1
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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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2
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Khalilidehkordi E, Clarke L, Arnett S, Bukhari W, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation. Front Neurol 2020; 11:537. [PMID: 32612571 PMCID: PMC7308484 DOI: 10.3389/fneur.2020.00537] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) show overlap in their clinical features. We performed an analysis of relapses with the aim of determining differences between the two conditions. Cases of NMOSD and age- and sex-matched MS controls were collected from across Australia and New Zealand. Demographic and clinical information, including relapse histories, were recorded using a standard questionnaire. There were 75 cases of NMOSD and 101 MS controls. There were 328 relapses in the NMOSD cases and 375 in MS controls. Spinal cord and optic neuritis attacks were the most common relapses in both NMOSD and MS. Optic neuritis (p < 0.001) and area postrema relapses (P = 0.002) were more common in NMOSD and other brainstem attacks were more common in MS (p < 0.001). Prior to age 30 years, attacks of optic neuritis were more common in NMOSD than transverse myelitis. After 30 this pattern was reversed. Relapses in NMOSD were more likely to be treated with acute immunotherapies and were less likely to recover completely. Analysis by month of relapse in NMOSD showed a trend toward reduced risk of relapse in February to April compared to a peak in November to January (P = 0.065). Optic neuritis and transverse myelitis are the most common types of relapse in NMOSD and MS. Optic neuritis tends to occur more frequently in NMOSD prior to the age of 30, with transverse myelitis being more common thereafter. Relapses in NMOSD were more severe. A seasonal bias for relapses in spring-summer may exist in NMOSD.
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Affiliation(s)
- Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, United Kingdom
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville University Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Bruce J Brew
- Peter Duncan Neurosciences Unit, Centre for Applied Medical Research and Department of Neurology, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Matthew Brown
- Institute of Health Biomedical Innovation, Translational Research Institute, Queensland University of Technology, Woolloongabba, QLD, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - David Gillis
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chris Kneebone
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- Division of Immunology, HSQ Pathology Queensland Central Laboratory, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia
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3
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Bukhari W, Clarke L, O'Gorman C, Khalilidehkordi E, Arnett S, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Ramanathan S, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonnell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt J, Slee M, Taylor BV, Willoughby E, Wilson RJ, Brilot F, Vincent A, Waters P, Broadley SA. The clinical profile of NMOSD in Australia and New Zealand. J Neurol 2020; 267:1431-1443. [PMID: 32006158 DOI: 10.1007/s00415-020-09716-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 12/13/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are an inflammation of the central nervous system associated with autoantibodies to aquaporin-4. We have undertaken a clinic-based survey of NMOSD in the Australia and New Zealand populations with the aim of characterising the clinical features and establishing the value of recently revised diagnostic criteria. Cases of possible NMOSD and age and sex-matched controls with multiple sclerosis (MS) were referred from centres across Australia and New Zealand. Cases were classified as NMOSD if they met the 2015 IPND criteria and remained as suspected NMOSD if they did not. Clinical and paraclinical data were compared across the three groups. NMOSD was confirmed in 75 cases and 89 had suspected NMOSD. There were 101 controls with MS. Age at onset, relapse rates and EDSS scores were significantly higher in NMOSD than in MS. Lesions and symptoms referable to the optic nerve were more common in NMOSD whereas brainstem, cerebellar and cerebral lesions were more common in MS. Longitudinally extensive spinal cord lesions were seen in 48/71 (68%) of cases with NMOSD. Elevations of CSF, white cell count and protein were more common in NMOSD. We have confirmed a clinical pattern of NMOSD that has been seen in several geographical regions. We have demonstrated the clinical utility of the current diagnostic criteria. Distinct patterns of disease are evident in NMOSD and MS, but there remains a large number of patients with NMOSD-like features who do not meet the current diagnostic criteria for NMOSD and remain a diagnostic challenge.
