in approximatively half of cases. Even when persistently positive, most anti-MOG antibody–positive children experience a monophasic disease. The presence of anti-MOG antibodies at the time of incident demyelination should not immediately prompt the initiation of long-term immunomodulatory therapy.
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Affiliation(s)
- Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Giulia Fadda
- Perelman Center for Advanced Medicine, Department of Neurology, University of Pennsylvania, Philadelphia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Julia O'Mahony
- Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Brown
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Denise A Castro
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Giulia Longoni
- Hospital for Sick Children Research Institute, Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Bo Sun
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - E Ann Yeh
- Hospital for Sick Children Research Institute, Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Brenda Banwell
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Neuroinflammation and Experimental Therapeutics, University of Pennsylvania, Philadelphia
| | - Amit Bar-Or
- Perelman Center for Advanced Medicine, Department of Neurology, University of Pennsylvania, Philadelphia.,Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Center for Neuroinflammation and Experimental Therapeutics, University of Pennsylvania, Philadelphia
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18
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Nagaishi A, Narita T, Woodhall M, Jacobson L, Waters P, Irani SR, Vincent A, Matsuo H. Autoantibodies in Japanese patients with ocular myasthenia gravis. Muscle Nerve 2020; 63:262-267. [PMID: 33094484 PMCID: PMC7983878 DOI: 10.1002/mus.27103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 12/16/2022]
Abstract
Introduction The majority of patients with myasthenia gravis (MG) initially present with ocular symptoms, but it is difficult to predict which cases will remain as ocular MG (OMG) or will progress to generalized MG. Herein we evaluated the serologic profile of Japanese OMG and its relationship with clinical features. Methods Seventy‐three patients with OMG from five Japanese myasthenia gravis (MG) centers were enrolled. Live cell‐based assays (CBAs) were used to determine the presence of autoantibodies (Abs) to clustered adult (2α, β, δ, ε) and fetal (2α, β, δ, γ) acetylcholine receptor (AChR) isoforms, muscle‐specific receptor tyrosine kinase (MuSK), and lipoprotein receptor–related protein‐4 (LRP4). Results Thirty‐four of 73 (46.5%) serum samples were positive for Abs against both the adult‐type and fetal‐type AChR, as expected, but 7 (9.6%) and 2 (2.7%) were positive only for fetal or adult AChR‐Abs, respectively. Four (5.4%) samples were positive for MuSK‐Abs, but two of these also contained antibodies to fetal AChR or LRP4. Twenty‐six (35.6%) samples were seronegative. Discussion Abs against fetal‐specific AChR, MuSK, and LRP4 are found in some patients with OMG. Future studies attempting to predict conversion from ocular symptoms to generalized MG may benefit from measurement of these antibodies.
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Affiliation(s)
- Akiko Nagaishi
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan.,Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Tomoko Narita
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hidenori Matsuo
- Department of Neurology, Nagasaki Kawatana Medical Center, Nagasaki, Japan
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19
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Marchionatti A, Woodhall M, Waters PJ, Sato DK. Detection of MOG-IgG by cell-based assay: moving from discovery to clinical practice. Neurol Sci 2020; 42:73-80. [PMID: 33063216 DOI: 10.1007/s10072-020-04828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/12/2020] [Indexed: 01/05/2023]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) is a unique CNS-specific mammalian protein that is expressed on the surface of compact myelin and oligodendrocyte cell bodies. MOG is an accessible target for autoantibodies, associated with immune-mediated demyelination in the central nervous system. The identification of MOG reactive immunoglobulin G antibodies (MOG-IgG) helps to distinguish a subgroup of patients from multiple sclerosis and other CNS disorders, reducing the risk of clinical misdiagnosis. The development of the cell-based assays (CBA) improved the detection of clinically meaningful MOG-IgG binding to conformational MOG expressed in the cell membrane surface. In this review, we describe factors that impact on the results of CBA, such as MOG conformation, protein glycosylation, addition of fluorescent tags, serum dilution, secondary antibodies, and data interpretation.
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Affiliation(s)
- Amanda Marchionatti
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Porto Alegre, Brazil.,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Patrick Joseph Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Douglas Kazutoshi Sato
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Porto Alegre, Brazil. .,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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20
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O'Connell K, Hamilton-Shield A, Woodhall M, Messina S, Mariano R, Waters P, Ramdas S, Leite MI, Palace J. Prevalence and incidence of neuromyelitis optica spectrum disorder, aquaporin-4 antibody-positive NMOSD and MOG antibody-positive disease in Oxfordshire, UK. J Neurol Neurosurg Psychiatry 2020; 91:1126-1128. [PMID: 32576617 DOI: 10.1136/jnnp-2020-323158] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Karen O'Connell
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Antonia Hamilton-Shield
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Sithara Ramdas
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
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21
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Khalilidehkordi E, Clarke L, Arnett S, Bukhari W, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation. Front Neurol 2020; 11:537. [PMID: 32612571 PMCID: PMC7308484 DOI: 10.3389/fneur.2020.00537] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) show overlap in their clinical features. We performed an analysis of relapses with the aim of determining differences between the two conditions. Cases of NMOSD and age- and sex-matched MS controls were collected from across Australia and New Zealand. Demographic and clinical information, including relapse histories, were recorded using a standard questionnaire. There were 75 cases of NMOSD and 101 MS controls. There were 328 relapses in the NMOSD cases and 375 in MS controls. Spinal cord and optic neuritis attacks were the most common relapses in both NMOSD and MS. Optic neuritis (p < 0.001) and area postrema relapses (P = 0.002) were more common in NMOSD and other brainstem attacks were more common in MS (p < 0.001). Prior to age 30 years, attacks of optic neuritis were more common in NMOSD than transverse myelitis. After 30 this pattern was reversed. Relapses in NMOSD were more likely to be treated with acute immunotherapies and were less likely to recover completely. Analysis by month of relapse in NMOSD showed a trend toward reduced risk of relapse in February to April compared to a peak in November to January (P = 0.065). Optic neuritis and transverse myelitis are the most common types of relapse in NMOSD and MS. Optic neuritis tends to occur more frequently in NMOSD prior to the age of 30, with transverse myelitis being more common thereafter. Relapses in NMOSD were more severe. A seasonal bias for relapses in spring-summer may exist in NMOSD.
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Affiliation(s)
- Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, United Kingdom
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville University Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit, Centre for Applied Medical Research and Department of Neurology, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Matthew Brown
- Institute of Health Biomedical Innovation, Translational Research Institute, Queensland University of Technology, Woolloongabba, QLD, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - David Gillis
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chris Kneebone
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
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Reindl M, Schanda K, Woodhall M, Tea F, Ramanathan S, Sagen J, Fryer JP, Mills J, Teegen B, Mindorf S, Ritter N, Krummrei U, Stöcker W, Eggert J, Flanagan EP, Ramberger M, Hegen H, Rostasy K, Berger T, Leite MI, Palace J, Irani SR, Dale RC, Probst C, Probst M, Brilot F, Pittock SJ, Waters P. International multicenter examination of MOG antibody assays. Neurol Neuroimmunol Neuroinflamm 2020; 7:e674. [PMID: 32024795 PMCID: PMC7051197 DOI: 10.1212/nxi.0000000000000674] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare the reproducibility of 11 antibody assays for immunoglobulin (Ig) G and IgM myelin oligodendrocyte glycoprotein antibodies (MOG-IgG and MOG-IgM) from 5 international centers. METHODS The following samples were analyzed: MOG-IgG clearly positive sera (n = 39), MOG-IgG low positive sera (n = 39), borderline negative sera (n = 13), clearly negative sera (n = 40), and healthy blood donors (n = 30). As technical controls, 18 replicates (9 MOG-IgG positive and 9 negative) were included. All samples and controls were recoded, aliquoted, and distributed to the 5 testing centers, which performed the following antibody assays: 5 live and 1 fixed immunofluorescence cell-based assays (CBA-IF, 5 MOG-IgG, and 1 MOG-IgM), 3 live flow cytometry cell-based assays (CBA-FACS, all MOG-IgG), and 2 ELISAs (both MOG-IgG). RESULTS We found excellent agreement (96%) between the live CBAs for MOG-IgG for samples previously identified as clearly positive or negative from 4 different national testing centers. The agreement was lower with fixed CBA-IF (90%), and the ELISA showed no concordance with CBAs for detection of human MOG-IgG. All CBAs showed excellent interassay reproducibility. The agreement of MOG-IgG CBAs for borderline negative (77%) and particularly low positive (33%) samples was less good. Finally, most samples from healthy blood donors (97%) were negative for MOG-IgG in all CBAs. CONCLUSIONS Live MOG-IgG CBAs showed excellent agreement for high positive and negative samples at 3 international testing centers. Low positive samples were more frequently discordant than in a similar comparison of aquaporin-4 antibody assays. Further research is needed to improve international standardization for clinical care.
