脑脊液寡克隆区带在多发性硬化和视神经脊髓炎中的应用

目的探讨脑脊液寡克隆区带在多发性硬化和视神经脊髓炎2组疾病中的应用价值。方法通过等电聚焦电泳加免疫固定染色的实验室方法检测多发性硬化和视神经脊髓炎2组患者的脑脊液寡克隆区带,比较2组疾病的脑脊液寡克隆区带特点。结果多发性硬化患者共120例,其中脑脊液寡克隆区带阳性39例,阳性率为32.5%;视神经脊髓炎患者共45例,其中脑脊液寡克隆区带阳性4例,阳性率为8.9%。多发性硬化组脑脊液寡克隆区带阳性率明显高于视神经脊髓炎组,差异有统计学意义(P=0.002)。结论本结果对2组疾病的鉴别诊断具有一定的指导意义,且支持多发性硬化和视神经脊髓炎发病机制不同的观点。     

AQP4-IgG阳性视神经脊髓炎谱系疾病的脑脊液细胞学特点

目的探讨水通道蛋白4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)的脑脊液细胞学特点。方法回顾性收集AQP4-IgG阳性的NMOSD患者的脑脊液细胞学、脑脊液常规、生化及寡克隆区带结果,并分析其特点。结果共收集237例AQP4-IgG阳性的NMOSD患者的脑脊液细胞学资料。女∶男=7.8∶1。120例(50.6%)患者脑脊液细胞学可见炎性反应,炎性反应程度为轻、中、重度者分别为63、43、14例。95例为淋巴细胞性炎性反应,20例为淋巴细胞与中性粒细胞性炎性反应,4例为淋巴细胞与嗜酸性粒细胞性炎性反应,1例为淋巴细胞、中性粒细胞与嗜酸性粒细胞性炎性反应。71例(30.0%)患者可见激活淋巴细胞,11例(4.6%)可见激活单核细胞,15例(6.3%)可见浆细胞。176例患者行寡克隆区带检测,其中脑脊液特异性寡克隆区带阳性47例(26.7%)。结论达1/2的AQP4-IgG阳性NMOSD患者脑脊液细胞学可见炎性反应,以淋巴细胞性炎性反应为主,也可见中性粒细胞与嗜酸性粒细胞参与;部分患者脑脊液细胞学可见激活淋巴细胞、激活单核细胞和浆细胞;AQP4-IgG阳性NMOSD患者脑脊液特异性寡克隆区带阳性率较多发性硬化低。上述脑脊液特点有助于NMOSD的诊断和鉴别。     

水通道蛋白4抗体阳性多发性硬化临床特点分析

目的分析水通道蛋白4(AQP4)抗体阳性多发性硬化的临床特征。方法共18例多发性硬化患者,均符合Mc Donald诊断标准(2010年版),分为AQP4抗体阳性组(5例)和AQP4抗体阴性组(13例),并门诊随访。结果 5例AQP4抗体阳性多发性硬化患者,男性2例、女性3例,中位发病年龄43岁,中位病程4个月;脊髓病变和视神经受累常见;MRI显示脑组织广泛多发性长T1、长T2异常信号伴颈胸髓长T1、长T2异常信号(3/5例)或单纯颈胸髓多发性长T1、长T2异常信号(2/5例);脑脊液Ig G指数(4/4例)、24 h Ig G鞘内合成率(3/4例)升高,寡克隆区带阳性(3/4例);血清抗核抗体阳性(2/5例)或合并干燥综合征(1/5例)。结论 AQP4抗体阳性多发性硬化有其特异性,发病机制可能与经典多发性硬化不同,在临床诊断与治疗时需加以重视并区别处理。     