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Affiliation(s)
- Wajih Bukhari
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Laura Clarke
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford, OX3 9DU, UK
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital, Westmead, NSW, 2145, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, 2010, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Celia Chen
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Russell C Dale
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, 2605, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Marzena J Fabis-Pedrini
- Western Australian Neuroscience Research Institute, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - David Fulcher
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Robert Heard
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Sofia Jimenez-Sanchez
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, 3010, Australia
| | - Chris Kneebone
- Department of Neurology, Townsville Hospital, Douglas, QLD, 4814, Australia
| | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Christopher Lynch
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, 8140, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, 1142, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Stephen W Reddel
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Cameron Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Judith Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst, NSW, 2010, Australia
| | - Steve Vucic
- The Children's Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, 2145, Australia
| | - Michael Walsh
- Department of Neurology, Wellington Hospital, Newtown, 6021, New Zealand
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, 4029, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
| | - John Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
| | - Bruce V Taylor
- School of Medicine, Deakin University, Waurn Ponds, VIC, 3217, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, 1023, New Zealand
| | - Robert J Wilson
- Department of Neurology, Princess Alexandra Hospital, Wooloongabba, QLD, 4102, Australia
| | - Fabienne Brilot
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, 6009, Australia
| | - Angela Vincent
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Patrick Waters
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia. .,Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
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4
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Prain K, Woodhall M, Vincent A, Ramanathan S, Barnett MH, Bundell CS, Parratt JDE, Silvestrini RA, Bukhari W, Brilot F, Waters P, Broadley SA. AQP4 Antibody Assay Sensitivity Comparison in the Era of the 2015 Diagnostic Criteria for NMOSD. Front Neurol 2019; 10:1028. [PMID: 31636597 PMCID: PMC6787171 DOI: 10.3389/fneur.2019.01028] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
We have compared five different assays for antibodies to aquaporin-4 in 181 cases of suspected Neuromyelitis optica spectrum disorders (NMOSD) and 253 controls to assess their relative utility. As part of a clinically-based survey of NMOSD in Australia and New Zealand, cases of suspected NMOSD were referred from 23 centers. Clinical details and magnetic imaging were reviewed and used to apply the 2015 IPND diagnostic criteria. In addition, 101 age- and sex-matched patients with multiple sclerosis were referred. Other inflammatory disease (n = 49) and healthy controls (n = 103) were also recruited. Samples from all participants were tested using tissue-based indirect immunofluorescence assays and a subset were tested using four additional ELISA and cell-based assays. Antibodies to myelin oligodendrocyte glycoprotein (MOG) were also assayed. All aquaporin-4 antibody assays proved to be highly specific. Sensitivities ranged from 60 to 94%, with cell-based assays having the highest sensitivity. Antibodies to MOG were detected in 8/79 (10%) of the residual suspected cases of NMOSD. Under the 2015 IPND diagnostic criteria for NMOSD, cell-based assays for aquaporin-4 are sensitive and highly specific, performing better than tissue-based and ELISA assays. A fixed cell-based assay showed near-identical results to a live-cell based assay. Antibodies to MOG account for only a small number of suspected cases.
