NEUROMYELITIS OPTICA (NMO) SPECTRUM DISORDERSINCREASED SENSITIVITY AND SPECIFICITY WITH AQUAPORIN-4-IgG CELL-BINDING ASSAYS

WHAT IS NEUROMYELITIS OPTICA (NMO)?

Neuromyelitis optica (NMO) is an

inflammatory, demyelinating disease

of the central nervous system. NMO is

characterized by severe relapsing attacks

of optic neuritis and transverse myelitis.

Unlike the attacks associated with multiple

sclerosis, NMO attacks commonly spare

the brain in the early stages.

The spectrum of NMO was traditionally

restricted to the optic nerves and the

spinal cord. However, Mayo Clinic

physician Dr. Vanda Lennon discovered an

antibody called aquaporin-4 (AQP4), which

targets the water channel on astrocytes.

Since then, a much broader category

called “NMO spectrum” disorders has

evolved to include patients with:

} Single or recurrent episodes of optic neuritis who test positive for AQP4-IgG

} Single or recurrent episodes of transverse myelitis who test positive for AQP4-IgG

WHY TEST FOR NMO?

TO DIFFERENTIATE BETWEEN NMO AND MULTIPLE SCLEROSIS.} Although NMO spectrum disorders have very similar

clinical and radiologic characteristics to multiple sclerosis (MS), the diseases are treated very differently.

} A majority of NMO patients, typically women, are initially misdiagnosed with MS.

} While NMO is treated by immunosuppressant therapy, MS is treated by immunomodulation therapy, which may worsen NMO.

BECAUSE AN EARLY DIAGNOSIS CAN STOP THE DISABILITY.} Unlike MS, the neurological disability caused by

NMO spectrum disorders is based on the number of attacks rather than a progressive phase of the illness.

} Initiating therapy early in the course to eliminate recurrence of attacks will minimize patient disability.

} If not treated appropriately, within 5 years, 50% of NMO patients lose functional vision in at least 1 eye or are unable to walk.

MAYO MEDICAL LABORATORIES: YOUR PARTNER IN COMMUNITY LABORATORY MEDICINE

With a strong emphasis on patient care and community-based medicine, Mayo Medical Laboratories does more than deliver groundbreaking testing solutions. We con-nect you with world-renowned neurologists and labora-tory experts who help you work with your results every step of the way.

FOR MORE INFORMATION ABOUT DIAGNOSIS AND TREATMENT OF NMO, CONTACT US AT 855-516-8404

N E U R O L O G Y A T M A Y O C L I N I C

M A Y O M E D I C A L L A B O R A T O R I E S . C O M / N M O

CELL-BINDING ASSAY

ELISAINDIRECT

IMMUNOFLUORESCENCE

SENSITIVITY1 70–75% 60–65% 50–55%

SPECIFICITY >99% 99% >99%

NEW METHOD FOR TESTING AVAILABLE THROUGH MAYO MEDICAL LABORATORIES

Mayo Clinic studies, involving thousands of

patients, have found the cell-based AQP4

antibody assay to be more sensitive and

specific than ELISA methods. The improved

sensitivity and specificity of the AQP4 test

offered by Mayo Medical Laboratories will

assist clinicians in distinguishing early-stage

NMO spectrum disorders from MS.

WHEN SHOULD I ORDER THESE TESTS?

N E U R O M Y E L I T I S O P T I C A ( N M O ) S P E C T R U M D I S O R D E R T E S T I N G

THE LIKELIHOOD HAVING A FALSE-POSITIVE RESULT WITH ELISA METHODOLOGY IS AT LEAST 5X GREATER WHEN COMPARED WITH THE MAYO CLINIC CELL-BINDING ASSAY5x

� RECOMMENDED �

1. Waters PJ, McKeon A, Leite MI, et al: Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays. Neurology 2012 Feb 28;78(9):665-671

WHICH TESTS SHOULD I ORDER?} Neuromyelitis Optica (NMO)/Aquaporin-4-IgG

Cell-Binding Assay, Serum* (Mayo ID: NMOCS) TAT: 2 days negative / 3 days positive

* Serum is generally more sensitive than CSF for detection

of NMO/Aquaporin-4-IgG

} Neuromyelitis Optica (NMO)/Aquaporin-4-IgG Cell-Binding Assay, CSF (Mayo ID: NMOCC) TAT: 2 days negative / 3 days positive

LONG SPINAL CORD

LESION

CONSIDER ORDERING AQUAPORIN-4-IgG CELL-BINDING ASSAY

DEFINITELY ORDER AQUAPORIN-4-IgG

CELL-BINDING ASSAY

SHORT SPINAL CORD

LESION

SINGLE EPISODE OF

OPTIC NEURITIS

MULTIPLE EPISODES OF

OPTIC NEURITIS

C U S T O M E R S E R V I C E F O R C L I N I C A L S P E C I A L I S T S / 8 5 5 - 5 1 6 - 8 4 0 4

MC2775-80rev0316

@mayocliniclabs/mayocliniclabsnews.mayomedicallaboratories.commayomedicallaboratories.com

TAP INTO THE EXPERTISE OF MAYO CLINIC

The Mayo Clinic Neuroimmunology Laboratory

was the first to introduce comprehensive

serological evaluations to aid the diagnosis

of neurological autoimmunity. The laboratory

continues to discover and clinically validate novel

autoantibody profiles that inform neurological

decision-making and guide the search for cancer.

The clinical and research activities of the Mayo

Clinic Neuroimmunology Laboratory focus on

autoimmunity affecting the brain, optic nerve,

retina, spinal cord, autonomic and somatic nerves

and muscle. The neuroimmunology laboratory

complements Mayo Clinic’s Autoimmune

Neurology Clinic.

FOR MORE INFORMATION ABOUT AUTOIMMUNE NEUROLOGY TESTINGMayoMedicalLaboratories.com/NMO

LABORATORY DIRECTORS1 SEAN PITTOCK, M.D.2 ANDREW MCKEON, M.D.

CONSULTANTS3 CHRISTOPHER KLEIN, M.D.4 DANIEL LACHANCE, M.D.

NEUROLOGISTS STAFFING THE CLINICAL LABORATORY ARE AVAILABLE FOR CONSULTATION AND ASSISTANCE IN THE INTERPRETATION OF AUTOANTIBODY EVALUATIONS

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