Misu T, Takano R, Fujihara K, Takahashi T, Sato S, Itoyama Y
Department of Neurology, Tohoku University Graduate School of Medicine, Aobaku, Sendai, Japan.
J Neurol Neurosurg Psychiatry. 2009 May;80(5):575-7. doi: 10.1136/jnnp.2008.150698.
Neuromyelitis optica (NMO) is a neurological inflammatory disease associated with autoimmunity to aquaporin 4, predominantly localised in astrocytic foot processes. Recent studies have revealed that loss of aquaporin 4 and glial fibrillar acidic protein (GFAP) is a prominent feature of NMO lesions, suggesting astrocytic impairment.
To reveal a useful clinical biomarker of NMO.
Enzyme-linked immunosorbent assays were carried out for astrocytic markers GFAP and S100B in CSFs, obtained from the patients with NMO (n = 10) and multiple sclerosis (MS) (n = 10) manifesting acute myelitis, acute disseminated encephalomyelitis (ADEM) (n = 3), spinal infarction (n = 3), and other neurological diseases (OND) (n = 5).
The CSF-GFAP levels during relapse in NMO (7666.0 (SD 15 266.5) ng/ml) were significantly over several thousand times higher than those in MS (0.7 (1.5)) or OND (0.6 (0.3)), and considerably higher than those in spinal infarction (354.7 (459.0)) and ADEM (0.4 (0.2)). They returned close to normal levels along with clinical improvement soon after corticosteroid therapy in NMO. There were strong correlations between the CSF-GFAP or S100B levels and expanded disability status scales or spinal lesion length in NMO (r>0.9).
CSF-GFAP and S100B may be clinically useful biomarkers in NMO, and astrocytic damage is strongly suggested in the acute phase of NMO.
视神经脊髓炎（NMO）是一种与水通道蛋白4自身免疫相关的神经炎症性疾病，主要定位于星形胶质细胞足突。最近的研究表明，水通道蛋白4和胶质纤维酸性蛋白（GFAP）的缺失是NMO病变的一个显著特征，提示星形胶质细胞受损。
揭示一种有用的NMO临床生物标志物。
对10例表现为急性脊髓炎的NMO患者、10例多发性硬化（MS）患者、3例急性播散性脑脊髓炎（ADEM）患者、3例脊髓梗死患者及5例其他神经系统疾病（OND）患者的脑脊液进行星形胶质细胞标志物GFAP和S100B的酶联免疫吸附测定。
NMO复发时脑脊液GFAP水平（7666.0（标准差15266.5）ng/ml）比MS（0.7（1.5））或OND（0.6（0.3））高出数千倍，且显著高于脊髓梗死（354.7（459.0））和ADEM（0.4（0.2））。NMO患者在接受皮质类固醇治疗后，随着临床症状改善，脑脊液GFAP水平很快恢复到接近正常水平。NMO患者脑脊液GFAP或S100B水平与扩展残疾状态量表或脊髓病变长度之间存在强相关性（r>0.9）。
脑脊液GFAP和S100B可能是NMO临床上有用的生物标志物，强烈提示NMO急性期存在星形胶质细胞损伤。