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Affiliation(s)
- Kerri Prain
- Pathology Queensland Central Laboratory, Division of Immunology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Christine S Bundell
- School of Biomedical Science, Medicine, University of Western Australia, Nedlands, WA, Australia.,PathWest Laboratory Medicine, Department of Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - John D E Parratt
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Roger A Silvestrini
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia
| | - Wajih Bukhari
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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5
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Stevenson BR, Thompson GA, Watson MC, Bundell CS, Klinken EM, John M, Lake FR, McLean-Tooke AP. Autoantibodies in interstitial lung diseases. Pathology 2019; 51:518-523. [PMID: 31230817 DOI: 10.1016/j.pathol.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 10/26/2022]
Abstract
The role of autoantibody testing for patients with interstitial lung disease is an evolving area. Recent guidelines recommend routine anti-nuclear antibodies, rheumatoid factor, and anti-citrullinated cyclic peptide antibody testing for patients undergoing diagnostic evaluation for interstitial lung disease, with further autoantibody testing reserved for selected cases guided by rheumatological features. Even this approach may miss patients with clinically significant autoantibodies when interstitial lung disease is the dominant or first manifestation of autoimmune disease. We retrospectively performed autoimmune serology in a clinically well characterised cohort of interstitial lung disease patients. Using stored serum, additional testing was performed to ensure all patients had complete autoantibody profiles including anti-nuclear antibodies, extractable nuclear antigen antibodies, double-stranded DNA antibodies, rheumatoid factor, anti-citrullinated cyclic peptide antibodies, anti-neutrophil cytoplasmic antibodies, and myositis antibodies. Eighty patients with interstitial lung disease, and available stored serum, were assessed. Mean age at interstitial lung disease diagnosis was 65.2 years and 42 patients were male. Positive autoimmune serology was found in 56 of 80 (70.0%) patients; the most common positive result was anti-nuclear antibodies (n=34; 42.5%). Myositis antibodies were detected in 13 of 80 (16.2%) patients. Four (5%) patients had elevated anti-citrullinated cyclic peptide antibodies, and two (2.5%) patients had detectable myeloperoxidase antibodies. Eleven (13.7%) patients with negative anti-nuclear antibodies had other significant disease associated autoantibodies. An extended panel of autoantibody testing may detect cases of connective tissue disease associated interstitial lung disease, regardless of clinical or radiological subtype, and prior to extra-pulmonary manifestations of systemic autoimmunity.
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Affiliation(s)
- Brittany R Stevenson
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Grace A Thompson
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Monalyssa C Watson
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Christine S Bundell
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Elizabeth M Klinken
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mina John
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Royal Perth Hospital, Perth, WA, Australia; Institute for Immunology and Infectious Diseases (IIID), Murdoch University, Perth, WA, Australia
| | - Fiona R Lake
- UWA Medical School, The University of Western Australia, Perth, WA, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Andrew P McLean-Tooke
- Department of Immunology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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6
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Bukhari W, Prain KM, Waters P, Woodhall M, O'Gorman CM, Clarke L, Silvestrini RA, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee WJ, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Killpatrick T, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell R, Mason DF, McCombe PA, Pender MP, Pereira JA, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Wilson RJ, Vincent A, Broadley SA. Incidence and prevalence of NMOSD in Australia and New Zealand. J Neurol Neurosurg Psychiatry 2017; 88:632-638. [PMID: 28550069 DOI: 10.1136/jnnp-2016-314839] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We have undertaken a clinic-based survey of neuromyelitis optica spectrum disorders (NMOSDs) in Australia and New Zealand to establish incidence and prevalence across the region and in populations of differing ancestry. BACKGROUND NMOSD is a recently defined demyelinating disease of the central nervous system (CNS). The incidence and prevalence of NMOSD in Australia and New Zealand has not been established. METHODS Centres managing patients with demyelinating disease of the CNS across Australia and New Zealand reported patients with clinical and laboratory features that were suspicious for NMOSD. Testing for aquaporin 4 antibodies was undertaken in all suspected cases. From this group, cases were identified who fulfilled the 2015 Wingerchuk diagnostic criteria for NMOSD. A capture-recapture methodology was used to estimate incidence and prevalence, based on additional laboratory identified cases. RESULTS NMOSD was confirmed in 81/170 (48%) cases referred. Capture-recapture analysis gave an adjusted incidence estimate of 0.37 (95% CI 0.35 to 0.39) per million per year and a prevalence estimate for NMOSD of 0.70 (95% CI 0.61 to 0.78) per 100 000. NMOSD was three times more common in the Asian population (1.57 (95% CI 1.15 to 1.98) per 100 000) compared with the remainder of the population (0.57 (95% CI 0.50 to 0.65) per 100 000). The latitudinal gradient evident in multiple sclerosis was not seen in NMOSD. CONCLUSIONS NMOSD incidence and prevalence in Australia and New Zealand are comparable with figures from other populations of largely European ancestry. We found NMOSD to be more common in the population with Asian ancestry.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Laura Clarke