120例视神经脊髓炎谱系疾病临床特点分析

目的基于2015年诊断标准分析视神经脊髓炎谱系疾病(NMOSD)患者的临床特点和影像学特征。方法回顾性分析120例NMOSD患者的临床特点、影像学特征、以及对比水通道蛋白4(AQP4)抗体阳性和阴性患者的临床异同点。结果女性∶男性=2.75∶1,平均发病年龄37.1岁,平均病程21个月,80%患者为复发病程。起病症状视神经炎和脊髓炎分别占41.7%和40%。15.8%患者伴有自身免疫病;5.8%患者伴有内分泌疾病。78.1%的患者AQP4抗体阳性,抗体阳性组疾病严重程度评分显著高于抗体阴性组(P=0.026)。长节段横贯性脊髓炎占83.7%。头部MRI异常见于36.7%(44/120)患者。28.3%(34/120)患者脑脊液白细胞升高(5×10~6/L),脑脊液蛋白49.5 mg/dl(正常值:15~45 mg/dl);30.8%(37/120)患者寡克隆区带阳性;52.2%(24/46)患者髓鞘碱性蛋白阳性;40%(48/120)患者脑脊液免疫球蛋白G升高。结论 2015年诊断标准有助于NMOSD诊断,NMOSD长节段脊髓炎多见,短节段脊髓炎不能排除NMOSD,AQP4抗体阳性患者病情更重,应重视早期诊断。     

视神经脊髓炎——是否是多发性硬化的一个亚型？

目的 探讨视神经脊髓炎与多发性硬化的方法。方法 对１３例视神经脊髓炎患者的临床表现,脑脊液,电生理学及影像学检查结果进行分析。结果 ８５％的视神经脊髓炎患者有多次（平均３．１次）的缓解复发,复发时症状仅限于视神经和／或脊髓,其脑脊液中寡克隆区带阳性率３３％,脑干诱发电位异常率８％,头颅ＣＴ和ＭＲＩ未发现异常。结论 视神经脊髓炎和多发性硬化之间有所不同,支持视神经脊髓炎是一个单独的疾病单元学说。     

寡克隆区带及抗水通道蛋白4抗体在多发性硬化诊断中的意义

目的通过观察多发性硬化(multiple sclerosis,MS)患者寡克隆区带(oligoclonal bands,OCB)及抗水通道蛋白4(aquaporin-4,AQP4)抗体的阳性率,为临床MS的诊断及鉴别诊断提供一定的参考。方法入组30例MS、48例神经系统非炎性病变(neurological non-inflammatory disease,NND)及50例外科手术患者。分析3组患者OCB、脑脊液及血清抗AQP4抗体阳性率的差异。结果 NND组与外科手术组OCB、脑脊液及血清抗AQP4抗体阳性率的差异无统计学意义(P>0.05)。MS组与对照组(NND组+外科手术组)脑脊液抗AQP4抗体阳性率差异无统计学意义(P>0.05),MS组与对照组OCB、血清抗AQP4抗体阳性率差异有统计学意义(P<0.01)。结论 OCB阳性对MS具有诊断意义。MS部分患者可表现为血清或脑脊液抗AQP4抗体阳性,诊断时需结合病史、临床体征及影像学特点等综合分析。     

水通道蛋白4抗体的研究进展

水通道蛋白4抗体(anti-aquaporin 4antibody,AQP4-IgG)是能与细胞膜表面的水通道蛋白4(aquaporin 4,AQP4)特异性结合的抗体,是由LENNON等[1]于2005年在视神经脊髓炎(neuromyelitis optica,NMO)患者的血清中首次发现。AQP4抗体对NMO诊断的高度特异性,也使其成为了一种独立的疾病,并在此基础上延伸出了视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)这一概念。但并非所有的NMOSD患者都合并AQP4抗体,并且该抗体也可能参与了其他类型中枢神经系统脱髓鞘疾病的发病,如多发性硬化(multiple sclerosis,MS)及Balo同心圆硬化(Balo’s concentric sclerosis,BCS),本文围绕AQP4抗体的致病机制,检测方法以及与这些疾病的关系作以综述。     

