Highlights
- •This study evaluated CSF neopterin in patients with CNS demyelinating diseases.
- •CSF neopterin levels were significantly higher in AQP4-IgG-positive NMOSD than MS.
- •CSF neopterin levels tended to be higher in MOGAD compared with MS.
- •CSF neopterin accurately discriminated active and inactive phases of the disease.
Abstract
Background
There is some phenotypic overlap between MS, AQP4-IgG positive NMOSD, and MOG-IgG
associated disease (MOGAD), and distinguishing a true relapse and a pseudorelapse
can be difficult. CSF neopterin, a marker of inflammation-immune-mediated processes
in the CNS, may be a useful marker in a wide range of CNS infectious and inflammatory
diseases. We compared CSF neopterin levels and other CSF parameters in patients with
MS, AQP4-IgG-positive NMOSD, and MOGAD and also investigated whether CSF neopterin
levels can distinguish between active and inactive phases of the diseases.
Methods
We retrospectively reviewed the medical records of 22 patients with MS, 18 with AQP4-IgG-positive
NMOSD, and five with MOGAD. CSF neopterin concentrations were measured by HPLC with
fluorometric detection.
Results
CSF neopterin levels at diagnosis were significantly higher in patients with AQP4-IgG-positive
NMOSD (52.77 ± 34.56 pmol/mL) than patients with MS (16.92 ± 5.03 pmol/mL, p < 0.001), and tended to be higher in patients with MOGAD (28.87 ± 9.66 pmol/mL) than
patients with MS (p = 0.092). ROC analysis revealed that CSF neopterin most accurately discriminated
between MS and AQP4-IgG-positive NMOSD (AUC, 0.912; sensitivity, 75.0%; specificity,
100.0%). At diagnosis/relapse and during remission, CSF neopterin most accurately
discriminated between the disease phases in patients with MS (AUC, 0.779; sensitivity,
58.1%; specificity, 94.7%) and patients with AQP4-IgG-positive NMOSD (AUC, 0.934;
sensitivity, 83.3%; specificity, 94.1%).
Conclusion
Measurement of CSF neopterin may be useful for differential diagnosis and assessment
of disease activity in CNS demyelinating diseases. Further studies with larger cohorts,
including comparisons with other biomarkers, are needed to validate the utility of
CSF neopterin.
Keywords
Abbreviations:
AQP4 (aquaporin-4), CNS (central nervous system), CSF (cerebrospinal fluid), HPLC (high-performance liquid chromatography), MOG (myelin oligodendrocyte glycoprotein), MS (multiple sclerosis), NMOSD (neuromyelitis optica spectrum disorder), ROC (receiver operating characteristic.)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 18, 2022
Accepted:
August 15,
2022
Received in revised form:
August 8,
2022
Received:
June 5,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