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Affiliation(s)
- Markus Reindl
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria.
| | - Kathrin Schanda
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Mark Woodhall
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Fiona Tea
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Sudarshini Ramanathan
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Jessica Sagen
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - James P Fryer
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - John Mills
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Bianca Teegen
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Swantje Mindorf
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Nora Ritter
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Ulrike Krummrei
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Winfried Stöcker
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Juliane Eggert
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Eoin P Flanagan
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Melanie Ramberger
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Harald Hegen
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Kevin Rostasy
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Thomas Berger
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Maria Isabel Leite
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Jacqueline Palace
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Sarosh R Irani
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Russell C Dale
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Christian Probst
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Monika Probst
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria
| | - Fabienne Brilot
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria.
| | - Sean J Pittock
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria.
| | - Patrick Waters
- From the Clinical Department of Neurology (M. Reindl, K.S., M. Ramberger, H.H.), Medical University of Innsbruck, Innsbruck, Austria; Oxford Autoimmune Neurology Group (M.W., M. Ramberger, M.I.L., J.P., S.R.I., P.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Brain Autoimmunity Group (F.T., S.R., R.C.D., F.B.), Kids Neuroscience Centre at Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre, University of Sydney, New South Wales, Australia; Department of Neurology (J.S., J.P.F., J.M., E.P.F., S.J.P.), Mayo Clinic, Rochester, MN; Euroimmun Medizinische Labordiagnostika AG (B.T., S.M., N.R., U.K., W.S., C.P.), Lübeck, Germany; Institute for Quality Assurance (ifQ) affiliated to Euroimmun (J.E., M.P.), Lübeck, Germany; Paediatric Neurology (K.R.), Witten/Herdecke University, Children's Hospital Datteln, Datteln, Germany; and Department of Neurology (T.B.), Medical University of Vienna, Austria.
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23
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Bukhari W, Clarke L, O'Gorman C, Khalilidehkordi E, Arnett S, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Ramanathan S, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonnell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Wilson RJ, Brilot F, Vincent A, Waters P, Broadley SA. The clinical profile of NMOSD in Australia and New Zealand. J Neurol 2020; 267:1431-1443. [PMID: 32006158 DOI: 10.1007/s00415-020-09716-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are an inflammation of the central nervous system associated with autoantibodies to aquaporin-4. We have undertaken a clinic-based survey of NMOSD in the Australia and New Zealand populations with the aim of characterising the clinical features and establishing the value of recently revised diagnostic criteria. Cases of possible NMOSD and age and sex-matched controls with multiple sclerosis (MS) were referred from centres across Australia and New Zealand. Cases were classified as NMOSD if they met the 2015 IPND criteria and remained as suspected NMOSD if they did not. Clinical and paraclinical data were compared across the three groups. NMOSD was confirmed in 75 cases and 89 had suspected NMOSD. There were 101 controls with MS. Age at onset, relapse rates and EDSS scores were significantly higher in NMOSD than in MS. Lesions and symptoms referable to the optic nerve were more common in NMOSD whereas brainstem, cerebellar and cerebral lesions were more common in MS. Longitudinally extensive spinal cord lesions were seen in 48/71 (68%) of cases with NMOSD. Elevations of CSF, white cell count and protein were more common in NMOSD. We have confirmed a clinical pattern of NMOSD that has been seen in several geographical regions. We have demonstrated the clinical utility of the current diagnostic criteria. Distinct patterns of disease are evident in NMOSD and MS, but there remains a large number of patients with NMOSD-like features who do not meet the current diagnostic criteria for NMOSD and remain a diagnostic challenge.
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Affiliation(s)
- Wajih Bukhari
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, OX3 9DU, UK
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, 2145, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, 2010, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Russell C Dale
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, 2605, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Marzena J Fabis-Pedrini
- Western Australian Neuroscience Research Institute, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Robert Heard
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Sofia Jimenez-Sanchez
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, 3010, Australia
| | - Chris Kneebone
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christopher Lynch
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, 8140, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Steve Vucic
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Michael Walsh
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Bruce V Taylor
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Robert J Wilson
- Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Fabienne Brilot
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Angela Vincent
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Patrick Waters
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia. .,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
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24
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Huda S, Cao M, De Rosa A, Woodhall M, Rodriguez Cruz PM, Cossins J, Maestri M, Ricciardi R, Evoli A, Beeson D, Vincent A. SHP2 inhibitor protects AChRs from effects of myasthenia gravis MuSK antibody. Neurol Neuroimmunol Neuroinflamm 2019; 7:7/1/e645. [PMID: 31831571 PMCID: PMC6935836 DOI: 10.1212/nxi.0000000000000645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
Objective To determine whether an SRC homology 2 domain-containing phosphotyrosine phosphatase 2 (SHP2) inhibitor would increase muscle-specific kinase (MuSK) phosphorylation and override the inhibitory effect of MuSK-antibodies (Abs). Methods The effect of the SHP2 inhibitor NSC-87877 on MuSK phosphorylation and AChR clustering was tested in C2C12 myotubes with 31 MuSK-myasthenia gravis (MG) sera and purified MuSK-MG IgG4 preparations. Results In the absence of MuSK-MG Abs, NSC-87877 increased MuSK phosphorylation and the number of AChR clusters in C2C12 myotubes in vitro and in DOK7-overexpressing C2C12 myotubes that form spontaneous AChR clusters. In the presence of MuSK-MG sera, the AChR clusters were reduced, as expected, but NSC-87877 was able to protect or restore the clusters. Two purified MuSK-MG IgG4 preparations inhibited both MuSK phosphorylation and AChR cluster formation, and in both, clusters were restored with NSC-87877. Conclusions Stimulating the agrin-LRP4-MuSK-DOK7 AChR clustering pathway with NSC-87877, or other drugs, could represent a novel therapeutic approach for MuSK-MG and could potentially improve other NMJ disorders with reduced AChR numbers or disrupted NMJs.
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Affiliation(s)
- Saif Huda
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Michelangelo Cao
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Anna De Rosa
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Mark Woodhall
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Pedro M Rodriguez Cruz
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Judith Cossins
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Michelangelo Maestri
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Roberta Ricciardi
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Amelia Evoli
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - David Beeson
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Angela Vincent
- From the Department of Clinical Neurosciences (S.H., M.C., M.W., P.M.R.C., J.C., D.B., A.V.), Weatherall Institute of Molecular Medicine and Nuffield, University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy.
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25
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Yeo T, Probert F, Jurynczyk M, Sealey M, Cavey A, Claridge TDW, Woodhall M, Waters P, Leite MI, Anthony DC, Palace J. Classifying the antibody-negative NMO syndromes: Clinical, imaging, and metabolomic modeling. Neurol Neuroimmunol Neuroinflamm 2019; 6:e626. [PMID: 31659123 PMCID: PMC6865851 DOI: 10.1212/nxi.0000000000000626] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
Abstract
Objective To determine whether unsupervised principal component analysis (PCA) of comprehensive clinico-radiologic data can identify phenotypic subgroups within antibody-negative patients with overlapping features of multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSDs), and to validate the phenotypic classifications using high-resolution nuclear magnetic resonance (NMR) plasma metabolomics with inference to underlying pathologies. Methods Forty-one antibody-negative patients were recruited from the Oxford NMO Service. Thirty-six clinico-radiologic parameters, focusing on features known to distinguish NMOSD and MS, were collected to build an unbiased PCA model identifying phenotypic subgroups within antibody-negative patients. Metabolomics data from patients with relapsing-remitting MS (RRMS) (n = 34) and antibody-positive NMOSD (Ab-NMOSD) (aquaporin-4 antibody n = 54, myelin oligodendrocyte glycoprotein antibody n = 20) were used to identify discriminatory plasma metabolites separating RRMS and Ab-NMOSD. Results PCA of the 36 clinico-radiologic parameters revealed 3 phenotypic subgroups within antibody-negative patients: an MS-like subgroup, an NMOSD-like subgroup, and a low brain lesion subgroup. Supervised multivariate analysis of metabolomics data from patients with RRMS and Ab-NMOSD identified myoinositol and formate as the most discriminatory metabolites (both higher in RRMS). Within antibody-negative patients, myoinositol and formate were significantly higher in the MS-like vs NMOSD-like subgroup; myoinositol (mean [SD], 0.0023 [0.0002] vs 0.0019 [0.0003] arbitrary units [AU]; p = 0.041); formate (0.0027 [0.0006] vs 0.0019 [0.0006] AU; p = 0.010) (AU). Conclusions PCA identifies 3 phenotypic subgroups within antibody-negative patients and that the metabolite discriminators of RRMS and Ab-NMOSD suggest that these groupings have some pathogenic meaning. Thus, the identified clinico-radiologic discriminators may provide useful diagnostic clues when seeing antibody-negative patients in the clinic.
