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Miao Y, Shi Z, Zhang W, Zhu L, Tang S, Chen H, Wang X, Du Q, Li S, Zhang Y, Luo W, Jin X, Fang M, Zhou H. Immune Repertoire Profiling Reveals Its Clinical Application Potential and Triggers for Neuromyelitis Optica Spectrum Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200134. [PMID: 37414573 DOI: 10.1212/nxi.0000000000200134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorders (NMOSD) is widely recognized as a CNS demyelinating disease associated with AQP4-IgG (T cell-dependent antibody), and its trigger is still unclear. In addition, although the treatment of NMOSD currently can rely on traditional immunosuppressive and modulating agents, effective methods to predict the efficacy of these therapeutics are lacking. METHODS In this study, high-throughput T-cell receptor (TCR) sequencing was performed on peripheral blood from 151 pretreatment patients with AQP4-IgG+ NMOSD and 151 healthy individuals. We compared the TCR repertoire of those with NMOSD with that of healthy individuals and identified TCR clones that were significantly enriched in NMOSD. In addition, we treated 28 patients with AQP4-IgG+ NMOSD with immunosuppressants and followed up for 6 months to compare changes in NMOSD-specific TCRs (NMOSD-TCRs) before and after treatment. Moreover, we analyzed transcriptome and single-cell B-cell receptor (BCR) data from public databases and performed T-cell activation experiments using antigenic epitopes of cytomegalovirus (CMV) to further explore the triggers of AQP4-IgG+ NMOSD. RESULTS Compared with healthy controls, patients with AQP4-IgG+ NMOSD had significantly reduced diversity and shorter CDR3 length of TCRβ repertoire. Furthermore, we identified 597 NMOSD-TCRs with a high sequence similarity that have the potential to be used in the diagnosis and prognosis of NMOSD. The characterization of NMOSD-TCRs and pathology-associated clonotype annotation indicated that the occurrence of AQP4-IgG+ NMOSD may be associated with CMV infection, which was further corroborated by transcriptome and single-cell BCR analysis results from public databases and T-cell activation experiments. DISCUSSION Our findings suggest that the occurrence of AQP4-IgG+ NMOSD may be associated with CMV infection. In conclusion, our study provides new clues to uncover the causative factors of AQP4-IgG+ NMOSD and provides a theoretical foundation for treating and monitoring the disease.
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Affiliation(s)
- Yu Miao
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Ziyan Shi
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Wei Zhang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Lin Zhu
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Shanshan Tang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Hongxi Chen
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Xiaofei Wang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Qin Du
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Shuaicheng Li
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Ying Zhang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Wenqin Luo
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Xin Jin
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Mingyan Fang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Hongyu Zhou
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
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Chen P, Wu M, Wang N, Xia F, Du F, Liu Z, Wang J, Jin J, Jin B, Zhao G, Chen L, Yi J, Fang L. Expression of CD226 is upregulated on Tr1 cells from neuromyelitis optica spectrum disorder patients. Brain Behav 2022; 12:e2623. [PMID: 35587519 PMCID: PMC9226801 DOI: 10.1002/brb3.2623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/24/2022] [Accepted: 04/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a central and acute demyelinating disease of the central nervous system with unusual clinical course. The development of novel biomarkers for NMOSD is critical for implementing effective clinical treatment. CD226 is known to be expressed on many types of peripheral lymphoid cells. However, the expression level and function of CD226 on type 1 T regulatory (Tr1) cells during NMOSD is unknown. METHODS Eighteen patients with NMOSD and 10 healthy volunteers were enrolled in the test group to probe the difference of CD226 expression on Tr1 cells using flow cytometric analysis. RESULTS The expression of CD226 on Tr1 cells exhibited significantly increased tendency in NMOSD patients. Additionally, methylprednisolone and rituximab treatment decreased the expression of CD226 on Tr1 cells. Furthermore, the expression of CD226 on Tr1 cells was correlated with disease severity. CONCLUSION This study provides a new basic insight into CD226 expression pattern on Tr1 cells, which have great potential to be biomarkers for monitoring the development and treatment of NMOSD.
