Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Autoantibody Status Predict Outcome of Recurrent Optic Neuritis
Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Autoantibody Status Predict Outcome of Recurrent Optic Neuritis
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DOI：
10.1016/j.ophtha.2018.03.041
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发表时间：
2018-10-01
期刊：
影响因子：
13.7
通讯作者：
Pittock, Sean J.
中科院分区：
文献类型：
--
作者：
Jitprapaikulsan, Jiraporn;Chen, John J.;Pittock, Sean J.
目的：确定水通道蛋白-4和髓鞘少突胶质细胞糖蛋白（MOG）免疫球蛋白G（IgG）血清状态和视力的结果与复发性视神经炎（罗恩）最初寻求treatment.Design：横断面队列研究。参与者：该研究通过搜索马约诊所计算机化的中央诊断索引（2000年1月至2017年3月）确定患者。246名符合条件的患者符合以下标准：（1）最初寻求治疗至少2次连续发作的视神经炎（ON）和（2）血清可用于检测。方法：使用经内部验证的流式细胞术检测血清中的水通道蛋白-4 IgG和MOG IgG 1，使用转染M1水通道蛋白-4或全长MOG的活HEK 293细胞。水通道蛋白-4 IgG和MOG IgG 1血清状态，临床特征和视力outcomes.Results：在246例罗恩患者中，在32%（水通道蛋白-4 IgG，19%; MOG IgG 1，13%）中检测到胶质细胞自身抗体; 186例仅罗恩患者和60例罗恩患者随后额外的炎性脱髓鞘发作（rON+组）。仅rON队列包括以下患者：双重血清阴性（特发性），110例患者（59%）; MOG IgG 1阳性，27例患者（15%; 4例慢性复发性炎性视神经病变）;多发性硬化症（MS），25例患者（13%）;水通道蛋白-4 IgG阳性，24例患者（13%）。rON+队列包括以下患者：水通道蛋白-4 IgG阳性，23例患者（38%）; MS，22例患者（37%）;双重血清阴性，11例患者（18%）; MOG IgG 1阳性，4例患者（7%）。对于MOG IgG 1阳性患者，仅rON组的年复发率为1.2，双血清阴性患者为0.7，水通道蛋白-4 IgG阳性患者为0.6，MS患者为0.4（P = 0.005）。在最低点时，最差rON仅发作患者的中位视力（VA）为水通道蛋白-4 IgG阳性患者的手部运动，MOG IgG 1阳性患者的计数手指和手部运动之间，特发性患者为20/800，MS患者为20/100（P = 0.02）。仅接受rON治疗的队列中，水通道蛋白-4 IgG阳性患者、特发性患者、MS患者和MOG IgG 1阳性患者在末次随访时患眼的中位VA分别为20/40、20/25（P = 0.006）。在ON发病后5年，59%的水通道蛋白-4 IgG阳性患者，22%的特发性患者，12%的MOG IgG 1阳性患者，和8%的MS patients估计有严重的visualloss.Conclusions：胶质细胞自身抗体（MOG IgG 1或水通道蛋白-4 IgG）被发现在三分之一的所有患者与罗恩。水通道蛋白-4 IgG血清阳性比MOG IgG 1血清阳性、双重血清阴性或MS诊断预测更差的视觉结果。髓鞘少突胶质细胞糖蛋白IgG 1与更高的复发率和更好的视力结果相关。(C)2018年美国眼科学会
Purpose: To determine the aquaporin-4 and myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG) serostatus and visual outcomes in patients with recurrent optic neuritis (rON) initially seeking treatment.Design: Cross-sectional cohort study.Participants: The study identified patients by searching the Mayo Clinic computerized central diagnostic index (January 2000-March 2017). The 246 eligible patients fulfilled the following criteria: (1) initially seeking treatment for at least 2 consecutive episodes of optic neuritis (ON) and (2) serum available for testing.Methods: Serum was tested for aquaporin-4 IgG and MOG IgG1 using an in-house validated flow cytometric assay using live HEK293 cells transfected with M1 aquaporin-4 or full-length MOG.Main Outcomes Measures: Aquaporin-4 IgG and MOG IgG1 serostatus, clinical characteristics, and visual outcomes.Results: Among 246 patients with rON at presentation, glial autoantibodies were detected in 32% (aquaporin-4 IgG, 19%; MOG IgG1, 13%); 186 patients had rON only and 60 patients had rON with subsequent additional inflammatory demyelinating attacks (rON-plus group). The rON-only cohort comprised the following: double seronegative (idiopathic), 110 patients (59%); MOG IgG1 positive, 27 patients (15%; 4 with chronic relapsing inflammatory optic neuropathy); multiple sclerosis (MS), 25 patients (13%); and aquaporin-4 IgG positive, 24 patients (13%). The rON-plus cohort comprised the following: aquaporin-4 IgG positive, 23 patients (38%); MS, 22 patients (37%); double seronegative, 11 patients (18%); and MOG IgG1 positive, 4 patients (7%). The annualized relapse rate for the rON-only group was 1.2 for MOG IgG1-positive patients, 0.7 for double-seronegative patients, 0.6 for aquaporin-4 IgG-positive patients, and 0.4 for MS patients (P = 0.005). The median visual acuity (VA) of patients with the worst rON-only attack at nadir were hand movements in aquaporin-4 IgG-positive patients, between counting fingers and hand movements in MOG IgG1-positive patients, 20/800 in idiopathic patients, and 20/100 in MS patients (P = 0.02). The median VA at last follow-up for affected eyes of the rON-only cohort were counting fingers for aquaporin-4 IgG-positive patients, 20/40 for idiopathic patients, 20/25 for MS patients and MOG IgG1-positive patients (P = 0.006). At 5 years after ON onset, 59% of aquaporin-4 IgG-positive patients, 22% of idiopathic patients, 12% of MOG IgG1-positive patients, and 8% of MS patients were estimated to have severe visual loss.Conclusions: Glial autoantibodies (MOG IgG1 or aquaporin-4 IgG) are found in one third of all patients with rON. Aquaporin-4 IgG seropositivity predicts a worse visual outcome than MOG IgG1 seropositivity, double seronegativity, or MS diagnosis. Myelin oligodendrocyte glycoprotein IgG1 is associated with a greater relapse rate but better visual outcomes. (C) 2018 by the American Academy of Ophthalmology