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Affiliation(s)
- Tianrong Yeo
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Fay Probert
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Maciej Jurynczyk
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Megan Sealey
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Ana Cavey
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Timothy D W Claridge
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Mark Woodhall
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Patrick Waters
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Maria Isabel Leite
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK
| | - Daniel C Anthony
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK.
| | - Jacqueline Palace
- From the Department of Pharmacology (T.Y, F.P., M.S., D.C.A.), University of Oxford, UK; Department of Neurology (T.Y.), National Neuroscience Institute, Singapore; Nuffield Department of Clinical Neurosciences (M.J., A.C., M.W., P.W., M.I.L., J.P.), John Radcliffe Hospital, University of Oxford, UK; Department of Chemistry, (T.D.W.C.), Chemistry Research Laboratory, University of Oxford, UK.
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26
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Prain K, Woodhall M, Vincent A, Ramanathan S, Barnett MH, Bundell CS, Parratt JDE, Silvestrini RA, Bukhari W, Brilot F, Waters P, Broadley SA. AQP4 Antibody Assay Sensitivity Comparison in the Era of the 2015 Diagnostic Criteria for NMOSD. Front Neurol 2019; 10:1028. [PMID: 31636597 PMCID: PMC6787171 DOI: 10.3389/fneur.2019.01028] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
We have compared five different assays for antibodies to aquaporin-4 in 181 cases of suspected Neuromyelitis optica spectrum disorders (NMOSD) and 253 controls to assess their relative utility. As part of a clinically-based survey of NMOSD in Australia and New Zealand, cases of suspected NMOSD were referred from 23 centers. Clinical details and magnetic imaging were reviewed and used to apply the 2015 IPND diagnostic criteria. In addition, 101 age- and sex-matched patients with multiple sclerosis were referred. Other inflammatory disease (n = 49) and healthy controls (n = 103) were also recruited. Samples from all participants were tested using tissue-based indirect immunofluorescence assays and a subset were tested using four additional ELISA and cell-based assays. Antibodies to myelin oligodendrocyte glycoprotein (MOG) were also assayed. All aquaporin-4 antibody assays proved to be highly specific. Sensitivities ranged from 60 to 94%, with cell-based assays having the highest sensitivity. Antibodies to MOG were detected in 8/79 (10%) of the residual suspected cases of NMOSD. Under the 2015 IPND diagnostic criteria for NMOSD, cell-based assays for aquaporin-4 are sensitive and highly specific, performing better than tissue-based and ELISA assays. A fixed cell-based assay showed near-identical results to a live-cell based assay. Antibodies to MOG account for only a small number of suspected cases.
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Affiliation(s)
- Kerri Prain
- Pathology Queensland Central Laboratory, Division of Immunology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Christine S Bundell
- School of Biomedical Science, Medicine, University of Western Australia, Nedlands, WA, Australia.,PathWest Laboratory Medicine, Department of Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - John D E Parratt
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Roger A Silvestrini
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia
| | - Wajih Bukhari
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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27
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Hamid SHM, Whittam D, Saviour M, Alorainy A, Mutch K, Linaker S, Solomon T, Bhojak M, Woodhall M, Waters P, Appleton R, Duddy M, Jacob A. Seizures and Encephalitis in Myelin Oligodendrocyte Glycoprotein IgG Disease vs Aquaporin 4 IgG Disease. JAMA Neurol 2019; 75:65-71. [PMID: 29131884 DOI: 10.1001/jamaneurol.2017.3196] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Antibodies to myelin oligodendrocyte glycoprotein IgG (MOG-IgG) are increasingly detected in patients with non-multiple sclerosis-related demyelination, some of whom manifest a neuromyelitis optica (NMO) phenotype. Cortical involvement, encephalopathy, and seizures are rare in aquaporin 4 antibody (AQP4-IgG)-related NMO in the white European population. However, the authors encountered several patients with seizures associated with MOG-IgG disease. Objective To compare incidence of seizures and encephalitis-like presentation, or both between AQP4-IgG-positive and MOG-IgG-positive patients. Design, Setting, and Participants Retrospective case series of all patients who were seropositive for MOG-IgG (n = 34) and the last 100 patients with AQP4-IgG disease (NMO spectrum disorder) seen in the NMO service between January 2013 and December 2016, and analysis was completed January 4, 2017. All patients were seen in a tertiary neurological center, The Walton Centre NHS Foundation Trust in Liverpool, England. Main Outcomes and Measures The difference in seizure frequency between the AQP4-IgG-positive and MOG-IgG-positive patient groups was determined. Results Thirty-four patients with MOG-IgG disease (20 female) with a median age at analysis of 30.5 years (interquartile range [IQR], 15-69 years), and 100 AQP4-IgG-positive patients (86 female) with a median age at analysis of 54 years (IQR, 12-91 years) were studied. Most patients were of white race. Five of the 34 patients with MOG-IgG (14.7%) had seizures compared with 1 patient with AQP4-IgG (2-sided P < .008, Fisher test). On magnetic resonance imaging, all 5 MOG-IgG-positive patients had inflammatory cortical brain lesions associated with the seizures. In 3 of the 5 MOG-IgG-positive patients, seizures occurred as part of the index event. Four of the 5 presented with encephalopathy and seizures, and disease relapsed in all 5 patients. Four of these patients were receiving immunosuppressant medication at last follow-up, and 3 continued to take antiepileptic medication. In contrast, the only AQP4-IgG-positive patient with seizures had a diagnosis of complex partial epilepsy preceding the onset of NMO by several years and experienced no encephalitic illness; her magnetic resonance imaging results demonstrated no cortical, subcortical, or basal ganglia involvement. Conclusions and Relevance Patients with MOG-IgG-associated disease were more likely to have seizures and encephalitis-like presentation than patients with AQP4-IgG-associated disease.
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Affiliation(s)
- Shahd H M Hamid
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Dan Whittam
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Mariyam Saviour
- University of Liverpool School of Medicine, Liverpool, England
| | - Amal Alorainy
- Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, England
| | - Kerry Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Samantha Linaker
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Maneesh Bhojak
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
| | - Mark Woodhall
- Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, England
| | - Patrick Waters
- Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, England
| | - Richard Appleton
- Department of Neurology, Alder Hey Children's Hospital, Liverpool, England
| | - Martin Duddy
- Department of Neurology, Royal Victoria Infirmary, Newcastle, Newcastle upon Tyne, England
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, England
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28
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Petzold A, Woodhall M, Khaleeli Z, Tobin WO, Pittock SJ, Weinshenker BG, Vincent A, Waters P, Plant GT. Aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies in immune-mediated optic neuritis at long-term follow-up. J Neurol Neurosurg Psychiatry 2019; 90:1021-1026. [PMID: 31118222 DOI: 10.1136/jnnp-2019-320493] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To re-evaluate serum samples from our 2007 cohort of patients with single-episode isolated ON (SION), recurrent isolated ON (RION), chronic relapsing inflammatory optic neuropathy (CRION), multiple sclerosis-associated ON (MSON) and neuromyelitis optica (NMO). METHODS We re-screened 103/114 patients with available serum on live cell-based assays (CBA) for aquaporin-4 (AQP4)-M23-IgG and myelin-oligodendrocyte glycoprotein (MOG)-α1-IgG. Further testing included oligoclonal bands, serum levels of glial fibrillar acidic and neurofilament proteins and S100B. We show the impact of updated serology on these patients. RESULTS Reanalysis of our original cohort revealed that AQP4-IgG seropositivity increased from 56% to 75% for NMO, 5% to 22% for CRION, 6% to 7% for RION, 0% to 7% for MSON and 5% to 6% for SION. MOG-IgG1 was identified in 25% of RION, 25% of CRION, 10% of SION, 0% of MSON and 0% of NMO. As a result, patients have been reclassified incorporating their autoantibody status. Presenting visual acuity was significantly worse in patients who were AQP4-IgG seropositive (p=0.034), but there was no relationship between antibody seropositivity and either ON relapse rate or visual acuity outcome. CONCLUSIONS The number of patients with seronegative CRION and RION has decreased due to improved detection of autoantibodies over the past decade. It remains essential that the clinical phenotype guides both antibody testing and clinical management. Careful monitoring of the disease course is key when considering whether to treat with prophylactic immune suppression.