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Affiliation(s)
- Ping Chen
- Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China.,Department of Immunology, Medical College of Yan'an University, Yan'an, China.,Department of Immunology, the Fourth Military Medical University, Xi'an, China
| | - Mingmei Wu
- Department of Neurobiology, the Fourth Military Medical University, Xi'an, China
| | - Ning Wang
- Department of Immunology, the Fourth Military Medical University, Xi'an, China
| | - Feng Xia
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Fang Du
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Zhirong Liu
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Jinchun Wang
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Jingyi Jin
- Department of Immunology, the Fourth Military Medical University, Xi'an, China
| | - Boquan Jin
- Department of Immunology, the Fourth Military Medical University, Xi'an, China
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Lihua Chen
- Department of Immunology, the Fourth Military Medical University, Xi'an, China
| | - Jing Yi
- Department of Transfusion Medicine, Xijing Hospital, the Fourth Military Medical University, Xi'an, China
| | - Liang Fang
- Department of Immunology, the Fourth Military Medical University, Xi'an, China
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Lee HL, Kim SH, Seok JM, Kim BJ, Kim HJ, Kim BJ. Results of a Survey on Diagnostic Procedures and Treatment Choices for Neuromyelitis Optica Spectrum Disorder in Korea: Beyond the Context of Current Clinical Guidelines. J Clin Neurol 2022; 18:207-213. [PMID: 35274837 PMCID: PMC8926765 DOI: 10.3988/jcn.2022.18.2.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease of the central nervous system (CNS). We investigated the medical behaviors of experts in Korea when they are diagnosing and treating NMOSD. Methods An anonymous questionnaire on the diagnosis and treatment of NMOSD was distributed to experts in CNS demyelinating diseases. Results Most respondents used the 2015 diagnostic criteria for NMOSD and applied a cerebrospinal fluid examination, magnetic resonance imaging (MRI) of the brain and spine, and anti-aquaporin-4 antibody testing to all suspected cases of NMOSD. All respondents prescribed steroid pulse therapy as an first-line therapy in the acute phase of NMOSD, and 67% prescribed azathioprine for maintenance therapy in NMOSD. However, details regarding monitoring, the tapering period of oral steroids, second-line therapy use in refractory cases, management during pregnancy, and schedule of follow-up MRI differed according to the circumstances of individual patients. We analyzed the differences in response rates between two groups of respondents according to the annual number of NMOSD patients that they treated. The group that had been treating ≥10 NMOSD patients annually preferred rituximab more often as the second-line therapy (p=0.011) and had more experience with rituximab treatment (p=0.015) compared with the group that had been treating <10 NMOSD patients. Conclusions This study has revealed that NMOSD experts in Korea principally follow the available treatment guidelines. However, the differences in specific clinical practices applied to uncertain cases that have been revealed will need to be investigated further in order to formulate suitable recommendations.
