TY - JOUR
T1 - Intractable Nausea and Vomiting From Autoantibodies Against a Brain Water Channel
AU - Iorio, Raffaele
AU - Lucchinetti, Claudia F.
AU - Lennon, Vanda A.
AU - Farrugia, Gianrico
AU - Pasricha, Pankaj J.
AU - Weinshenker, Brian G.
AU - Pittock, Sean J.
N1 - Funding Information:
Funding This study was supported by the Guthy-Jackson Charitable Foundation, the National Institutes of Health (grants RO1 NS065829 and DK071209 , and PO1 DK06855 ) and the Mayo Clinic Foundation, and was an ancillary study (AS09) of the Gastroparesis Clinical Research Consortium. The Gastroparesis Clinical Research Consortium is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073983 , U01DK073975 , U01DK074035 , U01DK073985 , U01DK074007 , U01DK073974 , and U01DK074008 ).
Funding Information:
Conflicts of interest These authors disclose the following: Dr Lucchinetti may accrue revenue for a patent re: Aquaporin (AQP)-4 associated antibodies for diagnosis of neuromyelitis optica; receives royalties from the publication of Blue Books of Neurology: Multiple Sclerosis 3 (Saunders Elsevier, 2010); and receives research support from the National Institutes of Health ( NS49577-R01 [principal investigator]), the Guthy Jackson Charitable Foundation (principal investigator), and the National MS Society ( RG 3185-B-3 [principal investigator]). Dr Lennon is named inventor on 2 patent applications filed by Mayo Foundation for Medical Education and Research that relate to NMO (aquaporin-4) antibody and its application to cancer and functional assays for detecting AQP4-IgG. A patent issued for technology related to NMO-IgG testing has been licensed to a commercial entity. Dr Lennon and Mayo Clinic have received royalties that exceed the federal threshold for significant financial interest from licensing of the above listed technology and have rights to receive future royalties. Serological testing for neural autoantibodies is offered on a service basis by Mayo Collaborative Service, Inc, an agency of Mayo Foundation. Neither Dr Lennon nor her laboratory benefit financially from this testing. Dr Lennon has received research support from the Guthy-Jackson Charitable Foundation and the National Institutes of Health ( R01 DK71209 and PO1 DK068055 ). Dr Pittock has received no royalties to date but may accrue revenue for patents regarding AQP4-associated antibodies for diagnosis of neuromyelitis optica and AQP4 autoantibody as a cancer marker. He has received research support from the Guthy-Jackson Charitable Foundation, Alexion Pharmaceuticals, Inc, and the National Institutes of Health ( RO1 NS065829 ). Dr Weinshenker serves on data safety monitoring boards for Novartis and Biogen Idec; serves on the editorial boards of the Canadian Journal of Neurological Sciences and the Turkish Journal of Neurology; has received research support from Genzyme Corporation and the Guthy-Jackson Charitable Foundation; and receives license royalties from RSR Ltd for a patent regarding AQP4-associated antibodies for diagnosis of neuromyelitis optica. The remaining authors disclose no conflicts.
PY - 2013/3
Y1 - 2013/3
N2 - Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.
AB - Background & Aims: Antibodies against the water channel protein aquaporin (AQP)-4 cause a spectrum of inflammatory, demyelinating, central nervous system disorders called neuromyelitis optica spectrum disorders (NMOSDs); these primarily affect the optic nerves and spinal cord but also the brain. Symptoms of intractable nausea, vomiting, and hiccups reflect involvement of AQP4 in the brainstem area postrema and account for gastroenterological presentations. We investigated the frequency of intractable nausea, vomiting, or hiccups in patients with NMOSD who tested positive for immunoglobulin G against AQP4 (AQP4-IgG). We also analyzed sera from patients with idiopathic nausea or vomiting for the presence of AQP4-IgG. Methods: We reviewed the Mayo Clinic AQP4-IgG positive NMOSD database (n = 70) to identify patients who presented with vomiting, focusing on results from gastroenterological evaluations. We also tested serum samples (from the Gastroparesis Clinical Research Consortium repository) from patients who presented with idiopathic nausea or vomiting for AQP4-IgG (controls, n = 318 with gastroparesis and 117 without gastroparesis). Results: Ten AQP4-IgG-positive patients diagnosed with NMOSD (14% of patients in the database) initially presented with intractable vomiting. Extensive gastroenterological evaluation was noninformative. AQP4-IgG was not detected in any of the controls. Conclusions: Although NMOSDs are rare, tests for AQP4-IgG should be considered for patients who present with unexplained, intractable vomiting. Detection of the antibody before the development of optic neuritis or transverse myelitis allows patients to receive immunosuppressive therapy before the development of neurologic disabilities.
KW - Aquaporin-4 Antibody
KW - Central Nervous System
KW - Chronic Nausea and Vomiting
KW - Diagnosis
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U2 - 10.1016/j.cgh.2012.11.021
DO - 10.1016/j.cgh.2012.11.021
M3 - Article
C2 - 23211959
AN - SCOPUS:84874564556
SN - 1542-3565
VL - 11
SP - 240
EP - 245
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -