Aquaporin-4 autoantibodies in a paraneoplastic context
Aquaporin-4 autoantibodies in a paraneoplastic context
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DOI：
10.1001/archneur.65.5.629
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发表时间：
2008-05-01
影响因子：
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通讯作者：
Lennon, Vanda A.
中科院分区：
文献类型：
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作者：
Pittock, Sean J.;Lennon, Vanda A.
背景：视神经脊髓炎Ig G自身抗体(NMO-Ig G)是NMO和炎性中枢神经系统脱髓鞘疾病的一种新出现的生物标志物。其抗原为星形细胞水通道水通道蛋白-4；目的：报道(1)在副肿瘤自身抗体盲法评估中偶然确诊为NMO-Ig G阳性患者的神经学和肿瘤学相关性，以及(2)NMO-Ig G阳性患者的癌症发生率。设计：观察，回顾性病例系列。地点：梅奥临床医学院神经免疫学实验室和神经病学临床实践。患者和方法：1998-2007年，我们检测了两组患者的NMO-IgG：(1)在18万名副肿瘤自身抗体评估患者中偶然发现31名患者(88%为女性)和(2)141名经医生要求的血清学评估疑似NMO谱系疾病的患者。结果：在第一组患者中，有28名患者(90%)获得了临床信息。26例患者(93%)被诊断为NMO谱疾病，其中6例有肿瘤(5例癌[2例乳腺癌，1例肺，1例胸腺，1例宫颈]和1例B细胞淋巴瘤)，1例单克隆性伽马病。在4名患者中，NMO相关症状在肿瘤检测之后(中位数为14[3-18]个月)，在2名患者中，症状先于肿瘤检测(分别为5个月和3个月)。两名患者患有癌症(1名乳腺癌和1名肺癌)，没有神经学证据表明有NMO谱系障碍。在第二组中，7例血清阳性患者(5.0%)伴有临床诊断的NMO谱障碍：3例癌(全乳腺)，1例甲状腺赫氏细胞癌，1例类癌，1例垂体促生长激素瘤，1例B细胞淋巴瘤。结论：部分NMO患者水通道蛋白-4特异性免疫球蛋白可能反映了副肿瘤免疫反应。这种自身抗体作为癌症标记物的临床应用值得进行前瞻性研究。
Background: The neuromyelitis optica IgG autoantibody (NMO-IgG) is a validated biomarker for NMO and an emerging spectrum of inflammatory central nervous system - demyelinating disorders. Its antigen is the astrocytic water channel aquaporin-4; NMO-IgG has not been described in a cancer context.Objectives: To report (1) neurologic and oncologic correlates for patients incidentally identified as NMO-IgG seropositive in a blinded evaluation for paraneoplastic autoantibodies and (2) the frequency of cancer in NMO-IgG - seropositive patients.Design: Observational, retrospective case series.Setting: Neuroimmunology Laboratory and Neurology Clinical Practice, Mayo Clinic College of Medicine.Patients and Methods: From 1998 to 2007, we detected NMO-IgG in 2 patient groups: (1) 31 patients (88% female) identified incidentally among 180 000 patients evaluated for paraneoplastic autoantibodies and (2) 141 patients identified through physician-requested serological evaluation for a suspected NMO-spectrum disorder.Results: In the first group, clinical information was available for 28 patients (90%). An NMO-spectrum disorder was diagnosed in 26 patients (93%), of whom 6 had a neoplasm (5 carcinomas [ 2 breast, 1 lung, 1 thymic, and 1 uterine cervical] and 1 B-cell lymphoma) and 1 had monoclonal gammopathy. In 4 patients, NMO-related symptoms followed neoplasia detection (median, 14 [range 3-18] months), and in 2 patients, symptoms preceded neoplasia detection (by 5 and 3 months). Two patients had carcinoma (1 breast and 1 lung) without neurological evidence of an NMO-spectrum disorder. In the second group, neoplasms were recorded in 7 seropositive patients (5.0%) with a clinically diagnosed NMO-spectrum disorder: 3 carcinomas (all breast), 1 thyroid Hurthle cell, 1 carcinoid, 1 pituitary somatotropinoma, and 1 B-cell lymphoma. An eighth patient had monoclonal gammopathy.Conclusions: Aquaporin-4 - specific IgG in some cases of NMO may reflect a paraneoplastic immune response. The clinical utility of this autoantibody as a cancer marker warrants prospective investigation.