AUTHOR=Wang Jingqi , Cui Chunping , Lu Yaxin , Chang Yanyu , Wang Yuge , Li Rui , Shan Yilong , Sun Xiaobo , Long Youming , Wang Honghao , Wang Zhanhang , Lee Michael , He Shane , Lu Zhengqi , Qiu Wei , Tan Sha 

TITLE=Therapeutic Response and Possible Biomarkers in Acute Attacks of Neuromyelitis Optica Spectrum Disorders: A Prospective Observational Study

JOURNAL=Frontiers in Immunology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.720907

DOI=10.3389/fimmu.2021.720907

ISSN=1664-3224

ABSTRACT=<sec><title>Objective</title><p>To explore the outcomes of NMOSD attacks and investigate serum biomarkers for prognosis and severity.</p></sec><sec><title>Method</title><p>Patients with NMOSD attacks were prospectively and observationally enrolled from January 2019 to December 2020 at four hospitals in Guangzhou, southern China. Data were collected at attack, discharge and 1/3/6 months after acute treatment. Serum cytokine/chemokine and neurofilament light chain (NfL) levels were examined at the onset stage.</p></sec><sec><title>Results</title><p>One hundred patients with NMOSD attacks were included. The treatment comprised intravenous methylprednisolone pulse therapy alone (IVMP, 71%), IVMP combined with apheresis (8%), IVMP combined with intravenous immunoglobulin (18%) and other therapies (3%). EDSS scores decreased significantly from a medium of 4 (interquartile range 3.0–5.5) at attack to 3.5 (3.0–4.5) at discharge, 3.5 (2.0–4.0) at the 1-month visit and 3.0 (2.0–4.0) at the 3-month visit (p&lt;0.01 in all comparisons). The remission rate was 38.0% at discharge and 63.3% at the 1-month visit. Notably, relapse occurred in 12.2% of 74 patients by the 6-month follow-up. Higher levels of T helper cell 2 (Th2)-related cytokines, including interleukin (IL)-4, IL-10, IL-13, and IL-1 receptor antagonist, predicted remission at the 1-month visit (OR=9.33, p=0.04). Serum NfL levels correlated positively with onset EDSS scores in acute-phase NMOSD (p&lt;0.001, R<sup>2</sup> = 0.487).</p></sec><sec><title>Conclusions</title><p>Outcomes of NMOSD attacks were generally moderate. A high level of serum Th2-related cytokines predicted remission at the 1-month visit, and serum NfL may serve as a biomarker of disease severity at attack.</p></sec><sec><title>Clinical Trial Registration</title><p><uri xlink:href="https://clinicaltrials.gov/ct2/show/NCT04101058" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04101058</uri>, identifier NCT04101058.</p></sec>