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Sandeep Bhuta
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Matthew Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wallace J Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, London, UK
| | - Helmut Butzkueven
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Alan Coulthard
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Russell C Dale
- Childrens Hospital at Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Canberra, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | | | - David Fulcher
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Gillis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Simon Hawke
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robert Heard
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Saman Heshmat
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, Australia.,South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | | | - Trevor Killpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John King
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christpher Lynch
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | - Michael P Pender
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | - John D Pollard
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Cameron Shaw
- Department of Neurology, Geelong Hospital, Geelong, VIC, Australia
| | - Judith Spies
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Michael Walsh
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Richard C Wong
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Eppie M Yiu
- Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Allan G Kermode
- Western Australian Neuroscience Research Institute, Nedlands, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | | | - Robert J Wilson
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia.,Department of Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia
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7
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Bundell CS, Thompson G, Power A, Hew M. ASCIA-P72: SOX-1 ANTIBODIES ARE WE READY TO REPORT THEM. Intern Med J 2016. [DOI: 10.1111/imj.72_13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christine S Bundell
- PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Crawley
| | - Grace Thompson
- PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Australia
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
| | - Alison Power
- PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Australia
| | - Meilyn Hew
- PathWest Laboratory Medicine; QEII Medical Centre; Nedlands Australia
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8
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Bundell CS, Jackaman C, Suhrbier A, Robinson BWS, Nelson DJ. Functional endogenous cytotoxic T lymphocytes are generated to multiple antigens co-expressed by progressing tumors; after intra-tumoral IL-2 therapy these effector cells eradicate established tumors. Cancer Immunol Immunother 2006; 55:933-47. [PMID: 16283304 PMCID: PMC11030810 DOI: 10.1007/s00262-005-0086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Accepted: 09/14/2005] [Indexed: 11/24/2022]
Abstract
Tumors contain many antigens that may be recognized by the immune system. It is not known whether these antigens, and the epitopes within these antigens, can all be recognized by the anti-tumor immune response or if such responses are restricted to a few dominant epitopes. Effector function of endogenous cytotoxic T lymphocytes (CTL) generated during tumor progression has previously been assessed by indirect, ex vivo assays, which often focused on a single antigen. Therefore, we evaluated the endogenous in vivo CTL response to multiple neo tumor antigens using murine Lewis lung carcinoma tumor cells transfected with ovalbumin or a polyepitope construct. Both express multiple MHC class I-restricted epitopes. Ovalbumin contains a known hierarchy of epitopes for given MHC molecules, whilst the polyepitope expresses a number of dominant epitopes. We show that as tumors progress, potent effector CTL are generated in vivo that are restricted to dominant epitopes; we did not see the responses to subdominant or cryptic epitopes. Our data show that the CTL recognizing tumor antigens vary in their lytic capacity, as the CTL responding to two of the four epitopes were particularly potent killers. The presence of these effector CTLs did not prevent tumor growth. However, intra-tumoral IL-2 treatment altered the potency, but not the hierarchy, of these CTL such that they mediated tumor regression. These results have implications for immunotherapy protocols.