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Affiliation(s)
- Axel Petzold
- Neuroinflammation & Neuro-ophthalmology, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery UCLH & Moorfields Eye Hospital, London, UK .,Expertise Centre Neuro-ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC-Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
| | - Mark Woodhall
- Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Z Khaleeli
- Neurology, The National Hospital for Neurology and Neurosurgery UCLH, St. Thomas Hospital & Moorfields Eye Hospital, London, UK
| | - W Oliver Tobin
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - B G Weinshenker
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela Vincent
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Patrick Waters
- Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gordon T Plant
- Neurology, The National Hospital for Neurology and Neurosurgery UCLH, St. Thomas Hospital & Moorfields Eye Hospital, London, UK
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29
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Wilson R, Makuch M, Kienzler AK, Varley J, Taylor J, Woodhall M, Palace J, Leite MI, Waters P, Irani SR. Condition-dependent generation of aquaporin-4 antibodies from circulating B cells in neuromyelitis optica. Brain 2019; 141:1063-1074. [PMID: 29447335 PMCID: PMC5889028 DOI: 10.1093/brain/awy010] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/01/2017] [Indexed: 01/04/2023] Open
Abstract
Autoantibodies to aquaporin-4 (AQP4) are pathogenic in neuromyelitis optica spectrum disorder (NMOSD). However, it is not known which B cells are the major contributors to circulating AQP4 antibodies nor which conditions promote their generation. Our experiments showed CD19+CD27++CD38++ circulating ex vivo antibody-secreting cells did not produce AQP4 antibodies under several culture conditions. To question whether other cells in circulation were capable of AQP4 antibody production, B cells were differentiated into antibody-secreting cells in vitro. Unfractionated peripheral blood mononuclear cells, isolated from 12 patients with NMOSD and a wide range of serum AQP4 antibody levels (91-26 610 units), were cultured with factors that mimicked established associations of NMOSD including T cell help, concurrent infections and cytokines reported to be elevated in NMOSD. Overall, the in vitro generation of CD19+CD27++CD38++ cells across several culture conditions correlated closely with the total IgG secreted (P < 0.0001, r = 0.71), but not the amount of AQP4 antibody. AQP4 antibody production was enhanced by CD40-ligand (P = 0.005), and by interleukin-2 plus toll-like receptor stimulation versus interleukin-21-predominant conditions (P < 0.0001), and did not require antigen. Across NMOSD patients, this in vitro generation of AQP4 antibodies correlated well with serum AQP4 antibody levels (P = 0.0023, r = 0.81). To understand how early within B cell lineages this AQP4 specificity was generated, purified B cell subsets were activated under these optimized conditions. Naïve pre-germinal centre B cells (CD19+CD27-IgD+) differentiated to secrete AQP4 antibodies as frequently as post-germinal centre cells (CD19+CD27+). Taken together, these human cell-culture experiments demonstrate that preformed B cells, rather than ex vivo circulating antibody-secreting cells, possess AQP4 reactivity. Their differentiation and AQP4 antibody secretion is preferentially driven by select cytokines and these cells may make the dominant contribution to serum AQP4 antibodies. Furthermore, as AQP4-specific B cells can derive from likely autoreactive naïve populations an early, pre-germinal centre loss of immunological tolerance appears present in some patients with NMOSD. This study has implications for understanding mechanisms of disease perpetuation and for rational choice of immunotherapies in NMOSD. Furthermore, the in vitro model presents an opportunity to apply condition-specific approaches to patients with NMOSD and may be a paradigm to study other antibody-mediated diseases.awy010media15732448284001.
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Affiliation(s)
- Robert Wilson
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mateusz Makuch
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anne-Kathrin Kienzler
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Varley
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jennifer Taylor
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford University Hospitals, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - M Isabel Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford University Hospitals, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford University Hospitals, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford University Hospitals, John Radcliffe Hospital, Oxford, OX3 9DS, UK
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30
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Waters PJ, Komorowski L, Woodhall M, Lederer S, Majed M, Fryer J, Mills J, Flanagan EP, Irani SR, Kunchok AC, McKeon A, Pittock SJ. A multicenter comparison of MOG-IgG cell-based assays. Neurology 2019; 92:e1250-e1255. [PMID: 30728305 PMCID: PMC6511109 DOI: 10.1212/wnl.0000000000007096] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/04/2018] [Indexed: 01/02/2023] Open
Abstract
Objectives To compares 3 different myelin oligodendrocyte glycoprotein–immunoglobulin G (IgG) cell-based assays (CBAs) from 3 international centers. Methods Serum samples from 394 patients were as follows: acute disseminated encephalomyelitis (28), seronegative neuromyelitis optica (27), optic neuritis (21 single, 2 relapsing), and longitudinally extensive (10 single, 3 recurrent). The control samples were from patients with multiple sclerosis (244), hypergammaglobulinemia (42), and other (17). Seropositivity was determined by visual observation on a fluorescence microscope (Euroimmun fixed CBA, Oxford live cell CBA) or flow cytometry (Mayo live cell fluorescence-activated cell sorting assay). Results Of 25 samples positive by any methodology, 21 were concordant on all 3 assays, 2 were positive at Oxford and Euroimmun, and 2 were positive only at Oxford. Euroimmun, Mayo, and Oxford results were as follows: clinical specificity 98.1%, 99.6%, and 100%; positive predictive values (PPVs) 82.1%, 95.5%, and 100%; and negative predictive values 79.0%, 78.8%, and 79.8%. Of 5 false-positives, 1 was positive at both Euroimmun and Mayo and 4 were positive at Euroimmun alone. Conclusions Overall, a high degree of agreement was observed across 3 different MOG-IgG CBAs. Both live cell-based methodologies had superior PPVs to the fixed cell assays, indicating that positive results in these assays are more reliable indicators of MOG autoimmune spectrum disorders.
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Affiliation(s)
- Patrick J Waters
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Lars Komorowski
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Mark Woodhall
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Sabine Lederer
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Masoud Majed
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Jim Fryer
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - John Mills
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Eoin P Flanagan
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Sarosh R Irani
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Amy C Kunchok
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Andrew McKeon
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN
| | - Sean J Pittock
- From the Oxford Autoimmune Neurology Group (P.J.W., M.W., S.R.I.), Nuffield Department of Clinical Neurosciences, UK; Institute for Experimental Immunology (L.K., S.L.), Affiliated to Euroimmun AG, Luebeck, Germany; and Departments of Neurology (M.M., E.P.F., A.C.K., A.M., S.J.P.) and Laboratory Medicine and Pathology (J.F., J.M., E.P.F., A.C.K., A.M., S.J.P.), Mayo Clinic, College of Medicine, Rochester, MN.
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Koneczny I, Rennspiess D, Marcuse F, Dankerlui N, Abdul Hamid M, Mané-Damas M, Maessen J, Van Schil P, Saxena A, Zisimopoulou P, Lazaridis K, Woodhall M, Karagiorgou K, Tzartos J, Tzartos S, De Baets MH, Molenaar PC, Marx A, Zur Hausen A, Losen M, Martinez-Martinez P. Characterization of the thymus in Lrp4 myasthenia gravis: Four cases. Autoimmun Rev 2018; 18:50-55. [PMID: 30414949 DOI: 10.1016/j.autrev.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction. Most patients have pathogenic autoantibodies against the acetylcholine receptor (AChR). In the last years a novel subpopulation of MG patients has been described that harbors antibodies against low-density lipoprotein receptor-related protein 4 (Lrp4), another postsynaptic neuromuscular antigen. In early-onset AChR MG (EOMG), the thymus plays an important role in immunopathogenesis, and early thymectomy is beneficial. It is still unknown if the thymus plays any role in Lrp4-MG. In this pilot study, we compared thymus samples from four patients with Lrp4-MG (one pre-treated with immunosuppressive drugs), four non-MG controls and five EOMG patients (not pretreated with immunosuppressive drugs). Immunohistochemistry of the Lrp4-MG thymi revealed normal architecture, with normal numbers and distribution of B-cells, lymphoid follicles and Hassall's corpuscles. Primary CD23+ lymphoid follicles were similarly infrequent in Lrp4-MG and control thymic sections. In none of the control or Lrp4-MG thymi did we find secondary follicles with CD10+ germinal centers. These were evident in 2 of the 5 EOMG thymi, where primary lymphoid follicles were also more frequent on average, thus showing considerable heterogeneity between patients. Even if characteristic pathological thymic changes were not observed in the Lrp4 subgroup, we cannot exclude a role for the thymus in Lrp4-MG pathogenesis, since one Lrp4-MG patient went into clinical remission after thymectomy alone (at one year follow-up) and one more improved after thymectomy in combination with immunosuppressive therapy.
