Seroconversion of anti-aquaporin-4 antibody in NMO spectrum disorder: a case report

Mori, Masahiro; Kawaguchi, Naoki; Uzawa, Akiyuki; Nemoto, Yuhko; Masuda, Saeko; Kuwabara, Satoshi

doi:10.1007/s00415-011-6288-2

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Development of anti-AQP 4 antibody occurred 3 years before the onset of myelitis. 11 We could not show clear evidence of seroconversion tested by CBA in the present NMOSD patient. The clinical manifestations and course of our patient strongly suggested the diagnosis of NMOSD, whether antibodies against AQP4 were present or not.…”

Section: Discussioncontrasting

confidence: 69%

Mysterious presentation of autoantibody in a neuromyelitis optica spectrum disorder patient

Sugawara

Sanpei

2019

Clinical & Exp Neuroim

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Background Treatment with interferon beta often leads to the development of relapses and expedites functional disability in neuromyelitis optica spectrum disorder patients. An accurate diagnosis frequently requires the presence of anti-aquaporin-4 (AQP4) antibodies when we encounter a patient who manifests atypical radiological findings. Case presentation A 35-year-old woman developed sudden vertigo and had lesions around her bilateral dentate nuclei, a part of which was enhanced with gadolinium. Soon, she developed optic neuritis. Other lesions in the central nervous system and anti-AQP4 antibody staining using cell-based assays were not detectable. During the treatment with interferon beta-1a, re-examination of the anti-AQP4 antibody staining led to a positive result; however, this was detectable by an enzyme-linked immunosorbent assay. The latent development of an intractable hiccup and a postrema lesion fulfilled the latest diagnostic criteria of neuromyelitis optica spectrum disorder, even if the patient did not have anti-AQP4 antibodies. Conclusions Anti-AQP4 antibodies detected only by enzyme-linked immunosorbent assay might be a false positive result. However, alteration in the immune balance between T-helper cell type 1 and T-helper cell type 2 were suspected during the treatment with interferon beta-1a.

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Section: Discussioncontrasting

confidence: 69%

Mysterious presentation of autoantibody in a neuromyelitis optica spectrum disorder patient

Sugawara

Sanpei

2019

Clinical & Exp Neuroim

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“…Provided the two events are pathophysiologically linked, vaccination could either have newly induced the disease (e.g., due to molecular mimicry/epitope spreading or inflammation-related demasking/release of MOG epitopes) or, alternatively, acted as an unspecific trigger causing clinical exacerbation of pre-existing subclinical MOG-EM. The latter notion is at least conceivable when one considers that other antibodies, such as AQP4-IgG in NMOSD [ 17 , 27 , 33 , 37 ], have been retrospectively found in stored serum samples obtained months to many years prior to clinical disease onset. Finally, a temporal coincidence of the two events also cannot be excluded given the currently high vaccination numbers worldwide.…”