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Affiliation(s)
- Christine S. Bundell
- School of Medicine and Pharmacology, University of Western Australia, 4th Floor, G Block, Queen Elizabeth II Medical Centre, Perth, WA 6009 Australia
| | - Connie Jackaman
- School of Medicine and Pharmacology, University of Western Australia, 4th Floor, G Block, Queen Elizabeth II Medical Centre, Perth, WA 6009 Australia
| | - Andreas Suhrbier
- Queensland Institute of Medical Research, Post Office Royal Brisbane Hospital, Brisbane, QLD 4029 Australia
| | - Bruce W. S. Robinson
- School of Medicine and Pharmacology, University of Western Australia, 4th Floor, G Block, Queen Elizabeth II Medical Centre, Perth, WA 6009 Australia
- West Australian Institute for Medical Research, Queen Elizabeth II Medical Centre, Perth, WA 6009 Australia
| | - Delia J. Nelson
- School of Medicine and Pharmacology, University of Western Australia, 4th Floor, G Block, Queen Elizabeth II Medical Centre, Perth, WA 6009 Australia
- Western Australian Biomedical Research Institute, Kent St., Curtin University, Bentley, WA 6102 Australia
- School of Biomedical Sciences, Kent St., Curtin University, Bentley, WA 6102 Australia
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9
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Jackaman C, Bundell CS, Kinnear BF, Smith AM, Filion P, van Hagen D, Robinson BWS, Nelson DJ. IL-2 intratumoral immunotherapy enhances CD8+ T cells that mediate destruction of tumor cells and tumor-associated vasculature: a novel mechanism for IL-2. J Immunol 2004; 171:5051-63. [PMID: 14607902 DOI: 10.4049/jimmunol.171.10.5051] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Therapeutic use of IL-2 can generate antitumor immunity; however, a variety of different mechanisms have been reported. We injected IL-2 intratumorally (i.t.) at different stages of growth, using our unique murine model of mesothelioma (AE17; and AE17 transfected with secretory OVA (AE17-sOVA)), and systematically analyzed real-time events as they occurred in vivo. The majority of mice with small tumors when treatment commenced displayed complete tumor regression, remained tumor free for >2 mo, and survived rechallenge with AE17 tumor cells. However, mice with large tumors at the start of treatment failed to respond. Timing experiments showed that IL-2-mediated responses were dependent upon tumor size, not on the duration of disease. Although i.t. IL-2 did not alter tumor Ag presentation in draining lymph nodes, it did enhance a previously primed, endogenous, tumor-specific in vivo CTL response that coincided with regressing tumors. Both CD4(+) and CD8(+) cells were required for IL-2-mediated tumor eradication, because IL-2 therapy failed in CD4(+)-depleted, CD8(+)-depleted, and both CD4(+)- and CD8(+)-depleted C57BL/6J animals. Tumor-infiltrating CD8(+) T cells, but not CD4(+) T cells, increased in association with a marked reduction in tumor-associated vascularity. Destruction of blood vessels required CD8(+) T cells, because this did not occur in nude mice or in CD8(+)-depleted C57BL/6J mice. These results show that repeated doses of i.t. (but not systemic) IL-2 mediates tumor regression via an enhanced endogenous tumor-specific CTL response concomitant with reduced vasculature, thereby demonstrating a novel mechanism for IL-2 activity.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/therapeutic use
- Animals
- Antigen Presentation
- Antigens, CD/biosynthesis
- Antigens, Neoplasm/administration & dosage
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/metabolism
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- B7-2 Antigen
- CD4-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/pathology
- Cell Death/immunology
- Cell Division/genetics
- Cell Division/immunology
- Cell Line, Tumor
- Cytotoxicity, Immunologic
- Egg Proteins/administration & dosage
- Egg Proteins/genetics
- Egg Proteins/pharmacokinetics
- Female
- Graft Rejection/immunology
- Graft Rejection/pathology
- Graft Rejection/physiopathology
- Growth Inhibitors/administration & dosage
- Growth Inhibitors/therapeutic use
- Histocompatibility Antigens Class I/metabolism
- Immunodominant Epitopes/biosynthesis
- Immunodominant Epitopes/genetics
- Immunodominant Epitopes/metabolism
- Immunotherapy, Active/methods
- Injections, Intralesional
- Injections, Intraperitoneal
- Interleukin-2/administration & dosage
- Interleukin-2/therapeutic use
- Lymphocytes, Tumor-Infiltrating/pathology
