Wang Xuying, Guo Ruoyi, Yao Zhichao, Liu Lu, Jia Zhen, Song Xiujuan, Li Bin
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, Shijiazhuang, China.
Front Immunol. 2025 Jun 11;16:1556259. doi: 10.3389/fimmu.2025.1556259. eCollection 2025.
Peripheral blood immune cell profiles of neuromyelitis optica spectrum disorder (NMOSD) are still unclear under different disease states and after B cell depletion therapy. Moreover, NMOSD is often confused with multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). The study aims to illustrate peripheral blood immune cell profiles of NMOSD under different disease states, after B cell depletion therapy, and compared with MS and MOGAD.
This study included 76 NMOSD patients, 20 MS patients, and 12 MOGAD patients in the acute phase, along with 37 controls whose sex and age were matched with NMOSD patients. Forty-two of 76 patients with acute NMOSD were followed in remission, of whom 13, 15, and 11 patients received rituximab treatment, inebilizumab treatment, or conventional immunosuppressive therapies alone, respectively. The levels of diverse peripheral blood immune cells were measured by blood routine examination and flow cytometry. Distinctions among groups were analyzed using statistical methods.
Compared with controls and NMOSD patients in remission, there was an elevation in the levels of neutrophils, platelets, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and systemic inflammation index in acute NMOSD patients, while a decline was observed in the levels of lymphocytes, eosinophils, basophils, CD3+ T cells, CD3+CD4+ T cells, and CD4/CD8 ratio. NMOSD had increased levels of platelets and platelet/lymphocyte ratio, and decreased levels of eosinophils, basophils, CD4/CD8 ratio, and CD3+CD4+ T cells compared with MS. NMOSD had decreased levels of eosinophils, basophils, and CD19+ B cells, along with elevated platelet/lymphocyte ratio compared with MOGAD. After rituximab treatment, not only did CD19+ B cell level decrease, but eosinophil counts also increased. After inebilizumab treatment, not only did CD19+ B cell level decrease, but also the ratios of CD3+ T cells and CD3+CD8+ T cells increased. The quantity and ratios of eosinophils in rituximab group surpassed those in inebilizumab group.
Peripheral blood immune cell profiles of acute NMOSD patients showed widespread distinctions compared to those of remission NMOSD patients, acute MS patients, acute MOGAD patients, and controls, as well as after differential therapies. Our findings provide clues to comprehensively understand the abnormality of the dynamic and integrated immune network in NMOSD, distinguish NMOSD from MS and MOGAD, and search for more effective and safe therapeutic targets.
视神经脊髓炎谱系障碍（NMOSD）在不同疾病状态下以及B细胞清除治疗后的外周血免疫细胞谱仍不清楚。此外，NMOSD常与多发性硬化症（MS）和髓鞘少突胶质细胞糖蛋白抗体病（MOGAD）相混淆。本研究旨在阐明NMOSD在不同疾病状态下、B细胞清除治疗后的外周血免疫细胞谱，并与MS和MOGAD进行比较。
本研究纳入了76例NMOSD患者、20例MS患者和12例急性期MOGAD患者，以及37名性别和年龄与NMOSD患者匹配的对照。76例急性NMOSD患者中有42例在缓解期进行了随访，其中13例、15例和11例患者分别接受了利妥昔单抗治疗、依奈西普治疗或单独的传统免疫抑制治疗。通过血常规检查和流式细胞术测量各种外周血免疫细胞的水平。使用统计方法分析组间差异。
与对照组和缓解期NMOSD患者相比，急性NMOSD患者的中性粒细胞、血小板、血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比值和全身炎症指数水平升高，而淋巴细胞、嗜酸性粒细胞、嗜碱性粒细胞、CD3+T细胞、CD3+CD4+T细胞水平和CD4/CD8比值下降。与MS相比，NMOSD患者的血小板和血小板/淋巴细胞比值升高，嗜酸性粒细胞、嗜碱性粒细胞、CD4/CD8比值和CD3+CD4+T细胞水平下降。与MOGAD相比，NMOSD患者的嗜酸性粒细胞、嗜碱性粒细胞和CD19+B细胞水平下降，血小板/淋巴细胞比值升高。利妥昔单抗治疗后，不仅CD19+B细胞水平下降，嗜酸性粒细胞计数也增加。依奈西普治疗后，不仅CD19+B细胞水平下降，CD3+T细胞和CD3+CD8+T细胞的比值也增加。利妥昔单抗组嗜酸性粒细胞的数量和比值超过依奈西普组。
急性NMOSD患者的外周血免疫细胞谱与缓解期NMOSD患者、急性MS患者、急性MOGAD患者和对照组相比，以及在不同治疗后均表现出广泛差异。我们的研究结果为全面了解NMOSD中动态和综合免疫网络的异常、将NMOSD与MS和MOGAD区分开来以及寻找更有效和安全的治疗靶点提供了线索。
