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Shannon R. Hinson, PhD; Andrew McKeon, MB, MRCPI; James P. Fryer, MS; Metha Apiwattanakul, MD; Vanda A. Lennon, MD, PhD; Sean J. Pittock, MD

Arch Neurol. 2009;66(9):1164-1167.

Background  Recent reports support a pathogenic role in neuromyelitis optica (NMO) for the aquaporin-4 (AQP4)–specific autoantibody (NMO-IgG). Neuromyelitis optica is an inflammatory demyelinating central nervous system disease, usually relapsing, that causes variable degrees of attack-related disability. The NMO-IgG binds in vitro to the extracellular domain of AQP4, activates complement, and causes astrocyte lesioning.

Objective  To compare the prognostic utility of NMO-IgG titer and quantitative measures of complement-mediated injury to AQP4-expressing cells in NMO attacks.

Design, Setting, and Participants  A retrospective clinical-serological correlative study at Mayo Clinic's Neuroimmunology Laboratory was undertaken. Over an 18-month period, we identified NMO-IgG–seropositive patients in whom sufficient serum and adequate clinical information pertaining to NMO attacks (6 severe, 6 mild) were available to analyze clinical-serological correlations. Sera from 9 patients with multiple sclerosis and 9 healthy subjects (all NMO-IgG seronegative) served as controls. Complement activation was measured by quantifying the number of green fluorescent protein–AQP4–transfected HEK 293 cells permeable to the viability dye propidium iodide after exposure to patient serum and active complement.

Main Outcome Measures  Attack severity (mild or severe), percentage of AQP4-transfected cells lesioned, and NMO-IgG titer.

Results  The median percentage of AQP4-transfected cells lesioned by complement in the presence of serum from patients with NMO was 14% for patients with mild attacks and 54% for patients with severe attacks (P = .005). Median complement activation values for sera from healthy subjects and patients with multiple sclerosis were 8% and 12%, respectively. Patients with mild NMO attacks and patients with severe NMO attacks did not differ significantly with respect to NMO-IgG titer (P = .089).

Conclusions  A laboratory measure of complement-mediated cell injury may serve as a prognostic biomarker in NMO. Larger prospective studies are required to validate this observation.

Author Affiliations: Departments of Laboratory Medicine and Pathology (Drs Hinson, Apiwattanakul, Lennon, and Pittock and Mr Fryer), Neurology (Drs McKeon, Lennon, and Pittock), and Immunology (Dr Lennon), Mayo Clinic College of Medicine, Rochester, Minnesota.

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