Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology

Elia Sechi, Eslam Shosha, Jonathan P. Williams, Sean J Pittock, Brian G Weinshenker, B Mark Keegan, Nicholas L. Zalewski, Alfonso Sebastian Lopez-Chiriboga, Jiraporn Jitprapaikulsan, Eoin Flanagan

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Diagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)-immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM. METHODS: For this observational study, we retrospectively identified all cases of incident (January 1, 2003-December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85% white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG. RESULTS: Twenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92%) and MOG-IgG in 21 of 24 (88%). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14% of total incident and 12% of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50% (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14%) subsequently fulfilled multiple sclerosis criteria within the study period. CONCLUSIONS: The availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.

Original languageEnglish (US)
Pages (from-to)e414-e420
JournalNeurology
Volume93
Issue number4
DOIs
StatePublished - Jul 23 2019

Fingerprint

Myelin-Oligodendrocyte Glycoprotein
Transverse Myelitis
Aquaporin 4
Autoantibodies
Epidemiology
Immunoglobulin G
Incidence
Medical Record Linkage
Prednisolone
Serum

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology. / Sechi, Elia; Shosha, Eslam; Williams, Jonathan P.; Pittock, Sean J; Weinshenker, Brian G; Keegan, B Mark; Zalewski, Nicholas L.; Lopez-Chiriboga, Alfonso Sebastian; Jitprapaikulsan, Jiraporn; Flanagan, Eoin.

In: Neurology, Vol. 93, No. 4, 23.07.2019, p. e414-e420.

Research output: Contribution to journalArticle

Sechi, E, Shosha, E, Williams, JP, Pittock, SJ, Weinshenker, BG, Keegan, BM, Zalewski, NL, Lopez-Chiriboga, AS, Jitprapaikulsan, J & Flanagan, E 2019, 'Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology', Neurology, vol. 93, no. 4, pp. e414-e420. https://doi.org/10.1212/WNL.0000000000007828
Sechi, Elia ; Shosha, Eslam ; Williams, Jonathan P. ; Pittock, Sean J ; Weinshenker, Brian G ; Keegan, B Mark ; Zalewski, Nicholas L. ; Lopez-Chiriboga, Alfonso Sebastian ; Jitprapaikulsan, Jiraporn ; Flanagan, Eoin. / Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology. In: Neurology. 2019 ; Vol. 93, No. 4. pp. e414-e420.
@article{d3ffa1a21f4f4aa2b53c930549b93125,
title = "Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology",
abstract = "OBJECTIVE: Diagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)-immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM. METHODS: For this observational study, we retrospectively identified all cases of incident (January 1, 2003-December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85{\%} white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG. RESULTS: Twenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92{\%}) and MOG-IgG in 21 of 24 (88{\%}). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14{\%} of total incident and 12{\%} of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50{\%} (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14{\%}) subsequently fulfilled multiple sclerosis criteria within the study period. CONCLUSIONS: The availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.",
author = "Elia Sechi and Eslam Shosha and Williams, {Jonathan P.} and Pittock, {Sean J} and Weinshenker, {Brian G} and Keegan, {B Mark} and Zalewski, {Nicholas L.} and Lopez-Chiriboga, {Alfonso Sebastian} and Jiraporn Jitprapaikulsan and Eoin Flanagan",
year = "2019",
month = "7",
day = "23",
doi = "10.1212/WNL.0000000000007828",
language = "English (US)",
volume = "93",
pages = "e414--e420",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Aquaporin-4 and MOG autoantibody discovery in idiopathic transverse myelitis epidemiology

AU - Sechi, Elia

AU - Shosha, Eslam

AU - Williams, Jonathan P.

AU - Pittock, Sean J

AU - Weinshenker, Brian G

AU - Keegan, B Mark

AU - Zalewski, Nicholas L.

AU - Lopez-Chiriboga, Alfonso Sebastian

AU - Jitprapaikulsan, Jiraporn

AU - Flanagan, Eoin

PY - 2019/7/23

Y1 - 2019/7/23

N2 - OBJECTIVE: Diagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)-immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM. METHODS: For this observational study, we retrospectively identified all cases of incident (January 1, 2003-December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85% white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG. RESULTS: Twenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92%) and MOG-IgG in 21 of 24 (88%). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14% of total incident and 12% of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50% (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14%) subsequently fulfilled multiple sclerosis criteria within the study period. CONCLUSIONS: The availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.

AB - OBJECTIVE: Diagnostic criteria from 2002 classify transverse myelitis (TM) as idiopathic or disease associated but predate the discovery of aquaporin-4 (AQP4)-immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG, which associate with TM. Prior incidence estimates of idiopathic TM (ITM) range from 1 to 6.2 per 1 million. We sought to determine whether the population-based incidence and prevalence of ITM were reduced by testing patients with ITM for AQP4/MOG-IgG and reclassifying seropositive cases as having disease-associated TM. METHODS: For this observational study, we retrospectively identified all cases of incident (January 1, 2003-December 31, 2016) and prevalent (December 31, 2016) ITM in Olmsted County (85% white) by using the Rochester Epidemiology Project medical records linkage system. ITM was defined by the 2002 Transverse MyelitisConsortium Working Group diagnostic criteria. Available sera were tested for AQP4-IgG and MOG-IgG. RESULTS: Twenty-four patients (incident 22, prevalent 17) initially met 2002 ITM criteria (longitudinally extensive TM [LETM] 6). Sera were tested for AQP4-IgG in 22 of 24 (92%) and MOG-IgG in 21 of 24 (88%). Three seropositive cases (AQP4-IgG 2, MOG-IgG 1) were identified and reclassified as having disease-associated TM, accounting for 14% of total incident and 12% of total prevalent cases. AQP4-IgG and MOG-IgG seropositive cases represented 50% (3 of 6) of idiopathic LETM. After reclassification of seropositive patients, the final ITM incidence was 8.6 per 1,000,000 and prevalence was 7.9 per 100,000. Three cases of ITM (14%) subsequently fulfilled multiple sclerosis criteria within the study period. CONCLUSIONS: The availability of AQP4-IgG and MOG-IgG modestly reduced ITM incidence and prevalence, which remained higher than previously reported in this predominantly white population. Incorporation of these biomarkers into future revisions of TM diagnostic criteria should be considered.

UR - http://www.scopus.com/inward/record.url?scp=85070183198&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070183198&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000007828

DO - 10.1212/WNL.0000000000007828

M3 - Article

VL - 93

SP - e414-e420

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 4

ER -