1
|
Cakan M, Cimen B, Acar-Ozen NP, Sara Y, Karabudak R, Tuncer A. Can serum C3/C4 complement ratio be used in the differential diagnosis of central nervous system demyelinating diseases? Mult Scler Relat Disord 2025; 95:106312. [PMID: 39921992 DOI: 10.1016/j.msard.2025.106312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/07/2025] [Accepted: 02/01/2025] [Indexed: 02/10/2025]
Abstract
BACKGROUND Neuromyelitis Optica Spectrum Disorders (NMOSD) and Multiple Sclerosis (MS) are primary demyelinating diseases of the central nervous system (CNS) with similar clinical features, complicating early differential diagnosis and treatment decisions. While both humoral and cellular immunity contribute to their immunopathogenesis, the complement system's role remains unclear. We considered complement-dependent cytotoxicity might have different roles in the pathophysiology of these diseases. Predictive value of C3 and C4 complement levels at the first attack for the definitive diagnosis aimed to be investigated. METHODS Treatment-naive, 14 seronegative (SN) NMO, 28 aquaporin-4-positive [AQP4(+)] NMO, 23 myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and 15 MS adult patients were included. Serum C3 and C4 levels were evaluated retrospectively. Complement levels were statistically adjusted according to the age of the patients and C3/C4 ratio was used to increase statistical power. RESULTS We found that C4 levels were lower and C3/C4 ratio was higher in SNNMO and AQP4(+)-NMO groups compared to the MS group. It has been determined that 5.32 and 4.85 cut-off values of the C3/C4 ratio can discriminate SNNMO and AQP4(+)-NMO groups from MS. CONCLUSION The classical complement pathway in SNNMO and AQP4(+)-NMO was thought to be more affected compared to MS, as activation of the classical pathway predominantly decreases the level of C4. Since the involvement of the complement system pathways at different levels may be presented with the C3/C4 ratio, it seems likely that this ratio may have value as a candidate biomarker in the differential diagnosis of primary CNS demyelinating diseases.
Collapse
Affiliation(s)
- Melike Cakan
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, , Türkiye
| | - Bariscan Cimen
- Department of Medical Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | | | - Yildirim Sara
- Department of Medical Pharmacology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Rana Karabudak
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, , Türkiye
| | - Aslı Tuncer
- Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, , Türkiye.
| |
Collapse
|
2
|
Lyou HJ, Shin HY, Lee HL, Kwon YN, Oh SI, Oh J, Cho EB, Kim S, Baek SH, Kim BJ, Sohn E, Seok JM, Min JH, Kim SW, Kim BJ. Quality of life in patients with myelin oligodendrocyte glycoprotein antibody associated disease compared to patients with AQP4-IgG positive neuromyelitis optica spectrum disorders: A Korean multicenter study. Mult Scler Relat Disord 2024; 91:105914. [PMID: 39369629 DOI: 10.1016/j.msard.2024.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/23/2024] [Accepted: 09/28/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Little is known about the quality of life (QOL) of patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). We compared QOL and associated factors in patients with MOGAD and aquaporin4 IgG (AQP4-IgG) positive neuromyelitis optica spectrum disorder (NMOSD). METHODS This multicenter questionnaire study compared the QOL of 41 patients with MOGAD and 78 with AQP4-IgG positive NMOSD. Patients who were positive for AQP4-IgG or MOG antibodies were included. WHO Quality of Life Scale Brief Version was used to assess QOL in physical, psychological, social, and environmental domains. QOL, sleep quality, pain, fatigue, and depression were compared between the two groups. The factors associated with QOL in each group and the entire cohort were analyzed. RESULTS The proportion of patients with poor QOL was not significantly different between MOGAD (51.22 %) and AQP4-IgG positive NMOSD (58.97 %, p = 0.054). In the MOGAD group, the pain score (β=-1.032, p = 0.001) and depression score (β=-0.694, p = 0.007) were negatively associated with physical and psychological QOL, respectively. Sleep quality was negatively associated with physical (β=-1.506, p = 0.034) and psychological (β =-2.064, p = 0.033) QOL. When the entire cohort was analyzed, a positive MOG antibody was independently associated with worse psychological QOL (β=-8.998, p = 0.013) compared to positive AQP4-Ab after adjustment for sleep quality, depression, fatigue, and pain. CONCLUSIONS The overall QOL of the patients of MOGAD was comparable to that of AQP4-IgG positive NMOSD. Patients with MOGAD were experiencing sleep disorder, fatigue, and depression at similar degrees to those of patients with AQP4-IgG positive NMOSD. Further consideration of sleep quality and psychological QOL is required to improve QOL in patients with MOGAD.
Collapse
Affiliation(s)
- Hyun Ji Lyou
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Seoul, South Korea
| | - Eun Bin Cho
- Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Sunyoung Kim
- Departments of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Byoung Joon Kim
- Department of Neurology, Neuroscience/Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
3
|
Marchionatti A, Hansel G, Avila GU, Sato DK. Detection of MOG-IgG in Clinical Samples by Live Cell-Based Assays: Performance of Immunofluorescence Microscopy and Flow Cytometry. Front Immunol 2021; 12:642272. [PMID: 34025652 PMCID: PMC8137838 DOI: 10.3389/fimmu.2021.642272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/19/2021] [Indexed: 02/05/2023] Open
Abstract
Human antibodies against Myelin Oligodendrocyte Glycoprotein (MOG) from immunoglobulin-G subclasses (MOG-IgG) have been recently associated with a new subgroup of neurological autoimmune diseases with distinct clinical characteristics from multiple sclerosis and neuromyelitis optica spectrum disorders. The use of MOG-IgG as a biomarker is an essential tool to assist in the diagnosis and clinical prognosis. The cell-based assay (CBA) is a methodology that expresses high levels of natively folded human MOG protein in the cell membrane being the methodology most used for clinical MOG-IgG diagnosis. However, there is still no consensus about the best approach to perform CBA to improve the results. The CBA using flow cytometry (CBA-FC) is an automated technique with objective quantification, reducing the subject of human bias that occurred at CBA using immunofluorescence (CBA-IF). In this study, we compared the performance of CBA-IF and CBA-FC as an acquisition tool analysis. The sera of 104 patients diagnosed with inflammatory Central Nervous System diseases were tested in both CBA-IF and CBA-FC. We used the dilution of 1:128 for CBA-IF and three different dilutions (1:20, 1:100, and 1:640) for CBA-FC. The CBA-FC and CBA-IF results had 88.5% agreement between assays and the CBA-IF titers by endpoint-dilution correlated with the CBA-FC titers. The highest serum dilution resulted in an increased CBA-FC specificity, but there was a reduction in the CBA-FC sensitivity. Our study showed that CBA-FC can be used in clinical practice as a diagnostic technique for MOG-IgG. In addition, in some specific cases, the combination of both techniques could be used as a tool to discriminate unspecific binding and overcome single assay limitations.
Collapse
Affiliation(s)
- Amanda Marchionatti
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gisele Hansel
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gabriela Urbanski Avila
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Douglas Kazutoshi Sato
- Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| |
Collapse
|