Blood Brain Barrier Permeability Could Be a Biomarker to Predict Severity of Neuromyelitis Optica Spectrum Disorders: A Retrospective Analysis.

Ying Wang,Jie Zhu,Mingqin Zhu,Nannan Zheng,Yu Zhang,Chao Lu,Shuang Wang,Yang Gao,Jinming Han,Shuai Hou,Caiyun Liu,Hong-Liang Zhang,Wenjuan Lang,Dong Wang,Yang Chen

doi:10.3389/fneur.2018.00648

Abstract

Background: Blood-brain barrier (BBB) pathology exists in neuromyelitis optica spectrum disorders (NMOSD). However, the clinical use of BBB permeability, such as predicting disease severity of NMOSD, has rarely been studied in a large cohort of patients.Objectives: The current study explored the association between BBB permeability and clinical parameters in order to assess if BBB permeability could be a biomarker to predict disease severity and clinical characteristics of NMOSD.Methods: Among 69 enrolled NMOSD patients, 47 with albumin index over 5 × 10−3 were assigned to the increased BBB permeability group, and the remaining 22 were to the normal BBB permeability group. Disease severity was assessed using the Expanded Disability Status Scale (EDSS).Results: Patients in the increased BBB permeability group had significantly higher EDSS scores, anti-aquporin-4 immunoglobulin G titers, more dense cerebrospinal fluid protein concentrations, white blood cell counts, myelin basic protein levels and more dense complement 3 concentrations than found in the comparative normal BBB permeability group. The albumin index was positively correlated to the length of lesions in spinal cord.Conclusions: BBB permeability was associated with clinical features, laboratory results and radiological data of NMOSD patients, and may be a potential biomarker to predict disease severity and clinical characteristics of NMOSD.

Highlights

Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated disorders in the central nervous system (CNS), and anti-aquporin-4 (AQP4) immunoglobulin G (IgG) is one of the major autoimmune antibodies that contributes the pathogenesis of NMOSD [1]
blood brain barrier (BBB) permeability was evaluated using the albumin index, and the data were collected from the records of inpatients
Patients were assigned to two groups on the basis of BBB permeability, 47 of the 69 patients with albumin index over 5 × 10−3 to the increased BBB permeability group, and the remaining 22, whose albumin index was within the reference range, to the normal BBB permeability group

Summary

Introduction

Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated disorders in the central nervous system (CNS), and anti-aquporin-4 (AQP4) immunoglobulin G (IgG) is one of the major autoimmune antibodies that contributes the pathogenesis of NMOSD [1]. When anti-AQP4-IgG obtained from a NMO patient was administered to mice, lesions of perivascular astrocyte were observed, indicating the involvement of BBB [4]. The clinical role of BBB permeability, such as predicting clinical severity and characteristics, has rarely been studied in large cohorts of NMOSD patients. The current study retrospectively investigates whether BBB permeability evaluated by albumin index could be a biomarker to predict clinical severity and characteristics of NMOSD. Investigations have indicated that various kinds of molecules are involved in the development of NMOSD, including inflammatory molecules, genetic biomarkers, CNS proteins, etc., evidence on their clinical roles of monitoring disease course is still lacking [15]. The clinical use of BBB permeability, such as predicting disease severity of NMOSD, has rarely been studied in a large cohort of patients

Objectives

Methods

Results

Conclusion