血清水通道蛋白4抗体与脑脊液寡克隆区带双阳性视神经脊髓炎谱系疾病患者临床特点研究

目的探讨血清水通道蛋白4(aquaporin-4,AQP4)抗体及脑脊液寡克隆区带(oligoclonal bands,OB)均阳性视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)患者的临床特点。方法。收集2013-02—2014-12期间于作者医院神经内科确诊为NMOSD患者60例的病例资料,进行回顾性分析。患者分为双阳组(血清AQP4抗体及脑脊液OB均阳性)、单阳组(仅血清AQP4抗体阳性)和双阴组(血清AQP4抗体及脑脊液OB阴性)。分析三组患者临床资料。结果 60例患者双阳组患者20例,单阳组患者25例,双阴组患者15例。三组患者累计发作次数差异有统计学意义[双阳组4.2次,单阳组4.0次,双阴组2.4次,x2=9.00,P=0.011]。双阳组患者累计发作次数最多。三组患者核MRI上胸髓及脑干病灶比例差异有统计学意义(χ~2=7.42,P=0.025;χ~2=7.55,P=0.023)。双阳组胸髓病灶比例高于双阴组[85.00%(17)vs.46.67%(7),χ~2=5.84,P=0.016];双阴组脑干病灶比例高于单阳组[60.00%(9)vs.20.00%(5),χ~2=6.59,P=0.010]。三组患者自身免疫病相关抗体[包括抗SSA抗体(Sjogren's syndrome A antibody,SSA-Ab)、抗SSB抗体(Sjogren's syndrome B antibody,SSB-Ab)、抗Ro-52抗体、甲状腺微粒体抗体(thyroid peroxidase antibody,TPO-Ab)、甲状腺球蛋白抗体(thyroglobulin antibody,TG-Ab)]阳性率差异有统计学意义[双阳组60.00%,单阳组24.00%,双阴组6.67%,χ~2=12.43,P=0.002)。双阳组患者自身免疫病相关抗体阳性率高于单阳组及双阴组(χ~2=6.00,P=0.014;χ~2=10.44,P=0.001)。三组之间神经功能状态评分差异有统计学意义[双阳组(4.15±1.822)分,单阳组(4.60±1.814)分,双阴组(2.97±1.642)分,F=4.021,P=0.023)]。单阳组EDSS评分高于双阴组(t=2.853,P=0.007)。结论血清AQP4抗体及脑脊液OB均阳性的NMOSD患者累计发作次数多,胸髓病灶比例高,脑干病灶比例低,易同时携带多种自身免疫病相关抗体。     

脑脊液MOG抗体阳性的视神经脊髓炎谱系疾病患者的临床特征

目的探讨MOG抗体阳性的NMOSD患者的临床特点。方法选择29例NMOSD患者,根据血清AQP-4抗体以及脑脊液MOG抗体检测结果,分为MOG抗体阳性、AQP4抗体阳性的NMOSD(剔除双阳性者),同时选择13例MS患者作为对照。回顾性分析上述三组患者临床信息,统计归纳其临床特点。结果 29例NMOSD患者中血清AQP4抗体阳性者11例,脑脊液MOG抗体阳性者8例。36.4%(4例/11例)AQP4抗体阳性、62.5%(5例/8例)MOG抗体阳性NMOSD患者,以及7.7%(1例/13例)MS患者合并脊髓炎与视神经炎,三组间差异有统计学意义(χ~2=7.128,P=0.028),其中MOG抗体阳性NMOSD患者较MS患者更易合并视神经炎(χ~2=7.289,P=0.014)。MOG抗体阳性NMOSD患者缓解期EDSS分数低于AQP4抗体阳性NMOSD患者[3.50(2.50,4.00),4.00(3.50,6.00),Z=-2.379,P=0.020]。MOG抗体阳性NMOSD脊髓病灶多表现为多发的长节段脊髓病灶,50%(4例/8例)MOG抗体阳性脊髓病灶个数大于1个,与MS组无明显差异,而AQP4抗体阳性组均为单个病灶。MOG抗体阳性NMOSD脊髓病灶长度较AQP4抗体阳性组短[分别(3(2,3)个椎体、4(3,5)个椎体,Z=-2.499,P=0.012],较MS组[(1.25(1,1.5)个椎体]长(Z=-3.447,P0.001)。8例MOG抗体阳性患者中5例存在颅内病灶,3例表现为NMOSD样颅内病灶,余2例表现为MS样颅内病灶,其病灶形态及部位与AQP4抗体阳性组无明显差异,而与MS组存在差异。结论 MOG抗体阳性NMOSD合并视神经炎的患者较多,临床残障程度较轻,预后较好,脊髓病灶为多发的长节段脊髓病灶;颅内病灶的形态及部位与MS无明显差异。     

视神经脊髓炎-IgG抗体阳性与阴性共存的视神经脊髓炎疾病谱一家系

视神经脊髓炎(neuromyelitis optica,NMO)早期被认为是多发性硬化(multiple sclerosis,MS)的特殊亚型.2004年发现水通道蛋白4( AQP4) IgG抗体后[1],大多数学者认为,NMO与MS发病机制不同,是一种独立的疾病,并且将NMO扩大为视神经脊髓炎疾病谱(NMO spectrum disorders,NMOSD),后者包括NMO、NMO限定型(单次或复发性长节段脊髓炎、复发性或双侧同时发生的视神经炎)、亚洲视神经脊髓型多发性硬化、伴有系统性自身免疫性疾病的视神经炎或长节段脊髓炎以及伴有NMO特征性脑部病灶(下丘脑、胼胝体、脑室旁或脑干)的视神经炎或脊髓炎[2].     

