视神经脊髓炎谱系疾病的免疫治疗策略

doi:10.3969/j.issn.1006-9771.2018.08.021

Abstract

Abstract: This paper assembled immunotherapy methods for neuromyelitis optica spectrum disorder (NMOSD) in recent years, including the treatment of acute stage, the prevention of relapse and the potential immunotherapy. The treatment of acute stage is mainly to inhibit inflammatory response and reduce aquaporin 4 (AQP4) antibody(Ab) titer, and this is done mainly by using high-dose hormone shock therapy and plasmapheresis. Remission treatment is to inhibit the proliferation of T cells and B cells and also remove B cells from the body, for the purpose of reducing the number of relapses. Azathioprine, rituximab and mycophenolate mofetil are mainly given during remission stage. The treatment of NMOSD will become more targeted/specific in the future. The mechanism of action of the new drug is mainly through blocking the binding of pathogenic AQP4-Ab and its antigen (Ag), reducing the generation of pathogenic AQP4-Ab, and blocking the downstream reaction after pathogenic Ab-Ag binding. The new drugs mainly include aquaporumab, tocilizumab, DNA vaccine, anti-CD₁₉ monoclonal Ab (MEDI-551), eculizumab and bevacizumab.

Key words: neuromyelitis optica spectrum disorder, aquaporin 4, immunotherapy

CLC Number:

R744.5

FANG Li-bo, LIU Guang-zhi, XUE Ying-hong. Immunotherapy Strategies for Neuromyelitis Optica Spectrum Disorder[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(8): 987-992.

References

[1] Lennon VA, Kryzer TJ, Pittock SJ, et al.IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel[J]. J Exp Med, 2005, 202(4): 473-477.
[2] Wingerchuk DM, Banwell B, Bennell JL, et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2): 177-189.
[3] 王月彩,檀国军,王程晓. 神经脊髓炎谱系疾病的治疗现状及进展[J]. 临床荟萃, 2016, 31(10): 1155-1160.
[4] Liao MF, Chang KH, Lye RK, et al.Comparison between the cranial magnetic resonance imaging features of neuromyelitis optica spectrum disorder versus multiple sclerosis in Taiwanese patients[J]. BMC Neurol, 2014, 14: 218.
[5] Wingerchuk DM, Banwel LB, Bennrtt JL, et al.International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2): 177-189.
[6] Waters P, Woodhall M, O'Connor KC, et al. MOG cell-based assay detects non-MS patients with inflammatory neurologic disease[J]. Neurol Neuroimmunol Neuroinflamm, 2015, 2(3): e89.
[7] Höftberger R, Sepulveda M, Armangue T, et al.Antibodies to MOG and AQP4 in adults with neuromyelitis optica and suspected limited forms of the disease[J]. Multiple Sclerosis, 2015, 21(7): 866-874.
[8] Papadopoulos MC, Bennett JI, Verkman AS.Treatment of neuromyelitis optica: state-of-the-art and emerging therapies[J]. Nat Rev Neu, 2014, 10(9): 493-506.
[9] Kimbrough DJ, Fujihara K, Jacob A, et al.Treatment of neuromyelitis optica: review and recommendations[J]. Mult Scler Relat Disord, 2012, 1(4): 180-187.
[10] Torres J, Pruitt A, Balcer L, et al.Analysis of the treatment of neuromyelitis optica[J]. J Neurol Sci, 2015, 351(1-2): 29-36.
[11] Yamasaki R, Matsushita T, Fukazawa T, et al.Efficacy of intravenous methylprednisolone pulse therapy in patients with multiple sclerosis and neuromyelitis optica[J]. Mult Scler, 2015, 22(10): 1337-1348.
[12] 叶静. 视神经脊髓炎[M]//刘广志. 多发性硬化. 北京:北京大学医学出版社, 2012: 245-246.
[13] Kim SH, Kim W, Huh SY, et al.Clinical efficacy of plasmapheresis in patients with neuromyelitis optica spectrum disorder and effects on circulating anti-aquaporin-4 antibody levels[J]. J Clin Neurol, 2013, 9(1): 36-42.
[14] Lim YM, Pyun SY, Kang BH, et al.Factors associated with the effectiveness of plasma exchange for the treatment of NMO-IgG-positive neuromyelitis optica spectrum disorders[J]. Mult Scler, 2013, 19(9): 1216-1218.
[15] Viswanathan S, Wong AHY, Quek AML, et al.Intravenous immunoglobulin may reduce relapse frequency in neuromyelitis optica[J]. J Neuroimmunol, 2015, 282: 92-96.
[16] Kleiter I, Gold R.Present and future therapies in neuromyelitis optica spectrum disorders[J]. Neurotherapeutics, 2015, 13(1): 70-83.
[17] Wei Q, Kermode AG, Rui L, et al.Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica[J]. J Clin Neuro Soci, 2015, 22(7): 1178-1182.
[18] Chen H, Zhang Y, Shi Z, et al.The efficacy and tolerability of mycophenolate mofetil in treating neuromyelitis optica and neuromyelitis optica spectrum disorder in western China[J]. Clin Neuropharmacol, 2016, 39(2): 81-87.
[19] Rommer PS, Dörner T, Freivogel K, et al.Safety and clinical outcomes of rituximab treatment in patients with multiple sclerosis and neuromyelitis optica: experience from a National Online Registry (GRAID)[J]. J Neuroimmune Pharmacol, 2015, 11(1): 1-8.
[20] Trebst C, Jarius S, Berthele A, et al.Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group(NEMOS)[J]. J Neurol, 2014, 261(1): 1-16.
[21] Yang CS, Yang L, Li T, et al.Responsiveness to reduced dosage of rituximab in Chinese patients with neuromyelitis optica[J]. Neurology, 2013, 81(8): 710-713.
[22] Kitley J, Elsone L, George J, et al.Methotrexate is an alternative to azathioprine in neuromyelitis optica spectrum disorders with aquaporin -4 antibodies[J]. J Neurol Neurosurg Psychiatry, 2013, 84: 918-921.
[23] Vodopivec I, Matiello M, Prasad S.Treatment of neuromyelitis optica[J]. Curr Opin Ophthalmol, 2015, 26(6): 476-483.
[24] Palace J, Leite MI, Nairne A, et al.Interferon Beta treatment in neuromyelitis optica:increase in relapses and aquaporin 4 antibody titers[J]. Arch Neurol, 2010, 67(8): 1016-1017.
[25] Miyazaki K, Abe Y, Iwanari H, et al.Establishment of monoclonal antibodies against the extracellular domain that block binding of NMO-IgG to AQP4[J]. J Neuroimmunol, 2013, 260(1-2): 107-116.
[26] Wang H, Wang K, Wang C, et al.Cerebrospinal fluid highmobility group box protein 1 in neuromyelitis optica and multiple sclerosis[J]. Neuroimmunomodulation, 2013, 20(2): 113-118.
[27] Varrin-Doyer M, Spencer CM, Schulze-Topphoff U, et al.Aquaporin 4-specific T cells in neuromyelitis optica exhibit a Th17 bias and recognize Clostridium ABC transporter[J]. Ann Neurol, 2012, 72(1): 53-64.
[28] Ayzenberg I, Kleiter I, Schröder A, et al.Interleukin 6 receptor blockade in patients with neuromyelitis optica nonresponsive to anti-CD₂₀ therapy[J]. JAMA Neurol, 2013, 70(3): 394-397.
[29] Kieseier BC, Stüve O, Dehmel T, et al.Disease amelioration with tocilizumab in a treatment-resistant patient with neuromyelitis optica: implication for cellular immune responses[J]. JAMA Neurol, 2013, 70(3): 390-393.
[30] Patrick A, Jamma L, Chris A, et al.Resolution of aquaporin-4 antibodies in a woman with neuromyelitis optica treated with human autologous stem cell transplant[J]. J Clin Neurosci, 2015, 22: 1215-1217.
[31] Pittock SJ, Lennon VA, McKcon A, et al. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study[J]. Lancet Neurol, 2013, 12(6): 554-562.
[32] Uzawa A, Mori M, Uchida T, et al.Increased levels of CSF CD₅₉ in the long-term course of neuromyelitis optica[J]. Clin Chim Acta, 2016, 453: 131-133.
[33] Saadoun S, Waters P, MacDonald C, et al. Neutrophil protease inhibition reduces neuromyelitis optica-immunoglobulin G-induced damage in mouse brain[J]. Ann Neurol, 2012, 71: 323-333.
[34] Zhang H, Verkman AS.Eosinophil pathogenicity mechanisms and therapeutics in neuromyelitis optica[J]. J Clin Invest, 2013, 123(5): 2306-2316.
[35] Kemp K, Redondo J, Hares K, et al.Oxidative injury in multiple sclerosis cerebellar grey matter[J]. Brain Res, 2016, 1642: 452-460.
[36] Mealy MA, Shin K, John G, et al.Bevacizumab is safe in acute relapses of neuromyelitis optica[J]. Clin Exp Neuroimmunol, 2015, 6(4): 413-418.
[37] Papadopoulos MC, Bennett JL, Verkman AS.Treatment of neuromyelitis optica: state-of-the-art and emerging therapies[J]. Nat Rev Neurol, 2014, 10(9): 493-506.

