Quantitative analysis of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies titres: correlation with relapses.

IF 4.5 Q1 CLINICAL NEUROLOGY
Brain communications Pub Date : 2025-08-22 eCollection Date: 2025-01-01 DOI:10.1093/braincomms/fcaf312
Martina Nasello, Mark Woodhall, Huiru Xue, Victor Mgbachi, Ruth Geraldes, Maria Isabel Leite, Patrick Waters, Jacqueline Palace
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引用次数: 0

Abstract

Detection of antibodies against aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) is essential for diagnosis of AQP4-IgG+ neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Uncertainties persist regarding the clinical significance of serum antibody titres to predict relapses. We aimed to analyse the trend of serum AQP4-IgG and myelin oligodendrocyte glycoprotein antibody-IgG titres during relapses and periods of clinical stability. In this retrospective study we analysed serum AQP4-IgG and myelin oligodendrocyte glycoprotein antibody -IgG titres from live cell-based assays from the Oxford Autoimmune Neurology Diagnostic Laboratory for the UK specialist NMO Service between February 2010 and June 2024. We recruited seropositive AQP4-neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease patients with serum samples available within 30 days of an attack ('attack') and at least one another sample for comparison within 1 year ('pre-attack' and 'post-attack'). Up to 3 further serum samples were selected within 2, 3 or 4 years after the attack. 117 attacks in 92 AQP4-IgG+ patients (81.5% female) and 127 attacks in 111 myelin oligodendrocyte glycoprotein antibody-IgG+ patients (62.2% female) had appropriate samples. Antibody titres significantly increased from 'pre-attack' to 'attack', decreased from 'attack' to 'post-attack', and remained stable from 2 to 4 years after attacks. Long-term immunosuppressant treatments induced a further decrease in titres during remission in both cohorts. In 40% of samples in both groups there was an increase in titre at relapse. A ≥ 2-fold increase in AQP4-IgG titres had an Odds Ratio (OR) of 6.59% and 91.5% specificity of being associated with a relapse, in myelin oligodendrocyte glycoprotein antibody-IgG+ an OR of 4.87% and 88.6% specificity. 29% (26/92) AQP4-IgG+ patients became 'seronegative' during follow: most patients (64%) had low attack titres (≤100), and the time to seroreversion related the attack titre. In contrast, 41% (46/111) myelin oligodendrocyte glycoprotein antibody-IgG+ patients became 'seronegative', mostly within the first year after the attack regardless of attack titre. In conclusion, in 60% of longitudinal serum samples from patients with AQP4-IgG or myelin oligodendrocyte glycoprotein antibody-IgG there is no increase in antibody titre. When there is an increase, it is most often at relapse. A ≥ 2-fold increase in titres should be a risk particularly in case of treatment de-escalation, non-adherence to treatment or if a pseudo-relapse is suspected.

定量分析水通道蛋白-4 (AQP4)和髓鞘少突胶质细胞糖蛋白(MOG)抗体滴度:与复发的相关性。
检测水通道蛋白-4 (AQP4-IgG)和髓鞘少突胶质细胞糖蛋白(MOG-IgG)抗体是诊断AQP4-IgG+视神经脊髓炎谱系障碍和髓鞘少突胶质细胞糖蛋白抗体相关疾病的必要条件。血清抗体滴度预测复发的临床意义仍不确定。我们的目的是分析血清AQP4-IgG和髓鞘少突胶质细胞糖蛋白抗体igg滴度在复发和临床稳定期间的变化趋势。在这项回顾性研究中,我们分析了2010年2月至2024年6月期间牛津自身免疫神经学诊断实验室为英国专家NMO服务提供的基于活细胞的血清AQP4-IgG和髓鞘少突胶质细胞糖蛋白抗体igg滴度。我们招募了血清阳性的aqp4 -视神经脊髓炎频谱障碍和髓鞘少突胶质细胞糖蛋白抗体相关疾病患者,这些患者在发作(“发作”)后30天内提供血清样本,并在1年内(“发作前”和“发作后”)至少提供另一个样本进行比较。在发病后2、3或4年内再抽取3份血清样本。92例AQP4-IgG阳性患者中有117例(女性占81.5%),111例髓鞘少突胶质细胞糖蛋白抗体- igg阳性患者中有127例(女性占62.2%)有合适的样本。抗体滴度从“发作前”到“发作”显著增加,从“发作”到“发作后”显著下降,并在发作后2至4年保持稳定。在两个队列中,长期免疫抑制剂治疗导致缓解期间滴度进一步下降。两组中40%的样本在复发时滴度增加。AQP4-IgG滴度升高≥2倍与复发相关的比值比(OR)为6.59%,特异性为91.5%;髓鞘少突胶质细胞糖蛋白抗体- igg +与复发相关的比值比为4.87%,特异性为88.6%。随访期间,29% (26/92)AQP4-IgG阳性患者血清呈阴性,多数患者(64%)发作滴度较低(≤100),血清逆转时间与发作滴度相关。相比之下,41%(46/111)髓鞘少突胶质细胞糖蛋白抗体igg阳性的患者变为“血清阴性”,大多数在发作后的一年内,无论发作滴度如何。综上所述,在60%的AQP4-IgG或髓鞘少突胶质细胞糖蛋白抗体- igg患者的纵向血清样本中,抗体滴度没有增加。当有增加时,最常发生在复发时。特别是在治疗降级、不坚持治疗或怀疑假复发的情况下,滴度增加≥2倍应该是一种风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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