Abstract
BackgroundGlial fibrillary acidic protein (GFAP) is a specific intermediate filament of the cytoskeleton of the astrocyte and may be used as a specific marker for astrocytic damage. It is detectable in the cerebrospinal fluid following a relapse caused by Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) spectrum disease. Higher levels are found following an NMO-related relapse. It is not known if GFAP is also detectable in the serum following such relapses. In particular, it is not known if lesions limited to the optic nerve release GFAP in sufficient quantities to be detectable within the serum. The aim of this study was to ascertain the extent to which serum GFAP levels can distinguish between an episode of optic neuritis (ON) related to NMO spectrum disease and ON from other causes.Methodology/Principal FindingsOut of 150 patients consecutively presenting to our eye hospital over the period March 2009 until July 2010, we were able to collect a serum sample from 12 patients who had presented with MS-related ON and from 10 patients who had presented with NMO spectrum disease-related ON. We also identified 8 patients with recurrent isolated ON and 8 patients with a corticosteroid-dependent optic neuropathy in the absence of any identified aetiology. GFAP was detectable in the serum of all but three patients (two patients with MS-related ON and one with recurrent optic neuritis). The median serum GFAP level in the patient group with NMO spectrum disease was 4.63 pg/mL whereas in all other cases combined together, this was 2.14 pg/mL. The difference was statistically significant (P = 0.01). A similar statistically significant difference was found when cases with pathology limited to the optic nerve were compared (P = 0.03).ConclusionsGlial pathology in NMO related optic neuritis is reflected in elevated serum GFAP levels independently of whether or not there is extra-optic nerve disease.
Highlights
The conclusions of the optic neuritis treatment trial (ONTT) have guided the management of isolated idiopathic optic neuritis (ON) around the world [1]
Glial pathology in Neuromyelitis Optica (NMO) related optic neuritis is reflected in elevated serum Glial fibrillary acidic protein (GFAP) levels independently of whether or not there is extra-optic nerve disease
We identified 8 patients who had suffered from ON which relapsed upon the withdrawal of steroid therapy, in whom MR imaging the optic nerve, brain and spinal cord did not show demyelination, and there had been at least 3 relapses in the absence of any other evidence for disease including sarcoidosis, based on imaging and serology
Summary
The conclusions of the optic neuritis treatment trial (ONTT) have guided the management of isolated idiopathic optic neuritis (ON) around the world [1]. Following the ONTT treatment protocol in NMO related ON patients (and offering no treatment) may cause preventable nerve fibre loss [5]. Glial fibrillary acidic protein (GFAP) is a specific intermediate filament of the cytoskeleton of the astrocyte and may be used as a specific marker for astrocytic damage. It is detectable in the cerebrospinal fluid following a relapse caused by Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) spectrum disease. The aim of this study was to ascertain the extent to which serum GFAP levels can distinguish between an episode of optic neuritis (ON) related to NMO spectrum disease and ON from other causes
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