Changes in B and T-cell subsets and NMO-IgG level… [Neurologia. 2014] – PubMed – NCBI.
Changes in B and T-cell subsets and NMO-IgG levels after immunoglobulins and rituximab treatment for an acute attack of neuromyelitis optica.
Author information
- 1Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: claradeandres@hotmail.com.
- 2Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, España.
- 3Servicio de Neurología, Hospital Clínico e Institut d́Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
- 4Servicio de Neuroradiología, Hospital General Universitario Gregorio Marañón, Madrid, España.
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.