Identification of new serum autoantibodies in neuromyelitis optica using protein microarrays

Abstract

Neuromyelitis optica (NMO) or Devic’s disease is a severe demyelinating disease of the CNS affecting primarily optic nerves and spinal cord, secondary to a B-cell- and Ab-mediated autoimmune condition.1 This concept was recently bolstered by the demonstration of disease-specific NMO-Abs,2 and the apparent beneficial effect of B-cell depletion.3 Here, we used a protein microarray approach to profile the Ag reactivity of serum IgG from NMO patients. Sera from five patients fulfilling NMO criteria (Cases 2 through 6 described elsewhere3) and five healthy controls were tested. Because patients experienced relapses and progressive clinical impairment despite therapy, they received rituximab as an off-label, innovative treatment.3 A 20-year-old woman with NMO associated with a high relapse rate (19 relapses within the last 6 years) was blind, wheelchair bound, and had a mid-thoracic sensory level and urinary and stool incontinence. Following treatment with rituximab, she experienced improved strength and sensation in her legs. She had an attack of myelitis approximately 1 month after her first course of rituximab from which she recovered spontaneously without additional treatment. At 1 year follow up, her vision remained impaired but she recovered full strength in her legs, normal …