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Affiliation(s)
- Hye Lim Lee
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, College of Medicine, Cheonan, Korea
| | - Byung Jo Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Korea
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Wu Q, Yang B, Wang J. Association of Circulating T Follicular Helper Cells With Idiopathic Optic Neuritis and Neuromyelitis Optica Spectrum Disorders. Front Neurol 2021; 12:638473. [PMID: 34630268 PMCID: PMC8493933 DOI: 10.3389/fneur.2021.638473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background: T follicular helper cells (Tfh cells) play an important role in activating B lymphocytes and may associate with idiopathic Optic Neuritis (ON) and Neuromyelitis Optica Spectrum Disorders (NMOSD). Objective: This study aimed to examine the potential role of Tfh cells in pathogenesis of idiopathic ON and NMOSD. Methods: Circulating CD4+CXCR5+ and CD4+CXCR5+PD-1+ cells in 46 idiopathic ON and 68 NMOSD patients as well as 28 healthy controls were examined by flow cytometry before treatment. Serum AQP4 antibody, Expended Disability Status Scale (EDSS) and Visual Outcome Scale (VOS) were detected before and after treatment. Results: The percentages of circulating CD4+CXCR5+ and CD4+CXCR5+PD-1+Tfh cells in CD4+ cells (%) were significantly increased in idiopathic ON and NMOSD compared with those of healthy controls (p < 0.01). No significant difference of Tfh cells in blood and cerebral spinal fluid (CSF) was found between ON and NMOSD patients. The percentages of CSF, CD4+, CXCR5+, and CD4+CXCR5+PD-1+ cells in CD4+ cells (%) were positively correlated with those of the blood (r = 0.5781, r = 0.6079, p = 0.0076, and p = 0.0045, respectively). EDSS scores of NMOSD group were higher than those of ON group and the time course of NMOSD patients was longer than that of ON patients (p < 0.01). After methylprednisolone treatment, both EDSS and VOS scores were significantly decreased at discharge compared with before treatment (p < 0.01). There was no significant correlation among Tfh cell percentages in CD4+ cells, CSF leukocytes, CSF protein, annual recurrence rate, EDSS and VOS scores between two groups (p > 0.05). Conclusion: The Circulating T follicular helper cells were increased in both idiopathic ON and NMOSD.
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Affiliation(s)
- Qian Wu
- Department of Neurology, Tong Ren Hospital of Capital Medical University, Beijing, China
| | - Binbin Yang
- Department of Neurology, Tong Ren Hospital of Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Tong Ren Hospital of Capital Medical University, Beijing, China
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Zhang L, Tian J, Dong X, Jia Z, Sun Y, Guo L, Tan G, Li B. Efficacy of azathioprine, mycophenolate mofetil, and rituximab in the treatment of neuromyelitis optica spectrum disorder and analysis of prognostic factors. Neurol Sci 2021; 43:2651-2658. [PMID: 34585292 DOI: 10.1007/s10072-021-05609-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aims to compare the efficacies of the immunosuppressants most commonly prescribed for patients with neuromyelitis optica spectrum disorder (NMOSD). The predictors, which might be associated with relapse and disability in NMOSD, were also analyzed. METHODS This retrospective study included NMOSD patients treated with azathioprine (AZA), mycophenolate mofetil (MMF), and rituximab (RTX). The annual relapse rate (ARR) and the incidence rates of adverse events were compared. Cox proportional-hazards model calculated the potential predictors of NMOSD relapse and disability. RESULTS A total of 83 patients were included. The median treatment time of AZA group (n = 34), MMF group (n = 20), and RTX group (n = 29) were 19.5, 15.5, and 12 months, respectively. ARR of the three groups reduced significantly after treatment. In the three groups, 55.9%, 50%, and 79.3% of patients, respectively, were free from relapse. However, the difference among the three groups was of no statistical significance, possibly due to the small sample size. During the treatment, 32.4%, 15%, and 24.1% of patients experienced adverse events in the AZA group, MMF group, and RTX group, respectively. Additionally, the multivariate Cox analyses indicated that history of a severe attack and disease duration were associated with the risk of relapse after immunotherapy. Late-onset (≥ 50 years old) NMOSD patients were probably more susceptible to motor disability, and those with optic neuritis at onset were more likely to develop visual disability. CONCLUSIONS AZA, MMF, and low-dose RTX were all effective in reducing the relapse rate in NMOSD. The age at onset, disease duration, history of severe attacks, and primary syndromes might be significant prognostic predictors in NMOSD.
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Affiliation(s)
- Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Jingyuan Tian
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Xiuyu Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Yafei Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Guojun Tan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China. .,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China.
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China. .,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China.
