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Zhao R, Luo S, Zhao C. The role of innate immunity in myasthenia gravis. Autoimmun Rev 2021; 20:102800. [PMID: 33722749 DOI: 10.1016/j.autrev.2021.102800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022]
Abstract
Myasthenia gravis (MG) is a T cell-driven, B cell-mediated and autoantibody-dependent autoimmune disorder against neuromuscular junctions (NMJ). Accumulated evidence has emerged regarding the role of innate immunity in the pathogenesis of MG. In this review, we proposed two hypothesis underlying the pathological mechanism. In the context of gene predisposition, on the one hand, Toll-like receptors (TLRs) pathways were initiated by viral infection in the thymus with MG to generate chemokines and pro-inflammatory cytokines such as Type I interferon (IFN), which facilitate the thymus to function as a tertiary lymphoid organ (TLO). On the another hand, the antibodies against acetylcholine receptors (AChR) generated by thymus then activated the classical pathways on thymus and neuromuscular junction (NMJ). Futher, we also highlight the role of innate immune cells in the pathogenic response. Finally, we provide some future perspectives in developing new therapeutic approaches particularly targeting the innate immunity for MG.
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Affiliation(s)
- Rui Zhao
- Department of Neurology, Huashan hospital Fudan University, 200040 Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan hospital Fudan University, 200040 Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan hospital Fudan University, 200040 Shanghai, China.
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2
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Topuzova MP, Bisaga GN, Alekseeva TM, Isabekova PS, Сhaykovskaya AD, Panina EB, Pavlova TA, Ternovykh IK. [Transverse myelitis syndrom as a result of neuromyelitis optica spectrum disorders, systemic lupus erythematosus and myasthenia gravis combination]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:97-106. [PMID: 32844638 DOI: 10.17116/jnevro202012007297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) - autoimmune condition characterized by an inflammatory lesions mainly of the spinal cord with the development of longitudinally extensive transverse myelitis (LETM) and/or involvement of the optic nerve with the development of usually bilateral optical neuritis (ON). In recent years, there has been increased awareness that NMOSD can be combined with other autoimmune diseases, including myasthenia gravis (MG), systemic lupus erythematosus (SLE) et al. The simultaneous presence of several autoimmune diseases in one patient can adversely affect the course of each of the diseases, causing the so-called mutual burden or «overlap syndrome». In this article, we describe our own clinical observation of a 51-year-old woman of European origin who developed acute relapsing TM seropositive for AQP4-IgG, by 23 years after the diagnosis of generalized MG seropositive for antibodies to acetylcholine receptors (AChR-Ab) and the occurrence of SLE, criterially confirmed, several months after the initial TM attack. During the fourth TM attack, partial positive dynamics was achieved only against the background of the combined use of intravenous methylprednisolone (pulse therapy), high-volume plasma exchange, rituximab and cyclophosphamide. The NMOSD is a rare disease leading to severe disability. In patients with MG, when symptoms of damage to the central nervous system appear, an analysis should be performed for AQP4-IgG and possibly for antibodies to myelin glycoprotein of oligodendrocytes (MOG-Ab), as well as markers characteristic of systemic connective tissue diseases (SCTD). In patients with STDD, when symptoms of involvement nervous systemappear, testing for AQP4-IgG (and, if necessary, for MOG-Ab) should be performed to exclude NMOSD, as well as AChR-Ab (and, if necessary, antibodies against muscle specific kinase (MuSK-Ab)) to exclude MG.