Immunotherapy Strategies for Neuromyelitis Optica Spectrum Disorder

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 8

Metrics

Comments

Recommended 0

[1]	CHEN Tie-ge, GUO Yong-qiang, WANG Ming, ZHANG Dong-liang, XIA Ya-yi, WANG Jing, WU Ya-min, DANG Yue-xiu, ZHANG Hai-hong. Expression and Change of Microtubule, Aquaporins-4 and K⁺ Ion Channel Protein-4.1 after Spinal Cord Injury in Rats [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(10): 1151-1158.
[2]	XU Li-xin, DONG Li-ping, SHI Zhong-fang, YAN Xu, YANG Shao-hua, YUAN Fang. Expression of Aquaporin 4 in Astrocytes of Rats in Vitro [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(9): 1051-1055.
[3]	XU Qian;SUN Zhen-rong;LI Gui-lin;et al.. Loss of Perivascular Aquaporin 4 and Inwardly Rectifying Potassium Channel 4.1 in Human Mesial Temporal Lobe Epilepsy [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2012, 18(3): 215-218.
[4]	LU Yang;SHI Zhong-fang;YUAN Fang;et al.. Glutamate-induced Dynamic Expression of Aquaporin 4 in Cultured Rat Astrocytes [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2010, 16(1): 29-31.
[5]	SHI Zhong-fang;YUAN Fang. Advance in Regulation of Expression of Brain Aquaporin 4 (review) [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2007, 13(08): 724-726.
[6]	SONG Ge;YUAN Mei;CUI Xue-mei;et al. Combined Therapy with Mixed Heat Shock Protein/Peptide Vaccine and Interleukin-12 Results in Enhanced Antitumor Effects [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2007, 13(03): 252-254.
[7]	CUI Xiang-ning;YIN Ling;WANG Yu-lai. Effect of aquaporin 4 on traumatic brain edema [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2005, 11(09): 719-721.
[8]	JIA Xin;LI Rong;XU Ying-xin;et al. Effect of dendritic cells sensitized by tumor cells lysates on the murine breast cancer [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2004, 10(02): 79-81.