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Hsu JL, Liao MF, Chang KH, Cheng MY, Ro LS. Correlations among disability, anti-AQP4 antibody status and prognosis in the spinal cord involved patients with NMOSD. BMC Neurol 2021; 21:153. [PMID: 33836682 PMCID: PMC8033738 DOI: 10.1186/s12883-021-02171-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare neuroinflammatory disorder of the central nervous system that typically involves the optic nerve, the spinal cord and other specific brain regions. In relapse of the disease, factors associated with clinical features and lesion severity are important for clinicians to predict disease-related disability. Methods We retrospectively analyzed 22 female patients with NMOSD who had spinal cord lesions. Detailed clinical features, onset symptoms, motor disability, relapse episodes, serum aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) autoantibodies and MRI characteristics were documented to correlate their associations with the nadir and three-month Expanded Disability Status Scale (EDSS) scores. Patients with three-month EDSS scores below four (< 4) were categorized as the good outcome group, while those with scores of four or more (> 4) were categorized as the poor outcome group. Results In patients with NMOSD, the mean age was 44.5 ± 12.8 years, and the mean three-month EDSS score was 4.3 ± 1.9. A significantly higher all-limb muscle power score was found in the good EDSS group than in the poor EDSS group (p = 0.01). A tendency toward longer follow-up periods and lower anti-AQP4 antibody levels was found in the good outcome group. Serum anti-AQP4 antibodies were present in 86% of patients with NMOSD, and MOG autoantibodies were found in one anti-AQP4 antibody-negative patient (33.3%). In patients with NMOSD, more than 40% of spinal cord lesions were distributed at the middle cervical and upper thoracic levels. Conclusions Our findings suggest that EDSS scores and MRC scores at the nadir had significant associations with three-month EDSS scores. The topographic distributions of the spinal cord lesions might relate to different serum anti-AQP4 antibody status. However, further studies will be needed to corroborate this finding.
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Affiliation(s)
- Jung Lung Hsu
- Department of Neurology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.,Graduate Institute of Mind, Brain, & Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain & Consciousness Research Center, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Ming-Feng Liao
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.,Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Linkou, Taoyuan, Taiwan.
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Gastaldi M, Zardini E, Scaranzin S, Uccelli A, Andreetta F, Baggi F, Franciotta D. Autoantibody Diagnostics in Neuroimmunology: Experience From the 2018 Italian Neuroimmunology Association External Quality Assessment Program. Front Neurol 2020; 10:1385. [PMID: 32010046 PMCID: PMC6971200 DOI: 10.3389/fneur.2019.01385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Neuroimmunology has impressively expanded in the past decade. Novel assays, especially cell-based assays (CBAs) can detect conformational antibodies (Abs) recognizing antigens in their native conformation. Generally, the availability of in-house and of commercial tests has improved the diagnostics, but introduced demanding laboratory tasks. Hence, standardization and quality controls represent a key step to promote accuracy. We report on the results of the 2018 external quality assessment program (EQAP) organized by the Italian Neuroimmunology Association. Methods: EQAP regarded 10 schemes, including oligoclonal bands (OCBs), intracellular-neuronal (ICN)-Abs, neuronal-surface (NS)-Abs, aquaporin-4 (AQP4)-Abs, myelin oligodendrocyte glycoprotein (MOG)-Abs, myelin-associated glycoprotein (MAG)-Abs, ganglioside-Abs, acetylcholine-receptor (AChR)-Abs, and muscle-specific-kinase (MuSK)-Abs, and 34 laboratories. Assays were classified as tissue-based assays (TBAs), solid-phase assays (SPAs), liquid-phase assays (LPAs), and CBAs. Thirty-three samples were provided. Results: Three-quarter of the tests were commercial. Median accuracy for the laboratories was 75% (range 50–100). In 8/10 schemes, at least one sample provided discrepant results. Inter-laboratory “substantial agreement” was found in 6/10 schemes (AChR, MuSK, MAG, AQP4, MOG, and NS-Abs), whereas the worst agreements regarded OCBs and ganglioside-Abs. Both commercial and in-house assays performed better in experienced laboratories. Conclusions: Assays could be divided in (a) robust commercial tests with substantial inter-laboratory agreement (MAG-Abs; AChR- and MuSK-Abs); commercial/“in-house” tests with (b) partial inter-laboratory agreement (AQP4-Abs, MOG-Abs, NS-Abs, ICN-Abs), and (c) with large inter-laboratory disagreement (OCBs, ganglioside-Abs). This real-life snapshot of the neuroimmunology test performances highlights shortcomings attributable to technician-dependent performances, assay structural limitations, and errors in test interpretations.