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Affiliation(s)
- Inga Koneczny
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Dorit Rennspiess
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Florit Marcuse
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Nathalie Dankerlui
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Myurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Marina Mané-Damas
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Jos Maessen
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Paul Van Schil
- Dept. of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, Edegem (Antwerp), B- 2650, Belgium
| | - Abhishek Saxena
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Paraskevi Zisimopoulou
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Konstantinos Lazaridis
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Mark Woodhall
- Neurosciences Group, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, University of Oxford, Oxford OX3 9DU, UK
| | | | - John Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece; Tzartos Neuro Diagnostics, 3 Eslin Street, 11523 Athens, Greece
| | - Socrates Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Marc H De Baets
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Peter C Molenaar
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Axel Zur Hausen
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands; GROW: School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6200 MD Maastricht, the Netherlands
| | - Mario Losen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Pilar Martinez-Martinez
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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Lee HJ, Kim B, Waters P, Woodhall M, Irani S, Ahn S, Kim SJ, Kim SM. Chronic relapsing inflammatory optic neuropathy (CRION): a manifestation of myelin oligodendrocyte glycoprotein antibodies. J Neuroinflammation 2018; 15:302. [PMID: 30382857 PMCID: PMC6208174 DOI: 10.1186/s12974-018-1335-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Key clinical features of chronic relapsing inflammatory optic neuropathy (CRION) include relapsing inflammatory optic neuritis (ON) and steroid dependency, both of which have been reported among patients with myelin oligodendrocyte glycoprotein antibodies (MOG-Abs). We investigated the relevance of the presence of serum MOG-IgG with the current diagnostic criteria for CRION among patients with idiopathic inflammatory optic neuritis (iON). Methods Retrospective reviews of a database prospectively collated between 2011 and 2017 from the tertiary referral center for multiple sclerosis and neuromyelitis optica were performed. Sixty-four patients with iON, who did not meet the diagnostic criteria for multiple sclerosis, neuromyelitis optica (NMO) spectrum disorder with/without NMO-IgG, or acute disseminated encephalomyelitis and who had no symptomatic central nervous system (CNS) lesions other than on the optic nerve, were included from a cohort of 615 patients with inflammatory demyelinating diseases of the CNS. Fulfillment of the current diagnostic criteria for CRION, assay results for the serum IgG1 MOG-Ab, and characteristics of CRION patients with MOG-IgG were compared to those of non-CRION patients with MOG-IgG. Results Twelve iON patients fulfilled the current diagnostic criteria for CRION, 11 patients were positive for MOG-IgG, and one patient was borderline. Among the other 52 iON patients not meeting the criteria for CRION, 14 had relapsing disease courses and 38 had monophasic courses, of which MOG-IgG positivity were 0% and 29%, respectively. CRION patients with MOG-IgG had more relapsing disease courses (first steroid-dependent worsening/relapse in 2.3 months, range 0.4–7.0) and poorer optical coherence tomography outcomes at follow-up than non-CRION patients with MOG-IgG. However, patients in the two groups did not differ in terms of age of onset, sex, or steroid treatment duration after initial attack. Conclusions CRION, according to the current diagnostic criteria, is a relapsing optic neuritis associated with MOG-IgG. Among iON patients with MOG-IgG, the absence of steroid-dependent attacks in the early stages of the disease may predict a long-term non-relapsing disease course and a more favorable outcome. Electronic supplementary material The online version of this article (10.1186/s12974-018-1335-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haeng-Jin Lee
- Department of Ophthalmology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Boram Kim
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sarosh Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sohyun Ahn
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
| | - Sung-Min Kim
- Department of Neurology, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Correction: Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018; 13:e0200225. [PMID: 29958297 PMCID: PMC6025849 DOI: 10.1371/journal.pone.0200225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018. [PMID: 29518096 PMCID: PMC5843234 DOI: 10.1371/journal.pone.0193723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acquired myasthenia gravis (MG) is a prototype autoimmune disease of the neuromuscular junction, caused in most patients by autoantibodies to the muscle nicotinic acetylcholine receptor (AChR). There seem to be ethnic and regional differences in the frequency and clinical features of MG seronegative for the AChR antibody. This study aimed to describe the autoantibody profiles and clinical features of Korean patients with generalized MG seronegative for the AChR antibody. A total of 62 patients with a high index of clinical suspicion of seronegative generalized MG were identified from 18 centers, and we examined their sera for antibodies to clustered AChR, muscle-specific tyrosine kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (LRP4) by cell-based assays (CBA) and to MuSK by radioimmunoprecipitation assay (RIPA). We also included 8 patients with ocular MG, 3 with Lambert-Eaton myasthenic syndrome, 5 with motor neuron disease, and 9 with other diagnoses as comparators for the serological testing. Antibodies were identified in 25/62 (40.3%) patients: 7 had antibodies to clustered AChR, 17 to MuSK, and 2 to LRP4. Three patients were double seropositive: 1 for MuSK and LRP4, and 2 for MuSK and clustered AChR. The patients with MuSK antibodies were mostly female (88.2%) and characterized by predominantly bulbar involvement (70%) and frequent myasthenic crises (58.3%). The patients with antibodies to clustered AChR, including 2 with ocular MG, tended to have a mild phenotype and good prognosis.
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Affiliation(s)
- Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail: (YHH); (PW)
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Thomas Smith
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong-Geon Lim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Republic of Korea
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Byung-Nam Yoon
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University Medical Research Council, Seoul, Republic of Korea
- * E-mail: (YHH); (PW)
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Hyun JW, Huh SY, Shin HJ, Woodhall M, Kim SH, Irani SR, Lee SH, Waters P, Kim HJ. Evaluation of brain lesion distribution criteria at disease onset in differentiating MS from NMOSD and MOG-IgG-associated encephalomyelitis. Mult Scler 2018; 25:585-590. [PMID: 29512413 PMCID: PMC6425520 DOI: 10.1177/1352458518761186] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: We aimed to evaluate the utility of the recently described brain lesion distribution criteria to differentiate multiple sclerosis (MS) from aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein immunoglobulin G-associated encephalomyelitis (MOG-EM) at disease onset in an Asian cohort. Methods: A total of 214 patients who fulfilled the published criteria for MS, NMOSD, or MOG-EM and underwent brain magnetic resonance imaging (MRI) within 3 months of disease onset were enrolled. The brain lesion distribution criteria were defined as the presence of a lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe, or an S-shaped U-fiber lesion, or a Dawson’s finger-type lesion. Results: Brain lesions were identified in the initial MRI scans of 166/214 patients. The distribution criteria were applied to these scans (MS (n = 94), NMOSD (n = 64), and MOG-EM (n = 8)). The sensitivity, specificity, and positive and negative predictive values of the criteria for MS versus NMOSD were 79.8%, 87.5%, 90.4%, and 74.7%, and for MS versus MOG-EM these were 79.8%, 100%, 100%, and 29.6%, respectively. Conclusion: These findings suggest that the brain lesion distribution criteria are helpful in distinguishing MS from NMOSD and MOG-EM in an Asian population, even at disease onset.
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Affiliation(s)
- Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - So-Young Huh
- Department of Neurology, College of Medicine, Kosin University, Busan, Korea
| | - Hyun-June Shin
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Mark Woodhall
- Autoimmune Neurology group, Nuffield Department of Clinical Neurosciences and Oxford University, Oxford, UK
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Sarosh R Irani
- Autoimmune Neurology group, Nuffield Department of Clinical Neurosciences and Oxford University, Oxford, UK
| | - Sang Hyun Lee
- Department of Radiology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Patrick Waters
- Autoimmune Neurology group, Nuffield Department of Clinical Neurosciences and Oxford University, Oxford, UK
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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36
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Vincent A, Huda S, Cao M, Cetin H, Koneczny I, Rodriguez Cruz PM, Jacobson L, Viegas S, Jacob S, Woodhall M, Nagaishi A, Maniaol A, Damato V, Leite MI, Cossins J, Webster R, Palace J, Beeson D. Serological and experimental studies in different forms of myasthenia gravis. Ann N Y Acad Sci 2018; 1413:143-153. [PMID: 29377162 DOI: 10.1111/nyas.13592] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022]
Abstract
Antibodies to the acetylcholine receptor (AChR) have been recognized for over 40 years and have been important in the diagnosis of myasthenia gravis (MG), and its recognition in patients of different ages and thymic pathologies. The 10-20% of patients who do not have AChR antibodies are now known to comprise different subgroups, the most commonly reported of which is patients with antibodies to muscle-specific kinase (MuSK). The use of cell-based assays has extended the repertoire of antibody tests to clustered AChRs, low-density lipoprotein receptor-related protein 4, and agrin. Autoantibodies against intracellular targets, namely cortactin, titin, and ryanodine receptor (the latter two being associated with the presence of thymoma), may also be helpful as biomarkers in some patients. IgG4 MuSK antibodies are clearly pathogenic, but the coexisting IgG1, IgG2, and IgG3 antibodies, collectively, have effects that question the dominance of IgG4 as the sole pathologic factor in MuSK MG. After a brief historical review, we define the different subgroups and summarize the antibody characteristics. Experiments to demonstrate the in vitro and in vivo pathogenic roles of MuSK antibodies are discussed.
