Changes in B and T-cell subsets and NMO-IgG levels after immunoglobulins and rituximab treatment for an acute attack of neuromyelitis optica.

Abstract

BACKGROUND:

There is increasing evidence supporting that neuromyelitis optica (NMO) is an inflammatory humoral mediated disorder associated with NMO-IgG/AQP-4 antibodies. However, little is known about the subsets of B cells and T cells that contribute to the pathogenesis or therapy response.

OBJECTIVES:

To describe the clinical and immunological changes associated with intravenous immunoglobulins (IV-Igs) plus rituximab (RTX) in a patient with a severe acute attack of NMO and intrathecal synthesis of NMO-IgG/AQP-4, who previously did not respond to intravenous methylprednisolone and plasma exchange.

METHODS:

We sequentially analysed the levels of NMO-IgG/AQP-4 by immunohistochemistry, and B and T cells subsets by multiparametric flow-cytometry, in the CSF and peripheral blood (PB), before and alter IV-Igs plus RTX therapy.

RESULTS:

In the CSF before treatment, and compared with PB, there was a higher percentage of CD4(+) T cells and a lower percentage of CD8(+) T cells and CD19(+) B cells. After therapy, the percentage of CD4(+) T cells remained high, and that of CD8(+) T cells increased. The observed decrease in the percentage of CD19(+) B cells was lower than in the PB. When the CSF was compared, it was found that the percentage of effector-memory and effector CD8(+) T cells had increased after therapy, and that of IgM memory B cells and switched-memory B cells decreased. The observed changes paralleled the decrease of NMO-IgG/AQP-4 results to negative and the clinical improvement.

CONCLUSIONS:

Our findings confirm that, besides intrathecal humoral immune response against AQP4, B and T cell subsets are involved in the modulation of inflammation within and outside the central nervous system.

• Authors: C de Andrés, R Teijeiro, A Saiz, P Fernández, S Sánchez-Ramón
• Journal: Neurologia (Barcelona, Spain) (Neurologia) Vol. 30 Issue 5 Pg. 276-82 (Jun 2015) ISSN: 1578-1968 [Electronic] Spain
• PMID: 24674779 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Chemical References

• AQP4 protein, human
• Aquaporin 4
• Autoantibodies
• Immunoglobulins, Intravenous
• Immunologic Factors
• Rituximab

Topics

• Adolescent
• Aquaporin 4 (immunology)
• Autoantibodies (blood)
• B-Lymphocyte Subsets (immunology)
• CD8-Positive T-Lymphocytes (immunology)
• Drug Therapy, Combination
• Female
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunologic Factors (therapeutic use)
• Neuromyelitis Optica (cerebrospinal fluid, drug therapy, immunology)
• Rituximab (therapeutic use)
• Spinal Cord (immunology, pathology)
• T-Lymphocyte Subsets (immunology)