OBJECTIVES: Neuromyelitis optica (NMO) immunoglobulin G (IgG) (aquaporin-4 [AQP4] IgG) is highly specific for NMO and related disorders, and autoantibody detection has become an essential investigation in patients with demyelinating disease. However, although different techniques are now used, no multicenter comparisons have been performed. This study compares the sensitivity and specificity of different assays, including an in-house flow cytometric assay and 2 commercial assays (ELISA and transfected cell-based assay [CBA]). METHODS: Six assay methods (in-house or commercial) were performed in 2 international centers using coded serum from patients with NMO (35 patients), NMO spectrum disorders (25 patients), relapsing-remitting multiple sclerosis (39 patients), miscellaneous autoimmune diseases (25 patients), and healthy subjects (22 subjects). RESULTS: The highest sensitivities were yielded by assays detecting IgG binding to cells expressing recombinant AQP4 with quantitative flow cytometry (77; 46 of 60) or visual observation (CBA, 73%; 44 of 60). The fluorescence immunoprecipitation assay and tissue-based immunofluorescence assay were least sensitive (48%-53%). The CBA and ELISA commercial assays (100% specific) yielded sensitivities of 68% (41 of 60) and 60% (36 of 60), respectively, and sensitivity of 72% (43 of 60) when used in combination. CONCLUSIONS: The greater sensitivity and excellent specificity of second-generation recombinant antigen-based assays for detection of NMO-IgG in a clinical setting should enable earlier diagnosis of NMO spectrum disorders and prompt initiation of disease-appropriate therapies.
OBJECTIVES:Neuromyelitis optica (NMO) immunoglobulin G (IgG) (aquaporin-4 [AQP4] IgG) is highly specific for NMO and related disorders, and autoantibody detection has become an essential investigation in patients with demyelinating disease. However, although different techniques are now used, no multicenter comparisons have been performed. This study compares the sensitivity and specificity of different assays, including an in-house flow cytometric assay and 2 commercial assays (ELISA and transfected cell-based assay [CBA]). METHODS: Six assay methods (in-house or commercial) were performed in 2 international centers using coded serum from patients with NMO (35 patients), NMO spectrum disorders (25 patients), relapsing-remitting multiple sclerosis (39 patients), miscellaneous autoimmune diseases (25 patients), and healthy subjects (22 subjects). RESULTS: The highest sensitivities were yielded by assays detecting IgG binding to cells expressing recombinant AQP4 with quantitative flow cytometry (77; 46 of 60) or visual observation (CBA, 73%; 44 of 60). The fluorescence immunoprecipitation assay and tissue-based immunofluorescence assay were least sensitive (48%-53%). The CBA and ELISA commercial assays (100% specific) yielded sensitivities of 68% (41 of 60) and 60% (36 of 60), respectively, and sensitivity of 72% (43 of 60) when used in combination. CONCLUSIONS: The greater sensitivity and excellent specificity of second-generation recombinant antigen-based assays for detection of NMO-IgG in a clinical setting should enable earlier diagnosis of NMO spectrum disorders and prompt initiation of disease-appropriate therapies.
Authors: S Jarius; D Franciotta; R Bergamaschi; H Wright; E Littleton; J Palace; R Hohlfeld; A Vincent Journal: Neurology Date: 2007-02-07 Impact factor: 9.910
Authors: I De Vidi; G Boursier; N Delouche; P Portalès; E Cadars; M Bouthier; C Mettling; Y L Lin; E Thouvenot; B Carlander; W Camu; J P Antel; A Bar-Or; H Zephir; P Vermersch; J De Seze; P Corbeau; J F Eliaou; T Vincent Journal: Clin Immunol Date: 2010-12-28 Impact factor: 3.969
Authors: Vanda A Lennon; Dean M Wingerchuk; Thomas J Kryzer; Sean J Pittock; Claudia F Lucchinetti; Kazuo Fujihara; Ichiro Nakashima; Brian G Weinshenker Journal: Lancet Date: 2004 Dec 11-17 Impact factor: 79.321
Authors: Patrick Waters; Sven Jarius; Edward Littleton; Maria Isabel Leite; Saiju Jacob; Bryony Gray; Ruth Geraldes; Thomas Vale; Anu Jacob; Jacqueline Palace; Susan Maxwell; David Beeson; Angela Vincent Journal: Arch Neurol Date: 2008-07
Authors: S R Hinson; S J Pittock; C F Lucchinetti; S F Roemer; J P Fryer; T J Kryzer; V A Lennon Journal: Neurology Date: 2007-10-10 Impact factor: 9.910
Authors: Dean M Wingerchuk; Vanda A Lennon; Claudia F Lucchinetti; Sean J Pittock; Brian G Weinshenker Journal: Lancet Neurol Date: 2007-09 Impact factor: 44.182
Authors: Yujuan Jiao; James P Fryer; Vanda A Lennon; Sarah M Jenkins; Amy M L Quek; Carin Y Smith; Andrew McKeon; Chiara Costanzi; Raffaele Iorio; Brian G Weinshenker; Dean M Wingerchuk; Elizabeth A Shuster; Claudia F Lucchinetti; Sean J Pittock Journal: Neurology Date: 2013-08-30 Impact factor: 9.910
Authors: Elizabeth Cotzomi; Panos Stathopoulos; Casey S Lee; Alanna M Ritchie; John N Soltys; Fabien R Delmotte; Tyler Oe; Joel Sng; Ruoyi Jiang; Anthony K Ma; Jason A Vander Heiden; Steven H Kleinstein; Michael Levy; Jeffrey L Bennett; Eric Meffre; Kevin C O'Connor Journal: Brain Date: 2019-06-01 Impact factor: 13.501
Authors: Raffaele Iorio; James P Fryer; Shannon R Hinson; Petra Fallier-Becker; Hartwig Wolburg; Sean J Pittock; Vanda A Lennon Journal: J Autoimmun Date: 2012-08-18 Impact factor: 7.094