Pathogenic T cell responses against aquaporin 4

Inflammatory lesions in the central nervous system of patients with neuromyelitis optica are characterized by infiltration of T cells and deposition of aquaporin-4-specific antibodies and complement on astrocytes at the glia limitans. Although the contribution of aquaporin-4-specific autoantibodies to the disease process has been recently elucidated, a potential role of aquaporin-4-specific T cells in lesion formation is unresolved. To address this issue, we raised aquaporin-4-specific T cell lines in Lewis rats and characterized their pathogenic potential in the presence and absence of aquaporin-4-specific autoantibodies of neuromyelitis optica patients. We show that aquaporin-4-specific T cells induce brain inflammation with particular targeting of the astrocytic glia limitans and permit the entry of pathogenic anti-aquaporin-4-specific antibodies to induce NMO-like lesions in spinal cord and brain. In addition, transfer of aquaporin-4-specific T cells provoked mild (subclinical) myositis and interstitial nephritis. We further show that the expression of the conformational epitope, recognized by NMO patient-derived aquaporin-4-specific antibodies is induced in kidney cells by the pro-inflammatory cytokine gamma-interferon. Our data provide further support for the view that NMO lesions may be induced by a complex interplay of T cell mediated and humoral immune responses against aquaporin-4.     

Increased expression of water channel aquaporin 1 and aquaporin 4 in Creutzfeldt-Jakob disease and in bovine spongiform encephalopathy-infected bovine-PrP transgenic mice

Spongiform change is a cardinal feature in transmissible spongiform encephalopathies, including Creutzfeldt-Jakob disease (CJD) and bovine spongiform encephalopathy (BSE). It is characterized by swelling of the neuronal processes and vacuolization of the neuropil, leading to increased intraneuronal water content. The present study examines, by gel electrophoresis and Western blotting, the expression levels of the water channels aquaporin 1 (AQP1) and aquaporin 4 (AQP4) in the frontal cortex (area 8) homogenates of sporadic CJD cases (six men, four women; seven cases with methionine/methionine at codon 129 and PrP type 1; two cases with valine/valine at codon 129 and PrP type 2, and one case methionine/valine at codon 129 and PrP type 1) compared with age-matched controls, and cases with Alzheimer’s disease (AD, stage VI of Braak and Braak) and diffuse Lewy body disease (DLB). AQP1 and AQP4 protein levels were also studied in the cerebral cortex of BSE-infected bovine-PrP transgenic mice (BoPrP-Tg110 mice) examined at 60, 150, 210 and 270 days post-inoculation (dpi) compared with healthy brain-inoculated control mice. Quantitative densitometry of AQP bands normalized for β-actin was analyzed using Statgraphics plus 5.0 software from ANOVA and LSD statistical tests. Significant increased expression levels of AQP1 (as revealed with two different antibodies) and AQP4 were seen in CJD, but not in advanced AD and DLB cases when compared with controls. Immunohistochemistry revealed that AQP1 and AQP4 were expressed in astrocytes in diseased cases. No modifications in the expression levels of AQP1 and AQP4 were observed in BSE-infected bovine-PrP transgenic mice at 60, 150 and 210 dpi. However, a significant increase in the expression levels of AQP1 and AQP4 was found in mice at 270 dpi, the time corresponding with the appearance of PrP^res immunoreactivity in Western blots and typical spongiform lesions in the brain. Together, these findings show increased expression of water channels in the brain in human and animal prion diseases. These modifications may have implications in the regulation of water transport in astrocytes and may account for an imbalance in water and ion homeostasis in prion diseases.     

