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The clinical value of complement proteins in differentiating AQP4-IgG-positive from MOG-IgG-positive neuromyelitis optica spectrum disorders.
Mult Scler Relat Disord. 2019 Oct; 35:1-4.MS

Abstract

BACKGROUND

Neuromyelitis optica spectrum disorder (NMOSD) refers to a range of autoimmune inflammatory demyelinating diseases affecting the optic nerves, spinal cord, and periependymal regions of the brain. Classical NMOSD is characterized by the presentation of autoantibodies against the water channel aquaporin-4 (AQP4). However, a subset of patients fulfilling the clinical criteria for NMOSD is negative for AQP4-IgG but positive for autoantibodies against myelin oligodendrocyte glycoprotein (MOG); these patients are associated with different clinical manifestations and pathogenesis.

METHODS

Patients who received a first diagnosis of NMOSD were reviewed retrospectively between April 2015 and December 2018. Patients were classified according to the presence of AQP4-IgG and MOG-IgG in serum and/or cerebrospinal fluid. Clinical characteristics, magnetic resonance imaging findings, disease severity, and serum C3 and C4 levels at the first episode were compared between the groups.

RESULTS

The NMOSD patients with AQP4-IgG and MOG-IgG demonstrated specific, differential clinical features. The AQP4-IgG group featured more women, the presentation of transverse myelitis attacks and simultaneous occurrence of optic neuritis and transverse myelitis were more common, and intrathecal synthesis was more evident. The MOG-IgG group featured younger patients, more acute disseminated encephalomyelitis (ADEM) or ADEM-like attacks, more frequent cerebrospinal fluid pleocytosis, and a better overall outcome. C3 levels were significantly lower in AQP4-IgG-positive patients and higher in MOG-IgG-positive patients relative to healthy controls. C4 levels were significantly lower in the AQP4-IgG-positive NMOSD group when compared to both MOG-IgG-positive patients and controls. C3 and C4 were then combined in a receiver operating characteristic model. The area under the curve of the model was calculated to differentiate the AQP4-IgG-positive group from the MOG-IgG-positive group was 0.787, which was considered moderately predictive.

CONCLUSION

The combination of C3 and C4 could assist in the differential diagnosis of AQP4-IgG-positive NMOSD from MOG-IgG-positive NMOSD.

Authors+Show Affiliations

Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Mayo Clinic, Rochester, MN 55905, United States.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Electronic address: bubitao@tjh.tjmu.edu.cn.Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Electronic address: tiands@tjh.tjmu.edu.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31276911

Citation

Qin, Chuan, et al. "The Clinical Value of Complement Proteins in Differentiating AQP4-IgG-positive From MOG-IgG-positive Neuromyelitis Optica Spectrum Disorders." Multiple Sclerosis and Related Disorders, vol. 35, 2019, pp. 1-4.
Qin C, Chen B, Tao R, et al. The clinical value of complement proteins in differentiating AQP4-IgG-positive from MOG-IgG-positive neuromyelitis optica spectrum disorders. Mult Scler Relat Disord. 2019;35:1-4.
Qin, C., Chen, B., Tao, R., Chen, M., Ma, X., Shang, K., Wu, L. J., Wang, W., Bu, B. T., & Tian, D. S. (2019). The clinical value of complement proteins in differentiating AQP4-IgG-positive from MOG-IgG-positive neuromyelitis optica spectrum disorders. Multiple Sclerosis and Related Disorders, 35, 1-4. https://doi.org/10.1016/j.msard.2019.06.035
Qin C, et al. The Clinical Value of Complement Proteins in Differentiating AQP4-IgG-positive From MOG-IgG-positive Neuromyelitis Optica Spectrum Disorders. Mult Scler Relat Disord. 2019;35:1-4. PubMed PMID: 31276911.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The clinical value of complement proteins in differentiating AQP4-IgG-positive from MOG-IgG-positive neuromyelitis optica spectrum disorders. AU - Qin,Chuan, AU - Chen,Bo, AU - Tao,Ran, AU - Chen,Man, AU - Ma,Xue, AU - Shang,Ke, AU - Wu,Long-Jun, AU - Wang,Wei, AU - Bu,Bi-Tao, AU - Tian,Dai-Shi, Y1 - 2019/06/29/ PY - 2019/05/25/received PY - 2019/06/22/revised PY - 2019/06/28/accepted PY - 2019/7/6/pubmed PY - 2020/4/3/medline PY - 2019/7/6/entrez KW - AQP4 KW - Complement KW - MOG KW - NMOSD SP - 1 EP - 4 JF - Multiple sclerosis and related disorders JO - Mult Scler Relat Disord VL - 35 N2 - BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) refers to a range of autoimmune inflammatory demyelinating diseases affecting the optic nerves, spinal cord, and periependymal regions of the brain. Classical NMOSD is characterized by the presentation of autoantibodies against the water channel aquaporin-4 (AQP4). However, a subset of patients fulfilling the clinical criteria for NMOSD is negative for AQP4-IgG but positive for autoantibodies against myelin oligodendrocyte glycoprotein (MOG); these patients are associated with different clinical manifestations and pathogenesis. METHODS: Patients who received a first diagnosis of NMOSD were reviewed retrospectively between April 2015 and December 2018. Patients were classified according to the presence of AQP4-IgG and MOG-IgG in serum and/or cerebrospinal fluid. Clinical characteristics, magnetic resonance imaging findings, disease severity, and serum C3 and C4 levels at the first episode were compared between the groups. RESULTS: The NMOSD patients with AQP4-IgG and MOG-IgG demonstrated specific, differential clinical features. The AQP4-IgG group featured more women, the presentation of transverse myelitis attacks and simultaneous occurrence of optic neuritis and transverse myelitis were more common, and intrathecal synthesis was more evident. The MOG-IgG group featured younger patients, more acute disseminated encephalomyelitis (ADEM) or ADEM-like attacks, more frequent cerebrospinal fluid pleocytosis, and a better overall outcome. C3 levels were significantly lower in AQP4-IgG-positive patients and higher in MOG-IgG-positive patients relative to healthy controls. C4 levels were significantly lower in the AQP4-IgG-positive NMOSD group when compared to both MOG-IgG-positive patients and controls. C3 and C4 were then combined in a receiver operating characteristic model. The area under the curve of the model was calculated to differentiate the AQP4-IgG-positive group from the MOG-IgG-positive group was 0.787, which was considered moderately predictive. CONCLUSION: The combination of C3 and C4 could assist in the differential diagnosis of AQP4-IgG-positive NMOSD from MOG-IgG-positive NMOSD. SN - 2211-0356 UR - https://www.unboundmedicine.com/medline/citation/31276911/The_clinical_value_of_complement_proteins_in_differentiating_AQP4_IgG_positive_from_MOG_IgG_positive_neuromyelitis_optica_spectrum_disorders_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2211-0348(19)30281-0 DB - PRIME DP - Unbound Medicine ER -