- Membrane Glycoproteins/biosynthesis
- Mesothelioma/blood supply
- Mesothelioma/mortality
- Mesothelioma/therapy
- Mesothelioma/ultrastructure
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Nude
- Mice, Transgenic
- Necrosis
- Neoplasm Transplantation
- Neovascularization, Pathologic/immunology
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/prevention & control
- Ovalbumin/administration & dosage
- Ovalbumin/genetics
- Ovalbumin/pharmacokinetics
- Peptide Fragments
- Survival Rate
- T-Lymphocyte Subsets/immunology
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Affiliation(s)
- Connie Jackaman
- School of Medicine and Pharmacology, University of Western Australia
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10
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Abstract
Among 111 strains of Pseudomonas aeruginosa from 49 children with cystic fibrosis, duration of colonization correlated with bacterial phenotype. We confirmed that P. aeruginosa from chronically colonized patients tended to be less motile, produce lower levels of protease and elastase, to be more sensitive to normal serum and to be polyagglutinating or untypable with standard antisera. We also showed that phospholipase and heat-stable hemolysin, concerned in metabolism of inorganic phosphate, and exotoxin A, were lower in these isolates. In longitudinal studies there was a decrease in virulence properties when isolates from the same patient were compared. No reversion from altered phenotype to 'wild-type' characteristics was found.
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Affiliation(s)
- V Burke
- Gastroenterology and Nutrition Research Unit, Princess Margaret Children's Medical Research Foundation, Perth, Western Australia
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11
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Bundell CS, Watson IM, Burke V, Gracey M. Protection of rats against cholera toxin and cholera-like enterotoxins by immunization with enteric-coated cholera toxin. Ann Trop Paediatr 1986; 6:199-204. [PMID: 2430511 DOI: 10.1080/02724936.1986.11748439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pure cholera toxin (CT) given as a booster in enteric-coated tablets to rats produced a humoral and intestinal immune response similar to the result of instilling the boosting dose of CT directly into the duodenum. This method protects the antigen against gastric acid and allows delivery of the immunogen to intestinal mucosa, an essential step in producing intestinal secretory IgA. Immunization gave protection against pure CT during intestinal perfusion but also significantly protected against the secretory effects of E. coli LT and CT-like toxin of A. sobria. The use of enteric-coated vaccines offers advantages for mass immunization programmes and our results suggest that immunization with preparations containing CT holotoxin may protect against heterologous toxins which cross-react with CT.
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Stewart GA, Bundell CS, Burke V. Partial characterisation of a soluble haemagglutinin from human diarrhoeal isolates of Aeromonas. J Med Microbiol 1986; 21:319-24. [PMID: 3723584 DOI: 10.1099/00222615-21-4-319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A soluble haemagglutinin has been identified in cell-free culture supernates of human diarrhoeal isolates of Aeromonas sobria, A. hydrophila and A. caviae. It was oligomeric; a major peak of haemagglutinating activity had an apparent mol. wt of 780,000 but there was haemagglutinating activity throughout the mol. wt range less than 40,000- greater than 10(6). Human group O, A and B, horse, rabbit, chicken and rat erythrocytes, but not those of sheep and cow, were agglutinated by the soluble haemagglutinin, in contrast to the cell-bound agglutinin. Agglutination was inhibited by fetuin, a complex glycoprotein, but not by simple sugars. The haemagglutinating activity was not affected by 0.5 M NaCl, dithiothreitol or the presence or absence of Ca++. It was unrelated to the haemolytic, enterotoxigenic and proteolytic activities present in cell-free extracts of A. sobria. All A. sobria, 73% of A. hydrophila and 68% of A. caviae strains tested produced this soluble haemagglutinin. A. caviae does not appear to be an enteric pathogen, therefore this soluble haemagglutinin alone is unlikely to be a virulence factor in Aeromonas spp.
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