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Affiliation(s)
- Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisabetta Zardini
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesca Andreetta
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fulvio Baggi
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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de Souza Moraes A, Brum DG, Ierich JCM, Higa AM, Assis ASJ, Miyazaki CM, Shimizu FM, Peroni LA, Machini MT, Barreira AA, Ferreira M, Oliveira ON, Leite FL. A highly specific and sensitive nanoimmunosensor for the diagnosis of neuromyelitis optica spectrum disorders. Sci Rep 2019; 9:16136. [PMID: 31695085 PMCID: PMC6834626 DOI: 10.1038/s41598-019-52506-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 11/09/2022] Open
Abstract
A precise diagnosis for neuromyelitis optica spectrum disorders (NMOSD) is crucial to improve patients' prognostic, which requires highly specific and sensitive tests. The cell-based assay with a sensitivity of 76% and specificity of 100% is the most recommended test to detect anti-aquaporin-4 antibodies (AQP4-Ab). Here, we tested four AQP4 external loop peptides (AQP461-70, AQP4131-140, AQP4141-150, and AQP4201-210) with an atomic force microscopy nanoimmunosensor to develop a diagnostic assay. We obtained the highest reactivity with AQP461-70-nanoimunosensor. This assay was effective in detecting AQP4-Ab in sera of NMOSD patients with 100% specificity (95% CI 63.06-100), determined by the cut-off adhesion force value of 241.3 pN. NMOSD patients were successfully discriminated from a set of healthy volunteers, patients with multiple sclerosis, and AQP4-Ab-negative patients. AQP461-70 sensitivity was 81.25% (95% CI 56.50-99.43), slightly higher than with the CBA method. The results with the AQP461-70-nanoimmunosensor indicate that the differences between NMOSD seropositive and seronegative phenotypes are related to disease-specific epitopes. The absence of AQP4-Ab in sera of NMOSD AQP4-Ab-negative patients may be interpreted by assuming the existence of another potential AQP4 peptide sequence or non-AQP4 antigens as the antibody target.
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Affiliation(s)
- Ariana de Souza Moraes
- Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, São Paulo, 05403000, Brazil.,Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.,Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Doralina Guimarães Brum
- Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.,Department of Neurology, Psychology and Psychiatry, São Paulo State University, Botucatu, São Paulo, 18618687, Brazil
| | - Jéssica Cristiane Magalhães Ierich
- Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, São Paulo, 05403000, Brazil.,Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.,Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Akemi Martins Higa
- Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, São Paulo, 05403000, Brazil.,Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.,Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Amanda Stefanie Jabur Assis
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.,Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Celina Massumi Miyazaki
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Flávio Makoto Shimizu
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, 13560970, Brazil
| | - Luís Antonio Peroni
- Rheabiotech Laboratory of Research and Development, Campinas, São Paulo, 13084791, Brazil
| | - M Teresa Machini
- Department of Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, 05508000, Brazil
| | - Amilton Antunes Barreira
- Department of Neurosciences and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marystela Ferreira
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil
| | - Osvaldo N Oliveira
- São Carlos Institute of Physics, University of São Paulo, São Carlos, São Paulo, 13560970, Brazil
| | - Fabio Lima Leite
- Department of Physics, Chemistry and Mathematics, Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil. .,Nanoneurobiophysics research group (GNN), Federal University of São Carlos, Sorocaba, São Paulo, 18052780, Brazil.
