Immunological follow-up of patients with neuromyelitis optica: Is there a good biomarker?

A serial assessment of biomarkers related to disease activity could be clinically useful in some autoimmune diseases. Neuromyelitis optica (NMO) is a severe inflammatory disease of the optic nerves and spinal cord that can be associated with lupus erythematosus, Sjogren syndrome or myasthenia gravis. In this review, we discuss the existing data on the use of biomarkers of disease activity in NMO. A specific and pathogenic antibody (Ab) directed against aquaporin 4 (AQP4) was recently discovered in this disease. The relapses were frequently accompanied by a rise and immunosuppressive therapy by a decrease in serum anti-AQP4 Ab concentrations. However, this association is not strong enough to justify treatment changes based only on anti-AQP4 Ab level variations. This parameter might be helpful as a longitudinal biomarker but only if a threshold inducing a relapse and justifying a switch in therapy can be established. A link between disease severity and serum cytotoxicity against AQP4-expressing cells was proposed but has not yet been confirmed. Finally, the assessment of T cell immunity against AQP4 and specific cytokines could be future directions for research. Lupus (2013) 22, 229-232.