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Glial but not axonal protein biomarkers as a new supportive diagnostic criteria for Devic neuromyelitis optica? Preliminary results on 188 patients with different neurological diseases

Devic neuromyelitis optica (DNMO) is a severe demyelinating disease of the central nervous system (CNS). In 2004, Lennon et al described a new antibody, NMO–immunoglobulin G (IgG), which is highly specific (greater than 90%) and moderately sensitive (approximately 50%–80%) for patients with DNMO. NMO-IgG reacts with the water channel protein aquaporin 4 (AQP4), which is expressed in astrocytic foot processes. The precise mechanism by which NMO-IgG acts is not known, but complement activation leading to astrocytic necrosis has been shown. In this context, the description of several magnitudes of increased concentration of cerebrospinal fluid (CSF) glial fibrillar acidic protein (GFAP) in DNMO is intriguing.1 GFAP is a protein biomarker specific for astrocytosis and gliosis. 2 In multiple sclerosis (MS), CSF GFAP levels were only moderately elevated (see references in Petzold et al) compared with the findings in DNMO.1 This observation raises the question whether CSF GFAP levels have the potential to become an additional, sensitive diagnostic tool for diagnosing DNMO.

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