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Affiliation(s)
- Angela Vincent
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Saif Huda
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michelangelo Cao
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Hakan Cetin
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Inga Koneczny
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Pedro M Rodriguez Cruz
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Stuart Viegas
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Saiju Jacob
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Akiko Nagaishi
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Angelina Maniaol
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Valentina Damato
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Judith Cossins
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Richard Webster
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - David Beeson
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
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Zieda A, Ravina K, Glazere I, Pelcere L, Naudina MS, Liepina L, Kamsa I, Kurjane N, Woodhall M, Jacobson L, Leite MI, Tandon K, Kenina V. A nationwide epidemiological study of myasthenia gravis in Latvia. Eur J Neurol 2018; 25:519-526. [DOI: 10.1111/ene.13535] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/27/2017] [Indexed: 01/22/2023]
Affiliation(s)
- A. Zieda
- Department of General Medicine Glasgow Royal Infirmary Glasgow UK
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
| | - K. Ravina
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
- Department of Neurosurgery Stanford University Stanford CA USA
| | - I. Glazere
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
| | - L. Pelcere
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
| | - M. S. Naudina
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
| | - L. Liepina
- Department of Neurology Riga East Clinical University Hospital Riga Latvia
| | - I. Kamsa
- Department of Neurology Pauls Stradins Clinical University Hospital Riga Latvia
| | - N. Kurjane
- Centre of Clinical Immunology Pauls Stradins Clinical University Hospital Riga Latvia
| | - M. Woodhall
- Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - L. Jacobson
- Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - M. I. Leite
- Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - K. Tandon
- Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
| | - V. Kenina
- Department of Neurology Riga East Clinical University Hospital Riga Latvia
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Maclean R, Everett R, Slivkova R, Woodhall M, Rifkin-Zybutz R, Armstrong R, Weir A, Waters P, Booth M, Isabel Leite M. PO133 Neuromyelitis optica spectrum disease preceded by three year history of intermittent gastro-intestinal dysfunction. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Raza N, Jurynczyk M, Everett R, Woodhall M, Tackley G, Jacob A, Vincent A, Isabel Leite M, Waters P, Palace J. PO147 Myelin oligodendrocyte glycoprotein-antibody disease in the uk. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Thouin A, Gastaldi M, Woodhall M, Jacobson L, Irani S, Vincent A. PO154 A comparison of nmdar-antibody detection methods. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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41
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Gastaldi M, Marchioni E, Banfi P, Mariani V, Di Lodovico L, Bergamaschi R, Alfonsi E, Borrelli P, Ferraro OE, Zardini E, Pichiecchio A, Cortese A, Waters P, Woodhall M, Ceroni M, Mauri M, Franciotta D. Predictors of outcome in a large retrospective cohort of patients with transverse myelitis. Mult Scler 2017; 24:1743-1752. [PMID: 28967297 DOI: 10.1177/1352458517731911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transverse myelitis (TM) is an inflammatory disorder that can be idiopathic or associated with central nervous system autoimmune/dysimmune inflammatory diseases, connective tissue autoimmune diseases, or post-infectious neurological syndromes. Prognosis of initial TM presentations is uncertain. OBJECTIVE To identify outcome predictors in TM. METHODS Retrospective study on isolated TM at onset. Scores ⩾3 on the modified Rankin scale (mRS) marked high disability. RESULTS A total of 159 patients were identified. TM was classified as follows: idiopathic (I-TM, n = 53), post-infectious (PI-TM, n = 48), associated with multiple sclerosis (MS-TM, n = 51), or neuromyelitis optica spectrum disorders/connective tissue autoimmune diseases/neurosarcoidosis ( n = 7). At follow-up (median, 55 months; interquartile range, 32-80), 42 patients were severely disabled, and patients with I-TM or PI-TM showed the worst outcomes. Predictors of disability were infectious antecedents, sphincter and pyramidal symptoms, high mRS scores, blood-cerebrospinal fluid barrier damage, lumbar magnetic resonance imaging (MRI) lesions on univariate analysis, and older age (odds ratio (OR), 1.1; 95% confidence interval (CI), 1.0-1.1), overt/subclinical involvement of the peripheral nervous system (PNS) (OR, 9.4; 95% CI, 2.2-41.0), complete TM (OR, 10.8; 95% CI, 3.4-34.5) on multivariate analysis. CONCLUSION Our findings help define prognosis and therapies in TM at onset. Infectious antecedents and PNS involvement associate with severe prognosis. Nerve conduction studies and lumbar MRI could improve the prognostic assessment of this condition.
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Affiliation(s)
- Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Marchioni
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Banfi
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Valeria Mariani
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Laura Di Lodovico
- Department of Neuro-Oncology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Enrico Alfonsi
- Department of Neurophysiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Paola Borrelli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Ottavia Eleonora Ferraro
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy; University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Andrea Cortese
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Mauro Ceroni
- University of Pavia, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
| | - Marco Mauri
- Neurology and Stroke Unit, Circolo Hospital and Macchi Foundation, Varese, Italy/Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy/Department of General Neurology, IRCCS C. Mondino National Neurological Institute, Pavia, Italy
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Bukhari W, Prain KM, Waters P, Woodhall M, O'Gorman CM, Clarke L, Silvestrini RA, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee WJ, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Killpatrick T, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell R, Mason DF, McCombe PA, Pender MP, Pereira JA, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Wilson RJ, Vincent A, Broadley SA. Incidence and prevalence of NMOSD in Australia and New Zealand. J Neurol Neurosurg Psychiatry 2017; 88:632-638. [PMID: 28550069 DOI: 10.1136/jnnp-2016-314839] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We have undertaken a clinic-based survey of neuromyelitis optica spectrum disorders (NMOSDs) in Australia and New Zealand to establish incidence and prevalence across the region and in populations of differing ancestry. BACKGROUND NMOSD is a recently defined demyelinating disease of the central nervous system (CNS). The incidence and prevalence of NMOSD in Australia and New Zealand has not been established. METHODS Centres managing patients with demyelinating disease of the CNS across Australia and New Zealand reported patients with clinical and laboratory features that were suspicious for NMOSD. Testing for aquaporin 4 antibodies was undertaken in all suspected cases. From this group, cases were identified who fulfilled the 2015 Wingerchuk diagnostic criteria for NMOSD. A capture-recapture methodology was used to estimate incidence and prevalence, based on additional laboratory identified cases. RESULTS NMOSD was confirmed in 81/170 (48%) cases referred. Capture-recapture analysis gave an adjusted incidence estimate of 0.37 (95% CI 0.35 to 0.39) per million per year and a prevalence estimate for NMOSD of 0.70 (95% CI 0.61 to 0.78) per 100 000. NMOSD was three times more common in the Asian population (1.57 (95% CI 1.15 to 1.98) per 100 000) compared with the remainder of the population (0.57 (95% CI 0.50 to 0.65) per 100 000). The latitudinal gradient evident in multiple sclerosis was not seen in NMOSD. CONCLUSIONS NMOSD incidence and prevalence in Australia and New Zealand are comparable with figures from other populations of largely European ancestry. We found NMOSD to be more common in the population with Asian ancestry.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Laura Clarke
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Sandeep Bhuta
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Matthew Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wallace J Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, London, UK
| | - Helmut Butzkueven
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Alan Coulthard
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Russell C Dale
- Childrens Hospital at Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Canberra, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | | | - David Fulcher
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Gillis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Simon Hawke
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robert Heard
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Saman Heshmat
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, Australia.,South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | | | - Trevor Killpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John King
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christpher Lynch
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | - Michael P Pender
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | - John D Pollard
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Cameron Shaw
- Department of Neurology, Geelong Hospital, Geelong, VIC, Australia
| | - Judith Spies
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Michael Walsh
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Richard C Wong
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Eppie M Yiu
- Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Allan G Kermode
- Western Australian Neuroscience Research Institute, Nedlands, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | | | - Robert J Wilson
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia.,Department of Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia
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Huda S, Waters P, Woodhall M, Leite MI, Jacobson L, De Rosa A, Maestri M, Ricciardi R, Heckmann JM, Maniaol A, Evoli A, Cossins J, Hilton-Jones D, Vincent A. IgG-specific cell-based assay detects potentially pathogenic MuSK-Abs in seronegative MG. Neurol Neuroimmunol Neuroinflamm 2017; 4:e357. [PMID: 28626780 PMCID: PMC5459793 DOI: 10.1212/nxi.0000000000000357] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 04/06/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To increase the detection of MuSK-Abs using a CBA and test their pathogenicity. METHODS Sera from 69 MuSK-RIA-positive patients with myasthenia gravis (MG) (Definite MuSK-MG), 169 patients negative for MuSK-RIA and AChR-RIA (seronegative MG, SNMG), 35 healthy individuals (healthy controls, HCs), and 16 NMDA receptor-Ab-positive (NMDAR-Ab) disease controls were tested for binding to MuSK on a CBA using different secondary antibodies. RESULTS Initially, in addition to 18% of SNMG sera, 11% of HC and 19% of NMDAR-Ab sera showed positive binding to MuSK-transfected cells; this low specificity was due to anti-IgG(H+L) detection of IgM bound nonspecifically to MuSK. Using an IgG Fc gamma-specific secondary antibody, MuSK-Abs were detected by CBA in 68/69 (99%) of Definite MuSK-MG, 0/35 HCs, 0/16 NMDAR-Ab, and 14/169 (8%) of SNMG sera, providing increased sensitivity with high specificity. The RIA-negative, CBA-positive MuSK-IgG sera, but not IgM-MuSK-binding sera, reduced agrin-induced AChR clustering in C2C12 myotubes, qualitatively similar to RIA-positive MuSK-Abs. CONCLUSIONS An IgG-specific MuSK-CBA can reliably detect IgG MuSK-Abs and increase sensitivity. In the MuSK-CBA, IgG specificity is essential. The positive sera demonstrated pathogenic potential in the in vitro AChR-clustering assay, although less effective than Definite MuSK-MG sera, and the patients had less severe clinical disease. Use of IgG-specific secondary antibodies may improve the results of other antibody tests. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that an IgG-specific MuSK-CBA identifies patients with MG.