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Affiliation(s)
- M P Topuzova
- Almazov National Medical Research Centre, St Petersburg, Russia
| | - G N Bisaga
- Almazov National Medical Research Centre, St Petersburg, Russia
| | - T M Alekseeva
- Almazov National Medical Research Centre, St Petersburg, Russia
| | - P Sh Isabekova
- Almazov National Medical Research Centre, St Petersburg, Russia
| | | | - E B Panina
- Almazov National Medical Research Centre, St Petersburg, Russia
| | - T A Pavlova
- Almazov National Medical Research Centre, St Petersburg, Russia
| | - I K Ternovykh
- Almazov National Medical Research Centre, St Petersburg, Russia
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Weng Y, Min Y, Sheng Z, Li J, Huang D. Myasthenia Gravis With Reversible Pyramidal Tract Damage and Pseudo Internuclear Ophthalmoplegia. A Case Report and Literature Review. Front Neurol 2019; 10:957. [PMID: 31551914 PMCID: PMC6746911 DOI: 10.3389/fneur.2019.00957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022] Open
Abstract
Myasthenia gravis (MG) is a rare and treatable antibody-mediated autoimmune disease. Pseudo internuclear ophthalmoplegia (-INO) or pyramidal tract damage is rarely observed in MG, and there were no known cases of MG with both pseudo-INO and pyramidal tract damage. Here, we report a case of a 61-year-old female suffering from MG accompanied by pseudo-INO and pyramidal tract damage with a rapid progressive course. Her blood and cerebrospinal fluid (CSF) tests were normal, except for the presence of the anti-acetylcholine receptor antibody. CT and contrast enhancement of the chest showed a thymic involution. MRI and contrast enhancement images of the brain and whole spine were normal. Both the clinical response to the administration of neostigmine and the repetitive nerve stimulation test were positive. The motor evoked potentials at lower limb recordings were normal. According to her signs, symptoms, decrementing response on repetitive stimulation test, elevated anti-acetylcholine receptor antibody and positive response to neostigmine, the patient was diagnosed as having MG. After treatment with pyridostigmine, intravenous immunoglobulin, prednisone acetate tablets and methotrexate, all her symptoms disappeared, including pseudo-INO and pyramidal tract damage. To our best knowledge, this is the first report of a case of MG with both pseudo-INO and pyramidal tract damage. Based on our case and a review of the literature, we propose that pyramidal tract damage and pseudo-INO can be two signs of MG, and that MG can cause damage to other systems besides neuromuscular junctions.
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Affiliation(s)
- Yinghong Weng
- Department of Neurology, Guangzhou Hospital of Traditional Chinese Medicine Affiliated With Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Traditional Chinese Medicine, Liuzhou People's Hospital, Liuzhou, China
| | - Yan Min
- Department of Traditional Chinese Medicine, Liuzhou People's Hospital, Liuzhou, China
| | - Zhenghe Sheng
- Department of Traditional Chinese Medicine, Liuzhou People's Hospital, Liuzhou, China
| | - Jia Li
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dehong Huang
- Department of Neurology, Guangzhou Hospital of Traditional Chinese Medicine Affiliated With Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Dehong Huang
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Kimura K, Okada Y, Fujii C, Komatsu K, Takahashi R, Matsumoto S, Kondo T. Clinical characteristics of autoimmune disorders in the central nervous system associated with myasthenia gravis. J Neurol 2019; 266:2743-2751. [PMID: 31342158 DOI: 10.1007/s00415-019-09461-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 01/06/2023]
Abstract
Myasthenia gravis (MG) is occasionally associated with autoimmune diseases in the central nervous system (CNS), such as neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), Morvan syndrome, and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Here, we report five original cases associated with autoimmune disorders in the CNS among 42 patients with MG in a single tertiary hospital in Japan (11.9%). In four of these five cases, the second disease developed when the preceding disease was unstable. Accurate diagnosis of the newly developing disease may be difficult in such cases, because some neurological symptoms can be seen in both disorders. This implies the great importance of recognizing the possible co-occurrence of MG and disorders in the CNS. In addition, a comprehensive review of the literature revealed distinct clinical characteristics depending on the associated disease in the CNS, including thymic pathology and temporal relationship between MG and associated CNS disorders. Notably, NMOSD usually develops after the onset of MG and thymectomy, in clear contrast to MS. Thymoma is highly prevalent among patients with Morvan syndrome, in contract to cases with NMOSD and MS. The analysis of clinical characteristics, representing the first such investigation to the best of our knowledge, suggests different pathogeneses of these autoimmune diseases in the CNS, and provides significant implications for clinical practice.
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Affiliation(s)
- Kimitoshi Kimura
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
- Department of Immunology, National Center of Neurology and Psychiatry, National Institute of Neuroscience, 4-1-1 Ogawahigashi, Kodaira, 187-8502, Tokyo, Japan
| | - Yoichiro Okada
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, 570-8507, Osaka, Japan
| | - Chihiro Fujii
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kenichi Komatsu
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sadayuki Matsumoto
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Takayuki Kondo
- Department of Neurology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, 530-8480, Japan.
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, 570-8507, Osaka, Japan.
