Abstract Details

Title The Importance of Aquaporin-4 Antibody Assays in Patients beyond the Diagnostic Criteria for Neuromyelitis Optica Spectrum Disorders

Topic MS and Related Diseases

Presentation(s) P02 - (-)

Poster/Presentation
Number 156

Objective

Background BACKGROUND: The presence of anti-aquaporin-4 (AQP4) antibodies strongly suggests a diagnosis of neuromyelitis optica spectrum disorders (NMOSD); however, these patients may not present with both optic neuritis (ON) and myelitis.

Design/Methods DESIGN/METHODS: We used a transfected cell-based assay (CBA) and a commercial ELISA kit to assess the presence of AQP4-antibodies in 294 consecutive ICD patients (NMO = 36, NMO spectrum disorder = 46, MS = 98, monophasic ON = 48, short myelitis = 34, brainstem lesions = 8 and other inflammatory disorders = 24) and 15 control subjects with non-inflammatory etiologies.

Results RESULTS: In total, 19.4% (14/72) of the AQP4 antibody-positive patients did not meet NMO or NMOSD criteria because they presented with monophasic ON (n = 7), attacks restricted to the brainstem (n = 2) or myelitis with less than 3 vertebral segments (n = 5). The ELISA results were negative in 28.6% (4/14) of these patients. These patients had lower median titers in the CBA than patients who were positive according to both methods. All of the patients with discrepant results had one or more features resembling NMOSD.

Conclusions CONCLUSIONS: A highly sensitive assay to measure AQP4 antibodies is required to ensure that patients with NMOSD are not misdiagnosed.

Authors/Disclosures
Douglas K. Sato, MD PRESENTER	Dr. Sato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Sato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Sato has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Sato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Sato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Sato has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra-Zeneca. The institution of Dr. Sato has received research support from Biogen. The institution of Dr. Sato has received research support from Merck.
Ichiro Nakashima, MD, PhD (Department of Neurology, Tohoku Medical and Pharmaceutical University Hospital)	Dr. Nakashima has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Nakashima has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Nakashima has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Nakashima has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chugai. Dr. Nakashima has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Nakashima has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Nakashima has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Novartis. Dr. Nakashima has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Chugai. The institution of Dr. Nakashima has received research support from LSI Medience. The institution of Dr. Nakashima has received research support from BML.
Toshiaki Takahashi (Tohoku Univ-Dept Of Neuro)	No disclosure on file
Stuart D. Cook, MD, FAAN (Rutgers)	No disclosure on file
Tatsuro Misu	No disclosure on file
Patrick Waters, PhD (Oxford Autoimmune Neurology Diagnostic Lab - Nuffield Clinical Neurosciences)	Dr. Waters has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Waters has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Waters has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UBC. The institution of Dr. Waters has received research support from Guthy-Jackson Charitable Foundation. Dr. Waters has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Shuhei Nishiyama, MD	No disclosure on file
	No disclosure on file
Yoshiki Takai, MD (Tohoku unv.)	No disclosure on file
	No disclosure on file
Kazuo Fujihara, MD (Tohoku University, School of Medicine)	Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Boipharma. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Japan Tobacco. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Mitsubishi-Tanabe. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chugai/Roche. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Fujihara has received research support from Ministry of Health, Welfare and Labor of Japan. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a speaker, chair, etc with Novartis. Dr. Fujihara has received personal compensation in the range of $5,000-$9,999 for serving as a speaker, chair, etc with Biogen. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a speaker, chair, etc with Mitsubishi-Tanabe. Dr. Fujihara has received personal compensation in the range of $10,000-$49,999 for serving as a apeaker, chair, etc with Chugai/Roche. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker, chair, etc with Alexion. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a chair, speaker with Asahi Kasei Medical. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker with Eisai. Dr. Fujihara has received personal compensation in the range of $500-$4,999 for serving as a speaker, chair with Teijin.
Masashi Aoki, MD, PhD (Day Neuromuscular Research Laboratory)	Masashi Aoki, MD, PhD has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Tanabe Mitsubishi.

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