A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis
A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis
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DOI：
10.1016/s0140-6736(04)17551-x
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发表时间：
2004-12-11
期刊：
影响因子：
168.9
通讯作者：
Weinshenker, BG
中科院分区：
文献类型：
--
作者：
Lennon, VA;Wingerchuk, DM;Weinshenker, BG
研究背景视神经肌病是一种选择性靶向视神经和脊髓的炎症性脱髓鞘疾病，预后差。它通常被误诊为多发性硬化症。这两种疾病都没有明显的生物标志物，但最佳治疗方法不同。在亚洲视神经肌病与视脊髓多发性硬化症的关系尚不确定。我们评估了一个假定的标记neuromyelocytica（NMO-IgG）的能力，以区分neuromyelocytica和相关疾病多发性sclerosis.Methods间接免疫荧光与复合基板的小鼠组织确定了一个独特的NMO-IgG染色模式，其特征在于进一步通过双重免疫染色。我们测试了来自102名北美视神经肌萎缩症患者或提示该疾病高风险综合征患者和12名日本患者的掩蔽血清样本。患有视神经脊髓多发性硬化症对照组患者患有多发性硬化症、其他脊髓病、视神经病和其他疾病。我们还建立了14例患者的临床诊断偶然显示有NMO-IgG的85 000测试可疑的副肿瘤性自身immunity.Findings NMO-IgG概述CNS微血管，软脑膜，软脑膜下，和Virchow-Robin空间。它与层粘连蛋白部分共定位。视神经肌萎缩的敏感性和特异性分别为73%（95%CI 60-86）和91%（79-100），视神经脊髓多发性硬化的敏感性和特异性分别为58%（30-86）和100%（66-100）。NMO-IgG在半数高危综合征患者中检出。14例血清阳性的情况下，确定偶然，12有neuromyelodica或一个高风险的综合征的diseases.Interpretation NMO-IgG是一个特定的标记自身抗体neuromyelodica和结合或附近的血脑屏障。它能区分视神经肌萎缩症和多发性硬化症。亚洲视神经脊髓多发性硬化症似乎与视神经肌萎缩症相同。
Background Neuromyelitis optica is an inflammatory demyelinating disease with generally poor prognosis that selectively targets optic nerves and spinal cord. It is commonly misdiagnosed as multiple sclerosis. Neither disease has a distinguishing biomarker, but optimum treatments differ. The relation of neuromyelitis optica to optic-spinal multiple sclerosis in Asia is uncertain. We assessed the capacity of a putative marker for neuromyelitis optica (NMO-IgG) to distinguish neuromyelitis optica and related disorders from multiple sclerosis.Methods Indirect immunofluorescence with a composite substrate of mouse tissues identified a distinctive NMO-IgG staining pattern, which we characterised further by dual immunostaining. We tested masked serum samples from 102 North American patients with neuromyelitis optica or with syndromes that suggest high risk of the disorder, and 12 Japanese patients. with optic-spinal multiple sclerosis. Control patients had multiple sclerosis, other myelopathies, optic neuropathies, and miscellaneous disorders. We also established clinical diagnoses for 14 patients incidentally shown to have NMO-IgG among 85 000 tested for suspected paraneoplastic autoimmunity.Findings NMO-IgG outlines CNS microvessels, pia, subpia, and Virchow-Robin space. It partly colocalises with laminin. Sensitivity and specificity were 73% (95% CI 60-86) and 91% (79-100) for neuromyelitis optica and 58% (30-86) and 100% (66-100) for optic-spinal multiple sclerosis. NMO-IgG was detected in half of patients with high-risk syndromes. Of 14 seropositive cases identified incidentally, 12 had neuromyelitis optica or a high-risk syndrome for the disease.Interpretation NMO-IgG is a specific marker autoantibody of neuromyelitis optica and binds at or near the blood-brain barrier. it distinguishes neuromyelitis optica from multiple sclerosis. Asian optic-spinal multiple sclerosis seems to be the same as neuromyelitis optica.