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Affiliation(s)
- Saif Huda
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Anna De Rosa
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Michelangelo Maestri
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Roberta Ricciardi
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Jeannine M Heckmann
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Angelina Maniaol
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Amelia Evoli
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Judy Cossins
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - David Hilton-Jones
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences (S.H., P.W., M.W., M.I.L., L.J., J.C., D.H.-J., A.V.), University of Oxford, UK; Department of Clinical and Experimental Medicine (A.D.R., M.M., R.R.), Neurology Unit, Pisa, Italy; Division of Neurology (J.M.H.), University of Cape Town, South Africa; Oslo University Hospital (A.M.), Norway; and Department of Neuroscience (A.E.), Catholic University, Rome, Italy
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Huda S, Cao M, De Rosa A, Woodhall M, Cossins J, Maestri M, Ricciardi R, Beeson D, Vincent A. Inhibition of the tyrosine phosphatase Shp2 alleviates the pathogeniceff ects of MuSK antibodies in vitro. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30325-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tackley G, Vecchio D, Hamid S, Jurynczyk M, Kong Y, Gore R, Mutch K, Woodhall M, Waters P, Vincent A, Leite MI, Tracey I, Jacob A, Palace J. Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis. J Neurol Neurosurg Psychiatry 2017; 88:165-169. [PMID: 27884934 DOI: 10.1136/jnnp-2016-314991] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Chronic, intractable neuropathic pain is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment; few studies have yet to explore its aetiology. OBJECTIVE To establish if myelitis-associated chronic pain in NMOSD is related to the craniocaudal location of spinal cord lesions. METHOD (1) Retrospective cohort of 76 aquaporin 4-antibody (AQP4-Ab)-positive patients from Oxford and Liverpool's national NMOSD clinics, assessing current pain and craniocaudal location of cord lesion contemporary to pain onset. (2) Focused prospective study of 26 AQP4-Ab-positive Oxford patients, a subset of the retrospective cohort, assessing current craniocaudal lesion location and current pain. RESULTS Patients with isolated thoracic cord myelitis at the time of pain onset were significantly more disabled and suffered more pain. Cervical and thoracic lesions that persisted from pain onset to 'out of relapse' follow-up (current MRI) had highly significant (p<0.01) opposing effects on pain scores (std. β=-0.46 and 0.48, respectively). Lesion length, total lesion burden and number of transverse myelitis relapses did not correlate with pain. CONCLUSIONS Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.
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Affiliation(s)
- George Tackley
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Domizia Vecchio
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK.,Department of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Shahd Hamid
- Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Maciej Jurynczyk
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Yazhuo Kong
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Rosie Gore
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Kerry Mutch
- Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Irene Tracey
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
| | - Anu Jacob
- Department of Neurology, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK
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Juryńczyk M, Tackley G, Kong Y, Geraldes R, Matthews L, Woodhall M, Waters P, Kuker W, Craner M, Weir A, DeLuca GC, Kremer S, Leite MI, Vincent A, Jacob A, de Sèze J, Palace J. Brain lesion distribution criteria distinguish MS from AQP4-antibody NMOSD and MOG-antibody disease. J Neurol Neurosurg Psychiatry 2017; 88:132-136. [PMID: 27951522 DOI: 10.1136/jnnp-2016-314005] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Neuromyelitis optica spectrum disorders (NMOSD) can present with very similar clinical features to multiple sclerosis (MS), but the international diagnostic imaging criteria for MS are not necessarily helpful in distinguishing these two diseases. OBJECTIVE This multicentre study tested previously reported criteria of '(1) at least 1 lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe; or (2) the presence of a subcortical U-fibre lesion or (3) a Dawson's finger-type lesion' in an independent cohort of relapsing-remitting multiple sclerosis (RRMS) and AQP4-ab NMOSD patients and also assessed their value in myelin oligodendrocyte glycoprotein (MOG)-ab positive and ab-negative NMOSD. DESIGN Brain MRI scans were anonymised and scored on the criteria by 2 of 3 independent raters. In case of disagreement, the final opinion was made by the third rater. PARTICIPANTS 112 patients with NMOSD (31 AQP4-ab-positive, 21 MOG-ab-positive, 16 ab-negative) or MS (44) were selected from 3 centres (Oxford, Strasbourg and Liverpool) for the presence of brain lesions. RESULTS MRI brain lesion distribution criteria were able to distinguish RRMS with a sensitivity of 90.9% and with a specificity of 87.1% against AQP4-ab NMOSD, 95.2% against MOG-ab NMOSD and 87.5% in the heterogenous ab-negative NMOSD cohort. Over the whole NMOSD group, the specificity was 89.7%. CONCLUSIONS This study suggests that the brain MRI criteria for differentiating RRMS from NMOSD are sensitive and specific for all phenotypes.
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Affiliation(s)
- Maciej Juryńczyk
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - George Tackley
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Yazhuo Kong
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Wilhelm Kuker
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthew Craner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrew Weir
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stephane Kremer
- ICube (UMR 7357, UdS, Centre National de la Recherche Scientifique), Fédération de médecine translationelle de Strasbourg, University de Strasbourg, Strasbourg, France.,Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Anu Jacob
- NMO Clinical Service, The Walton Centre, Liverpool, UK
| | - Jérôme de Sèze
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.,Fédération de médecine translationelle de Strasbourg, CIC 1434, University of Strasbourg, Strasbourg, France
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Rivas JR, Ireland SJ, Chkheidze R, Rounds WH, Lim J, Johnson J, Ramirez DMO, Ligocki AJ, Chen D, Guzman AA, Woodhall M, Wilson PC, Meffre E, White C, Greenberg BM, Waters P, Cowell LG, Stowe AM, Monson NL. Peripheral VH4+ plasmablasts demonstrate autoreactive B cell expansion toward brain antigens in early multiple sclerosis patients. Acta Neuropathol 2017; 133:43-60. [PMID: 27730299 DOI: 10.1007/s00401-016-1627-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/24/2022]
Abstract
Plasmablasts are a highly differentiated, antibody secreting B cell subset whose prevalence correlates with disease activity in Multiple Sclerosis (MS). For most patients experiencing partial transverse myelitis (PTM), plasmablasts are elevated in the blood at the first clinical presentation of disease (known as a clinically isolated syndrome or CIS). In this study we found that many of these peripheral plasmablasts are autoreactive and recognize primarily gray matter targets in brain tissue. These plasmablasts express antibodies that over-utilize immunoglobulin heavy chain V-region subgroup 4 (VH4) genes, and the highly mutated VH4+ plasmablast antibodies recognize intracellular antigens of neurons and astrocytes. Most of the autoreactive, highly mutated VH4+ plasmablast antibodies recognize only a portion of cortical neurons, indicating that the response may be specific to neuronal subgroups or layers. Furthermore, CIS-PTM patients with this plasmablast response also exhibit modest reactivity toward neuroantigens in the plasma IgG antibody pool. Taken together, these data indicate that expanded VH4+ peripheral plasmablasts in early MS patients recognize brain gray matter antigens. Peripheral plasmablasts may be participating in the autoimmune response associated with MS, and provide an interesting avenue for investigating the expansion of autoreactive B cells at the time of the first documented clinical event.