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Shahmohammadi S, Doosti R, Shahmohammadi A, Mohammadianinejad SE, Sahraian MA, Azimi AR, Harirchian MH, Asgari N, Naser Moghadasi A. Autoimmune diseases associated with Neuromyelitis Optica Spectrum Disorders: A literature review. Mult Scler Relat Disord 2018; 27:350-363. [PMID: 30476871 DOI: 10.1016/j.msard.2018.11.008] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Neuromyelitis Optica (NMO) is an autoimmune inflammatory demyelinating disease of the central nervous system (CNS) which predominantly involves optic nerves and spinal cord. Since the introduction of Neuromyelitis Optica Spectrum Disorders (NMOSD) as a separate entity, there have been many reports on its association with other disorders including systemic and organ-specific autoimmune diseases. Here, we reviewed other immune-mediated diseases associated with NMOSD and tried to categorize them. METHODS The present review was conducted using the PUBMED database based on papers from 1976 (i.e., since the first NMO comorbidity with SLE was reported) to 2017. We included all articles published in English. The keywords utilized included Neuromyelitis optica, Neuromyelitis Optica Spectrum Disorders, Devic's disease, in combination with comorbidity or comorbidities. RESULTS Diseases with immune-based pathogenesis are the most frequently reported co-morbidities associated with NMOSD, most of which are antibody-mediated diseases. According to literature, Sjogren's Syndrome (SS) and Systemic Lupus Erythematosus (SLE) are the most frequently reported diseases associated with NMOSD among systemic autoimmune diseases. Further, myasthenia gravis in neurological and autoimmune thyroid diseases in non-neurological organ-specific autoimmune diseases are the most reported comorbidities associated with NMOSD in the literature. CONCLUSIONS NMOSD may be associated with a variety of different types of autoimmune diseases. Therefore, systemic or laboratory signs which are not typical for NMOSD should be properly investigated to exclude other associated comorbidities. These comorbidities may affect the treatment strategy and may improve the patients' care and management.
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Affiliation(s)
- Sareh Shahmohammadi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Doosti
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abootorab Shahmohammadi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian center for neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Asgari
- Owens-gruppen Næstved/Slagelse/Ringsted Sygehuse, Region Sjælland J.B. Winsløws Vej 9, indgang B, 1. Sal 5000, Odense C, Denmark
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Rosales D, Kister I. Common and Rare Manifestations of Neuromyelitis Optica Spectrum Disorder. Curr Allergy Asthma Rep 2017; 16:42. [PMID: 27167974 DOI: 10.1007/s11882-016-0619-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The discovery of a highly specific biomarker of neuromyelitis optica (NMO)-the anti-aquaporin-4 (AQP4) antibody-has opened new paths to understanding disease pathogenesis and afforded a way to confirm the diagnosis in clinical practice. An important consequence of the discovery is the broadening of the spectrum of syndromes seen in the context of AQP4 autoimmunity. These syndromes have been subsumed under the rubric of NMO spectrum disorder (NMOSD). The current classification recognizes not only optic neuritis and myelitis as core syndromes of NMOSD but also cerebral, diencephalic, brainstem, and area postrema syndromes. These neurologic syndromes are the focus of our review. AQP4 is also expressed in many organs outside of the central nervous system, and this may explain some of the unusual, non-neurologic features that have been occasionally reported in NMOSD. Our review catalogues non-neurologic manifestations seen in NMOSD and concludes with a discussion of frequently associated autoimmune and neoplastic comorbidities of NMOSD.
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Affiliation(s)
- Dominique Rosales
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA.
| | - Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA
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7
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Japanese cases of neuromyelitis optica spectrum disorder associated with myasthenia gravis and a review of the literature. Clin Neurol Neurosurg 2014; 125:217-21. [DOI: 10.1016/j.clineuro.2014.07.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 05/07/2014] [Accepted: 07/19/2014] [Indexed: 11/19/2022]
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Badaut J, Fukuda AM, Jullienne A, Petry KG. Aquaporin and brain diseases. BIOCHIMICA ET BIOPHYSICA ACTA 2014; 1840:1554-65. [PMID: 24513456 PMCID: PMC3960327 DOI: 10.1016/j.bbagen.2013.10.032] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/09/2013] [Accepted: 10/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of water channel proteins, aquaporins (AQPs), in the brain led to intense research in understanding the underlying roles of each of them under normal conditions and pathological conditions. SCOPE OF REVIEW In this review, we summarize some of the recent knowledge on the 3 main AQPs (AQP1, AQP4 and AQP9), with a special focus on AQP4, the most abundant AQP in the central nervous system. MAJOR CONCLUSIONS AQP4 was most studied in several brain pathological conditions ranging from acute brain injuries (stroke, traumatic brain injury) to the chronic brain disease with autoimmune neurodegenerative diseases. To date, no specific therapeutic agents have been developed to either inhibit or enhance water flux through these channels. However, experimental results strongly underline the importance of this topic for future investigation. Early inhibition of water channels may have positive effects in prevention of edema formation in brain injuries but at later time points during the course of a disease, AQP is critical for clearance of water from the brain into blood vessels. GENERAL SIGNIFICANCE Thus, AQPs, and in particular AQP4, have important roles both in the formation and resolution of edema after brain injury. The dual, complex function of these water channel proteins makes them an excellent therapeutic target. This article is part of a Special Issue entitled Aquaporins.
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Affiliation(s)
- Jérôme Badaut
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA; Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA; Univ Bordeaux, CNRS UMR 5287, 146 rue Leo Saignat33076 Bordeaux cedex.
| | - Andrew M Fukuda
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
| | - Amandine Jullienne
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
| | - Klaus G Petry
- INSERM U1049 Neuroinflammation, Imagerie et Thérapie de la Sclérose en Plaques, F-33076 Bordeaux, France
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Iyer A, Elsone L, Appleton R, Jacob A. A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica. Autoimmunity 2014; 47:154-61. [PMID: 24512514 DOI: 10.3109/08916934.2014.883501] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuromyelitis optica (NMO) is an immune-mediated neurological disorder characterised by recurrent episodes of optic neuritis and longitudinally extensive transverse myelitis. A serum biomarker, aquaporin-4 IgG, the autoantibody against aquaporin-4 water channel, has been specifically associated with NMO and has assisted early recognition and prediction of relapses. Less commonly, a monophasic course, associated with antibodies to myelin oligodendrocyte glycoprotein has been reported. Specific diagnostic criteria have been defined; however, some cases that do not fulfil these criteria (but are nevertheless associated with aquaporin-4 IgG) are classified as NMO spectrum disorder and follow the same relapsing course. An ever-growing list of autoimmune disorders, both organ-specific and non-organ-specific, have been associated in up to 20-30% of patients with NMO. These disorders, which may become symptomatic before or after the development of NMO, are often diagnosed long after the diagnosis of NMO, as symptoms may be wrongly attributed to NMO, its residual effects or medication side effects. In addition, autoantibodies can be found in patients with NMO without coexisting disease (up to 40% in some series) and maybe suggestive of a heightened humoral immune response. We present a comprehensive review of the current literature on autoimmune disorders co-existing with NMO and identified 22 autoimmune conditions (myasthenia gravis, coeliac disease, ulcerative colitis, sclerosing cholangitis, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid antibody syndrome, Sjogren's syndrome, autoimmune hypothyroidism, immune thrombocytopenic purpura, pernicious anaemia, narcolepsy, pemphigus foliaceus, alopecia areata, psoriasis, scleroderma, dermatitis herpetiformis, polymyositis, chronic inflammatory demyelinating polyneuropathy, paraneoplastic disorders, insulin dependent diabetes mellitus and autoimmune encephalitis).
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Affiliation(s)
- Anand Iyer
- The Walton Centre for Neurology and Neurosurgery , Liverpool , UK and
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Spillane J, Christofi G, Sidle KC, Kullmann DM, Howard RS. Myasthenia gravis and neuromyelitis opica: A causal link. Mult Scler Relat Disord 2013; 2:233-7. [PMID: 25877729 DOI: 10.1016/j.msard.2013.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/17/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Neuromyelitis Optica (NMO) and Myasthenia Gravis (MG) are rare antibody mediated disorders of the central nervous system (CNS) and neuromuscular junction (NMJ) respectively. Both diseases are predominantly mediated by IgG1 antibodies that activate complement. There have been increasing reports of patients who develop both disorders. Given the rarity of both diseases it would seem that these occurrences are not purely coincidental. There is heterogeneity between the cases described in the literature but common trends are observed in patients who develop both disorders. Most patients described are female. Typically the MG precedes the NMO and the majority of patients have undergone thymectomy. Generally, the symptoms of MG are mild but the NMO tends to follow a more aggressive clinical course. The pathogenesis of NMO in combination with MG is unknown, but thymectomy has been implicated in a subset of patients. We present the case of a female patient who developed NMO on a background of sero-positive MG and discuss the relevant literature.