Section: Discussionmentioning

confidence: 99%

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

et al. 2022

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Background In around 20% of cases, myelin oligodendrocyte glycoprotein (MOG) immunoglobulin (IgG)-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) first occurs in a postinfectious or postvaccinal setting. Objective To report a case of MOG-EM with onset after vaccination with the Pfizer BioNTech COVID-19 mRNA vaccine BNT162b2 (Comirnaty®) and to provide a comprehensive review of the epidemiological, clinical, radiological, electrophysiological and laboratory features as well as treatment outcomes of all published patients with SARS-CoV-2 vaccination-associated new-onset MOG-EM. Methods Case report and review of the literature. Results In our patient, MOG-IgG-positive (serum 1:1000, mainly IgG1 and IgG2; CSF 1:2; MOG-specific antibody index < 4) unilateral optic neuritis (ON) occurred 10 days after booster vaccination with BNT162b2, which had been preceded by two immunizations with the vector-based Oxford AstraZeneca vaccine ChAdOx1-S/ChAdOx1-nCoV-19 (AZD1222). High-dose steroid treatment with oral tapering resulted in complete recovery. Overall, 20 cases of SARS-CoV2 vaccination-associated MOG-EM were analysed (median age at onset 43.5 years, range 28–68; female to male ratio = 1:1.2). All cases occurred in adults and almost all after immunization with ChAdOx1-S/ChAdOx1 nCoV-19 (median interval 13 days, range 7–32), mostly after the first dose. In 70% of patients, more than one CNS region (spinal cord, brainstem, supratentorial brain, optic nerve) was affected at onset, in contrast to a much lower rate in conventional MOG-EM in adults, in which isolated ON is predominant at onset and ADEM-like phenotypes are rare. The cerebrospinal fluid white cell count (WCC) exceeded 100 cells/μl in 5/14 (36%) patients with available data (median peak WCC 58 cells/μl in those with pleocytosis; range 6–720). Severe disease with tetraparesis, paraplegia, functional blindness, brainstem involvement and/or bladder/bowel dysfunction and a high lesion load was common, and treatment escalation with plasma exchange (N = 9) and/or prolonged IVMP therapy was required in 50% of cases. Complete or partial recovery was achieved in the majority of patients, but residual symptoms were significant in some. MOG-IgG remained detectable in 7/7 cases after 3 or 6 months. Conclusions MOG-EM with postvaccinal onset was mostly observed after vaccination with ChAdOx1-S/ChAdOx1 nCoV-19. Attack severity was often high at onset. Escalation of immunotherapy was frequently required. MOG-IgG persisted in the long term.

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“…In most patients with NMO and MG, MG preceded NMO . In seven patients with this rare combination of autoimmune disorders, serum samples taken for AChR testing prior to the onset of NMO were available for retrospective NMO‐IgG/AQP4‐Ab serology . Interestingly, NMO‐IgG/AQP4‐Ab was present in six out of seven of these patients, at 3–14 years before the first clinically apparent attack of NMO.…”

Section: Special Issuesmentioning

confidence: 99%

Aquaporin‐4 Antibodies (NMO‐IgG) as a Serological Marker of Neuromyelitis Optica: A Critical Review of the Literature

2013

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Antibodies to aquaporin-4 (called NMO-IgG or AQP4-Ab) constitute a sensitive and highly specific serum marker of neuromyelitis optica (NMO) that can facilitate the differential diagnosis of NMO and classic multiple sclerosis. NMO-IgG/AQP4-Ab seropositive status has also important prognostic and therapeutic implications in patients with isolated longitudinally extensive myelitis (LETM) or optic neuritis (ON). In this article, we comprehensively review and critically appraise the existing literature on NMO-IgG/AQP4-Ab testing. All available immunoassays-including tissue-based (IHC), cell-based (ICC, FACS) and protein-based (RIPA, FIPA, ELISA, Western blotting) assays-and their differential advantages and disadvantages are discussed. Estimates for sensitivity, specificity, and positive and negative likelihood ratios are calculated for all published studies and accuracies of the various immunoassay techniques compared. Subgroup analyses are provided for NMO, LETM and ON, for relapsing vs. monophasic disease, and for various control groups (eg, MS vs. other controls). Numerous aspects of NMO-IgG/AQP4-Ab testing relevant for clinicians (eg, impact of antibody titers and longitudinal testing, indications for repeat testing, relevance of CSF testing and subclass analysis, NMO-IgG/AQP4-Ab in patients with rheumatic diseases) as well as technical aspects (eg, AQP4-M1 vs. AQP4-M23-based assays, intact AQP4 vs. peptide substrates, effect of storage conditions and freeze/thaw cycles) and pitfalls are discussed. Finally, recommendations for the clinical application of NMO-IgG/ AQP4-Ab serology are given.

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Seroconversion of anti-aquaporin-4 antibody in NMO spectrum disorder: a case report

Cited by 6 publications

References 8 publications

Mysterious presentation of autoantibody in a neuromyelitis optica spectrum disorder patient

Mysterious presentation of autoantibody in a neuromyelitis optica spectrum disorder patient

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature

Aquaporin‐4 Antibodies (NMO‐IgG) as a Serological Marker of Neuromyelitis Optica: A Critical Review of the Literature

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