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Chang VTW, Chang HM. Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder. Neuropathol Appl Neurobiol 2019; 46:199-218. [PMID: 31353503 DOI: 10.1111/nan.12574] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica is an autoimmune inflammatory disorder of the central nervous system that preferentially targets the spinal cord and optic nerve. Following the discovery of circulating antibodies against the astrocytic aquaporin 4 (AQP4) water channel protein, recent studies have expanded our knowledge of the unique complexities of the pathogenesis of neuromyelitis optica and its relationship with the immune response. This review describes and summarizes the recent advances in our understanding of the molecular mechanisms underlying neuromyelitis optica disease pathology and examines their potential as therapeutic targets. Additionally, we update the most recent research by proposing major unanswered questions regarding how peripheral AQP4 antibodies are produced and their entry into the central nervous system, the causes of AQP4-IgG-seronegative disease, why peripheral AQP4-expressing organs are spared from damage, and the impact of this disease on pregnancy.
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Affiliation(s)
- V T W Chang
- St George's, University of London, London, UK
| | - H-M Chang
- Department of Obstetrics and Gynaecology, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Tampoia M, Abbracciavento L, Barberio G, Fabris M, Bizzaro N. A new M23-based ELISA assay for anti-aquaporin 4 autoantibodies: diagnostic accuracy and clinical correlation. AUTOIMMUNITY HIGHLIGHTS 2019; 10:5. [PMID: 32257061 PMCID: PMC7065340 DOI: 10.1186/s13317-019-0115-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/30/2019] [Indexed: 01/05/2023]
Abstract
Purpose Although many assays have been developed to detect anti-aquaporin-4 (AQP4) antibodies, most of these assays require sophisticated techniques and are thus only available at specialized laboratories. The aim of this study was to evaluate the analytical and clinical performance of a new commercial enzyme-linked immunosorbent assay (ELISA RSR, AQP4 Ab Version 2) to detect anti-AQP4 antibodies performed on a fully automated system (SkyLAB 752). Methods Serum samples from 64 patients with neuromyelitis optica spectrum disorders (NMOSD) (including NMO, longitudinally extensive myelitis-LETM, optical neuritis and myelitis) and 27 controls were tested for anti-AQP4 antibodies. All sera were previously tested using an indirect immunofluorescence (IIF) method on primate tissue, as the reference method. Commercial control sera were used to determine within-run, between-day and within-laboratory precision (CLSI guidelines). Results At a cut-off value of 2.1 U/mL as determined by ROC curves, sensitivity and specificity for NMO were 83.3% and 100%, respectively. The ELISA assay provided 100% concordant results with the reference IIF method. The median concentration of anti-AQP4 antibodies was statistically higher in patients with NMO than in patients with LETM (p = 0.0006) or with other NMOSD and in controls (p < 0.0001). At the concentration of 12.4 and 28.1 U/mL, the within-run, between-day and within-laboratory coefficients of variation (CV) were 3.2% and 3%, 7.6% and 7.4%, and 8.2% and 8.0%, respectively. Conclusions This new ELISA method performed on a fully automated system, showed high sensitivity and absolute specificity, good CV in precision tests, and provided observer-independent quantitative results.