Linkage disequilibrium in aquaporin 4 gene and association study with schizophrenia

Aquaporin 4 (AQP4) has an important role in water homeostasis of human brain and a dysfunction of AQP4 could induce pathological conditions in neuronal activity. Several genome scan studies for schizophrenia found a suggestive linkage on 18q, where human AQP4 (18q11.2-12.1) is located nearby. A case-control study was performed which comprised 261 schizophrenia subjects and 278 controls from the Japanese population with four SNP markers. We found strong linkage disequilibrium (LD) and an LD block in the AQP4 gene but found no association between AQP4 and schizophrenia, both single SNP and haplotype analyses. The present study shows that AQP4 is not directly associated with schizophrenia in these Japanese patients.     

Viral regulation of aquaporin 4, connexin 43, microcephalin and nucleolin

The current study investigated whether human influenza viral infection in midpregnancy leads to alterations in proteins involved in brain development. Human influenza viral infection was administered to E9 pregnant Balb/c mice. Brains of control and virally-exposed littermates were subjected to microarray analysis, SDS-PAGE and western blotting at three postnatal stages. Microarray analysis of virally-exposed mouse brains showed significant, two-fold change in expression of multiple genes in both neocortex and cerebellum when compared to sham-infected controls. Levels of mRNA and protein levels of four selected genes were examined in brains of exposed mice. Nucleolin mRNA was significantly decreased in day 0 and day 35 neocortex and significantly increased in day 35 cerebellum. Protein levels were significantly upregulated at days 35 and 56 in neocortex and at day 56 in cerebellum. Connexin 43 protein levels were significantly decreased at day 56 in neocortex. Aquaporin 4 mRNA was significantly decreased in day 0 neocortex. Aquaporin 4 protein levels decreased in neocortex significantly at day 35. Finally, microcephalin mRNA was significantly decreased in day 56 neocortex and protein levels were significantly decreased at 56 cerebellum. These data suggest that influenza viral infection in midpregnancy in mice leads to long-term changes in brain markers for enhanced ribosome genesis (nucleolin), increased production of immature neurons (microcephalin), and abnormal glial-neuronal communication and neuron migration (connexin 43 and aquaporin 4).     

Enhanced expression of aquaporin 4 in human brain with infarction

A series of human brains with cerebral infarction obtained at autopsy were investigated to clarify the possible contribution of aquaporin 4 (AQP4) to the development of brain edema. Cellular localization of AQP4 and its relation to ischemic foci were examined with double-labeling immunohistochemistry. AQP4 immunoreactivity (IR) was more intense at the periphery of ischemic foci than at their center. Double-labeling study demonstrated that AQP4 IR was restricted to astrocytes and was localized to their entire processes, including their end feet facing the outer surface of capillaries. Moreover, AQP4 IR, detectable in the subpial and subependymal zone in the normal condition, was more intense in the vicinity of ischemic foci. Accumulation of AQP4 IR may reflect its participation in the development of brain edema in human brains by playing a role in the transport of water not only through blood vessel walls but also through pial and ependymal surface of the brain.     

Enhanced expression of aquaporin 4 in human brain with inflammatory diseases

Aquaporin 4 (AQP4), one of the water channel proteins on the plasma membrane of astrocytes, is up-regulated in various conditions with brain edema. Possible participation of AQP4 in various inflammatory lesions, more or less associated with edema, was examined in human autopsied brains. Immunohistochemistry was used to investigate AQP4 expression in autopsied brains with multiple sclerosis (MS), human immunodeficiency virus encephalitis (HIVE) or progressive multifocal leukoencephalopathy (PML). The cellular localization of AQP4 and its relation to inflammatory lesions were then examined with double-labeling immunohistochemistry. AQP4 immunoreactivity (IR) was restricted to astrocytes and localized to their entire processes, including their endfeet facing the abluminal surface of capillaries. In MS brains, AQP4-positive astrocytes were more abundant at the periphery of plaques than in their center, as seen in ischemic foci. Quantification of fluorescent signal demonstrated that AQP4 IR was greatly increased around plaques relative to that in unaffected area. Although the white matter was severely involved in HIVE and PML, AQP4-positive astrocytes were rare in the white matter even around perivascular active inflammatory foci. They were abundant in the gray matter and most prominent in the boundary between the gray and white matter, without apparent relation to inflammatory foci. Some bizarre astrocytes in PML exhibited AQP4 IR. Up-regulation of AQP4 was consistently found in astrocytes in various inflammatory lesions. However, the distribution of AQP4-positve astrocytes differed markedly according to disease and was not necessarily related to brain edema, indicating that functions and regulation of AQP4 in human brains are multiple.