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Affiliation(s)
- J Spillane
- UCL Institute of Neurology, Queen Square, London, UK.
| | - G Christofi
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - K C Sidle
- UCL Institute of Neurology, Queen Square, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - D M Kullmann
- UCL Institute of Neurology, Queen Square, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - R S Howard
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Fukuda AM, Badaut J. Aquaporin 4: a player in cerebral edema and neuroinflammation. J Neuroinflammation 2012; 9:279. [PMID: 23270503 PMCID: PMC3552817 DOI: 10.1186/1742-2094-9-279] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/07/2012] [Indexed: 02/07/2023] Open
Abstract
Neuroinflammation is a common pathological event observed in many different brain diseases, frequently associated with blood brain barrier (BBB) dysfunction and followed by cerebral edema. Neuroinflammation is characterized with microglia activation and astrogliosis, which is a hypertrophy of the astrocytes. Astrocytes express aquaporin 4, the water channel protein, involved in water homeostasis and edema formation. Aside from its function in water homeostasis, recent studies started to show possible interrelations between aquaporin 4 and neuroinflammation. In this review the roles of aquaporin 4 in neuroinflammation associated with BBB disruption and cerebral edema will be discussed with recent studies in the field.
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Affiliation(s)
- Andrew M Fukuda
- Department of Physiology, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
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12
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Etemadifar M, Abtahi MA, Razmjoo H, Abtahi SH, Dehghani AR, Abtahi ZA, Akbari M, Mazaheri S, Maghzi AH. Anti-aquaporin-4 IgG in Patients Presenting with Unilateral Optic Neuritis: A Cohort Study. Int J Prev Med 2012; 3:612-5. [PMID: 23024849 PMCID: PMC3445276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/26/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Optic neuritis (ON) can be the first presentation of multiple sclerosis (MS) or neuromyelitis optica (NMO). Anti-aquaporin-4 IgG (AQP4 IgG) is a highly specific and moderately sensitive biomarker for NMO. This study was designed to assess the rate of seropositivity for AQP4 IgG, and the short-term outcome of patients presenting with single isolated ON (SION). METHODS A cohort of 41 consecutive patients experiencing severe (< 20 / 200) SION (not fulfilling the diagnostic criteria for MS or NMO), was prospectively recruited. Blood sampling was carried out immediately after the diagnosis of ON, and AQP4 IgG was tested qualitatively, using an indirect immunofluorescence kit. After clinical and paraclinical investigations, all the patients were followed up for a short-term period of at least 18 months. RESULTS The seroprevalence among the initial ON patients was 9.7% (4 / 41). The short-term conversion rate to MS and NMO was estimated to be about 7.3 and 4.9%, respectively. The conversion rate to NMO in initially seropositive patients was greater than that for the whole cohort [2 / 4 (50%) vs. 2 / 41 (4.9%); P = 0.035; Odds ratio: 19.5, 95% confidence interval: 1.73 to 219.50]. CONCLUSION AQP4 IgG seropositive SION patients were more likely to develop NMO in comparison to the total SION population. Further studies, with a longer follow-up period and larger sample sizes are warranted to assess the clinical and prognostic value of assessing AQP4 IgG in SION.
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Affiliation(s)
- Masoud Etemadifar
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad-Ali Abtahi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Hassan Razmjoo
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Seyed-Hossein Abtahi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,,Correspondence to: Mr. Seyed-Hossein Abtahi, S.H.A. Research Center of Neurological–Ophthalmological Sciences (SHARNOS Co.), No. 9, Boroomand St., Seyed-Alikhan, Chaharbagh Abbasi St., Isfahan 81448-14581, Iran. E-mail:
| | - Ali-Reza Dehghani
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Zahra-Alsadat Abtahi
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Medical Students’ Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,,Department of Ophtalmology, Feiz Eye Hospital, Isfahan University of Medical Sciences, Isfahan
| | - Mojtaba Akbari
- Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Amir-Hadi Maghzi
- Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan, Iran,,Medical School, Isfahan University of Medical Sciences, Isfahan, Iran,Neuroimmunology Unit, Center for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK
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