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Published on: December 1, 2023
Polyspecific, antiviral immune response distinguishes multiple sclerosis and neuromyelitis optica
S Jarius1, D Franciotta, R Bergamaschi
1Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany.
Background:
A polyspecific, intrathecal humoral immune response against neurotropic viruses such as measles, rubella and varicella zoster virus (MRZ reaction, MRZR) is present in 80-100% of patients with multiple sclerosis (MS), but has not to date been evaluated in patients with neuromyelitis optica (NMO).
Aims:
To evaluate whether MRZR distinguishes NMO and MS.
Methods:
20 patients with NMO and 42 with MS were included. The intrathecal synthesis of antibodies against measles, rubella and varicella zoster virus was detected by calculation of the respective antibody indices (AI).
Results:
A positive MRZ reaction, as defined by a combination of at least two positive AIs, was found in 37/42 MS, but in only 1/20 NMO patients (p<0.0001). Median AI values differed significantly between the groups (p<0.0005).
Conclusions:
The polyspecific antiviral humoral immune response characteristic for MS is widely missing in NMO, irrespective of the NMO-IgG status of the patients. Our findings further strengthen the case for NMO being pathologically distinct from MS.
Insights
The measles, rubella, and varicella zoster virus (MRZ) reaction, a marker common in multiple sclerosis (MS), is rarely found in neuromyelitis optica (NMO). This indicates NMO is a distinct neurological condition from MS.
Area of Science:
- Neuroimmunology
- Viral Immunology
- Neurology
Background:
- A polyspecific intrathecal humoral immune response against neurotropic viruses, known as the MRZ reaction (MRZR), is prevalent in 80-100% of multiple sclerosis (MS) patients.
- This immune response has not been previously evaluated in patients with neuromyelitis optica (NMO).
Purpose of the Study:
- To determine if the MRZ reaction (MRZR) can differentiate between neuromyelitis optica (NMO) and multiple sclerosis (MS).
Main Methods:
- The study included 20 patients diagnosed with NMO and 42 patients diagnosed with MS.
- Intrathecal antibody synthesis against measles, rubella, and varicella zoster virus was assessed using antibody indices (AI).
Main Results:
- A positive MRZ reaction (MRZR), defined by at least two positive antibody indices (AI), was observed in 37 out of 42 MS patients.
- In contrast, only 1 out of 20 NMO patients exhibited a positive MRZ reaction (MRZR), with statistically significant differences in median AI values between the two groups (p<0.0001 and p<0.0005).
Conclusions:
- The characteristic polyspecific antiviral humoral immune response seen in MS is largely absent in NMO patients, regardless of their NMO-IgG status.
- These findings strongly support NMO as a distinct pathological entity separate from MS.
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