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Affiliation(s)
- Marilina Tampoia
- 1Clinical Pathology Laboratory, Polyclinic of Bari, Department of Biomedical Sciences and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Letizia Abbracciavento
- 1Clinical Pathology Laboratory, Polyclinic of Bari, Department of Biomedical Sciences and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Barberio
- 2Laboratory Medicine, Department of Clinical Pathology, Treviso Hospital, Treviso, Italy
| | - Martina Fabris
- 3Laboratory of Immunopathology and Allergology, University Hospital Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Nicola Bizzaro
- 4Laboratory of Clinical Pathology, San Antonio Hospital, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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Management of antibody-mediated autoimmune encephalitis in adults and children: literature review and consensus-based practical recommendations. Neurol Sci 2019; 40:2017-2030. [PMID: 31161339 DOI: 10.1007/s10072-019-03930-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/09/2019] [Indexed: 12/24/2022]
Abstract
Autoimmune encephalitis associated with antibodies against neuronal surface targets (NSAE) are rare but still underrecognized conditions that affect adult and pediatric patients. Clinical guidelines have recently been published with the aim of providing diagnostic clues regardless of antibody status. These syndromes are potentially treatable but the choice of treatment and its timing, as well as differential diagnoses, long-term management, and clinical and paraclinical follow-up, remain major challenges. In the absence of evidence-based guidelines, management of these conditions is commonly based on single-center expertise.Taking into account different published expert recommendations in addition to the multicenter experience of the Italian Working Group on Autoimmune Encephalitis, both widely accepted and critical aspects of diagnosis, management and particularly of immunotherapy for NSAE have been reviewed and are discussed.Finally, we provide consensus-based practical advice for managing hospitalization and follow-up of patients with NSAE.
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Marcinnò A, Marnetto F, Valentino P, Martire S, Balbo A, Drago A, Leto M, Capobianco M, Panzica G, Bertolotto A. Rituximab-induced hypogammaglobulinemia in patients with neuromyelitis optica spectrum disorders. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e498. [PMID: 30258855 PMCID: PMC6148550 DOI: 10.1212/nxi.0000000000000498] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/20/2018] [Indexed: 01/07/2023]
Abstract
Objective To evaluate the long-term effects of rituximab (RTX) on total and specific immunoglobulins (Igs) in patients with neuromyelitis optica spectrum disorders (NMOSDs). Methods Total IgG, IgA, and IgM levels were evaluated in 15 patients with NMOSDs treated with RTX (median follow-up 70 months). Anti-aquaporin 4 (AQP4)-IgG titration was performed on samples from 9 positive patients. Anti-tetanus (TET), anti-varicella-zoster virus (VZV), and anti-Epstein–Barr virus nuclear antigen (EBNA) IgGs were also tested in patients with NMOSDs and in 6 healthy controls (HCs). Results RTX reduced total IgG by 0.42 g/L per year, IgA by 0.08 g/L per year, and IgM by 0.07 g/L per year. Hypogammaglobulinemia (hypo-IgG) (IgG < 7 g/L) developed in 11/15 patients. Severe hypo-IgG (IgG < 4 g/L) was found in 3/15 patients, of whom 2 patients developed serious infectious complications. In group analysis, anti-AQP4 IgG titers were reduced by RTX over time, and a significant correlation between anti-AQP4 IgG titers and total IgG levels was found. The effects of RTX were observed on pathogen-specific IgGs as well. In particular, the levels of anti-TET IgG in patients were significantly lower than those in HCs. The half-life of anti-TET IgG was reduced by about 50% in patients compared with the general population. Conclusions Long-term RTX treatment is associated with the risk of hypo-Ig and reduction of anti-TET protection in patients with NMOSDs. Results obtained in this study suggest the importance of monitoring total and specific Ig levels before and during treatment with anti-CD20 drugs to prevent hypo-Ig–related complications and to optimize clinical management.
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Affiliation(s)
- Andrea Marcinnò
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Fabiana Marnetto
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Paola Valentino
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Serena Martire
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Alessia Balbo
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Aurora Drago
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Maria Leto
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Marco Capobianco
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Giancarlo Panzica
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
| | - Antonio Bertolotto
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., G.P.), Orbassano, Turin, Italy; Neurologia-CRESM (A.M., P.V., S.M., A. Balbo, A. Bertolotto, F.M., M.C.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy; "Rita Levi Montalcini" Neuroscience Department (F.M., G.P.), University of Turin, TO, Italy; and Humanitas Hospital Gradenigo (A.D., M.L.), Turin, Italy
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