Aquaporin-4 IgG: Overview and future perspectives
- Author:
Allan G Kermode
- Publication Type:Journal Article
- From:Neurology Asia
2008;13(1):179-183
- CountryMalaysia
- Language:English
-
Abstract:
The discovery of aquaporin-4 IgG in patients with demyelination is an exciting development. Initially
associated with the Devic’s phenotype, aquaporin-4 IgG has also been consistently found albeit less
frequently in tumefactive disease, encephalopathies, classical MS and by one group in GBS. Curiously the
cerebellum has the highest concentration of the target antigen, but remains the only part of the nervous
system yet to demonstrate “characteristic lesions” with aquaporin-4 IgG. Moreover there is tantalising
evidence that seropositivity is influenced by age, sex, and ancestral immunogenetic haplotypes. There
is no exclusive clinical or radiological feature of seropositivity, and prospective cohorts universally
find transitional cases. The use of teleological definitions is unhelpful and unscientific. Older detailed
pathological studies have documented changes of both neuromyelitis optica and multiple sclerosis in
the same individual, with both necrotising and classical lesions. Any hypothesis must accommodate
the above observations, amongst other problematic findings. A logical initial conclusion is that
demyelinating disease is a complex and extraordinarily heterogeneous process, and that aquaporin-4
IgG provides a new window into the disease. Crucially, the diagnostic and therapeutic implications
of aquaporin-4 IgG can only be ascertained with evidence from rigorous prospective clinical study in
different immunogenetic populations, and further pathological investigations are necessary.
- Full text:P020150901513911454768.pdf