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Affiliation(s)
- Jacqueline R Rivas
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Sara J Ireland
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Rati Chkheidze
- Department of Pathology, UT Southwestern, Dallas, TX, USA
| | - William H Rounds
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Joseph Lim
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Jordan Johnson
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Denise M O Ramirez
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Ann J Ligocki
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Ding Chen
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Alyssa A Guzman
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Mark Woodhall
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Patrick C Wilson
- Department of Biomedical Sciences, University of Chicago, Chicago, IL, USA
| | - Eric Meffre
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Charles White
- Department of Pathology, UT Southwestern, Dallas, TX, USA
| | | | - Patrick Waters
- Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Lindsay G Cowell
- Department of Clinical Science, UT Southwestern, Dallas, TX, USA
| | - Ann M Stowe
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, UT Southwestern, Dallas, TX, USA.
- Department of Immunology, UT Southwestern, Dallas, TX, USA.
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Kim SM, Waters P, Woodhall M, Kim YJ, Kim JA, Cheon SY, Lee S, Jo SR, Kim DG, Jung KC, Lee KW, Sung JJ, Park KS. Gender effect on neuromyelitis optica spectrum disorder with aquaporin4-immunoglobulin G. Mult Scler 2016; 23:1104-1111. [PMID: 27760862 DOI: 10.1177/1352458516674366] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder with aquaporin4-immunoglobulin G (NMOSD-AQP4) is an inflammatory disease characterised by a high female predominance. However, the effect of gender in patients with NMOSD-AQP4 has not been fully evaluated. OBJECTIVE The aim of this study was to determine the effect of gender in clinical manifestations and prognosis of patients with NMOSD-AQP4. METHODS The demographics, clinical and radiological characteristics, pattern reversal visual evoked potential (VEP) test results, and prognosis of 102 patients (18 males) with NMOSD-AQP4 were assessed. RESULTS Male patients had a higher age at onset (48.7 vs 41 years, p = 0.037) and less optic neuritis as the onset attack (17% vs 44%, p = 0.026), higher tendency to manifest as isolated myelitis over the follow-up period (67% vs 28%, p = 0.005), fewer optic neuritis attacks per year (0.08 vs 0.27, p < 0.001), and shorter relative P100 latency on VEP testing (97.1% vs 108.3%, p = 0.001). Moreover, male gender was significantly associated with the absence of optic neuritis attacks over the follow-up period independent of their age of onset. CONCLUSION In NMOSD-AQP4 patients, gender impacts on disease onset age and site of attack. This may be an important clue in identifying NMOSD-AQP4 patients with limited manifestations as well as in predicting their clinical courses.
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Affiliation(s)
- Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, Oxford, UK
| | - Yoo-Jin Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Ah Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Cheon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sehoon Lee
- Department of Neurology, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Seong Rae Jo
- Department of Neurology, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Dong Gun Kim
- Department of Neurology, Seoul National University, Bundang Hospital, Seongnam, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woo Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea/Department of Neurology, Seoul National University, Bundang Hospital, Seongnam, Korea
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Waters P, Reindl M, Saiz A, Schanda K, Tuller F, Kral V, Nytrova P, Sobek O, Nielsen HH, Barington T, Lillevang ST, Illes Z, Rentzsch K, Berthele A, Berki T, Granieri L, Bertolotto A, Giometto B, Zuliani L, Hamann D, van Pelt ED, Hintzen R, Höftberger R, Costa C, Comabella M, Montalban X, Tintoré M, Siva A, Altintas A, Deniz G, Woodhall M, Palace J, Paul F, Hartung HP, Aktas O, Jarius S, Wildemann B, Vedeler C, Ruiz A, Leite MI, Trillenberg P, Probst M, Saschenbrecker S, Vincent A, Marignier R. Multicentre comparison of a diagnostic assay: aquaporin-4 antibodies in neuromyelitis optica. J Neurol Neurosurg Psychiatry 2016; 87:1005-15. [PMID: 27113605 PMCID: PMC5013123 DOI: 10.1136/jnnp-2015-312601] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/06/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Antibodies to cell surface central nervous system proteins help to diagnose conditions which often respond to immunotherapies. The assessment of antibody assays needs to reflect their clinical utility. We report the results of a multicentre study of aquaporin (AQP) 4 antibody (AQP4-Ab) assays in neuromyelitis optica spectrum disorders (NMOSD). METHODS Coded samples from patients with neuromyelitis optica (NMO) or NMOSD (101) and controls (92) were tested at 15 European diagnostic centres using 21 assays including live (n=3) or fixed cell-based assays (n=10), flow cytometry (n=4), immunohistochemistry (n=3) and ELISA (n=1). RESULTS Results of tests on 92 controls identified 12assays as highly specific (0-1 false-positive results). 32 samples from 50 (64%) NMO sera and 34 from 51 (67%) NMOSD sera were positive on at least two of the 12 highly specific assays, leaving 35 patients with seronegative NMO/spectrum disorder (SD). On the basis of a combination of clinical phenotype and the highly specific assays, 66 AQP4-Ab seropositive samples were used to establish the sensitivities (51.5-100%) of all 21 assays. The specificities (85.8-100%) were based on 92 control samples and 35 seronegative NMO/SD patient samples. CONCLUSIONS The cell-based assays were most sensitive and specific overall, but immunohistochemistry or flow cytometry could be equally accurate in specialist centres. Since patients with AQP4-Ab negative NMO/SD require different management, the use of both appropriate control samples and defined seronegative NMOSD samples is essential to evaluate these assays in a clinically meaningful way. The process described here can be applied to the evaluation of other antibody assays in the newly evolving field of autoimmune neurology.
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Affiliation(s)
- Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Albert Saiz
- Neuroimmunology Program, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Friederike Tuller
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Vlastimil Kral
- Zdravotni ustav se sidlem v Usti nad Labem, Centrum imunologie a mikrobiologie, Usti nad Labem, Czech Republic
| | - Petra Nytrova
- Department of Neurology, Center of Clinical Neuroscience First Faculty of Medicine, General University Hospital and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ondrej Sobek
- Laboratory for CSF and Neuroimmunology, Topelex Ltd, Prague, Czech Republic
| | | | - Torben Barington
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Søren T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Zsolt Illes
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark Department of Neurology, University of Pécs, Pécs, Hungary
| | | | - Achim Berthele
- Klinikum rechts der Isar der TU München, Klinik für Neurologie, Munich, Germany
| | - Tímea Berki
- Department of Immunology and Biotechnology, University of Pécs, Pécs, Hungary
| | - Letizia Granieri
- Clinical Neurobiology Unit, Neuroscience Institute Cavalieri Ottolenghi (NICO), University Hospital San Luigi Gonzaga, Regional Referring Multiple Sclerosis Centre, Orbassano, Italy
| | - Antonio Bertolotto
- Clinical Neurobiology Unit, Neuroscience Institute Cavalieri Ottolenghi (NICO), University Hospital San Luigi Gonzaga, Regional Referring Multiple Sclerosis Centre, Orbassano, Italy
| | - Bruno Giometto
- Department of Neurology, Azienda ULSS 9 Treviso, Treviso, Italy
| | - Luigi Zuliani
- Department of Neurology, Azienda ULSS 9 Treviso, Treviso, Italy
| | - Dörte Hamann
- Sanquin Diagnostic Services, Department of Immunopathology and Blood Coagulation, Amsterdam, The Netherlands
| | - E Daniëlle van Pelt
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Rogier Hintzen
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Romana Höftberger
- Neuroimmunology Program, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Carme Costa
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aksel Siva
- Neurology Department, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Ayse Altintas
- Neurology Department, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Günnur Deniz
- Department of Immunology, Istanbul University, Institute of Experimental Medicine, Istanbul, Turkey
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Peter Hartung
- Medical Faculty, Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Orhan Aktas
- Medical Faculty, Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Germany
| | - Christian Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anne Ruiz
- Faculty of Medecine RTH Laennec, Lyon Neurosciences Research Centre, Neuro-inflammation and Neuro-oncology Team, Lyon, France
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Trillenberg
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | | | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Romain Marignier
- Faculty of Medecine RTH Laennec, Lyon Neurosciences Research Centre, Neuro-inflammation and Neuro-oncology Team, Lyon, France
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50
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Tackley G, O’Brien F, Rocha J, Woodhall M, Waters P, Chandratre S, Halfpenny C, Hemingway C, Wassmer E, Wasiewski W, Leite MI, Palace J. Neuromyelitis optica relapses: Race and rate, immunosuppression and impairment. Mult Scler Relat Disord 2016; 7:21-5. [DOI: 10.1016/j.msard.2016.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/31/2015] [Accepted: 02/14/2016] [Indexed: 10/22/2022]
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