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Loss of aquaporin-4 and GFAP in lesions of neuromyelitis optica: Immunohistochemical study

Background: Neuromyelitis optica (NMO) is an inflammatory disease mainly affecting optic and spinal cords, and was originally described by Devic in 1894. There has been a long controversy as to whether NMO is a variant of multiple sclerosis (MS) or a distinct disease. In Japan and Asian countries, relapsing NMO has been called as optic-spinal form of MS, but we reported in 2002 that optic-spinal MS was heterogeneous disease and comprised both typical NMO and MS with optic spinal presentation.1 Recently, a highly specific serum autoantibody marker, NMO-IgG, was found in the sera of Caucasian NMO and Japanese optic-spinal MS cases2, and the target antigen was identified as the water channel protein aquaporin-4 (AQP4).3 NMO-IgG has a 58% sensitivity and 100% specificity in optic-spinal MS, and a 73% sensitivity and 91% specificity in NMO.2 So in NMO and optic-spinal MS, similar autoimmune backgrounds were revealed. Pathologically, humoral immunity such as the perivascular deposition of immunoglobulin and complement together with dilated or hyalinized vessels were the dominant immuno-pathological features in the lesions of NMO.4 And we at the first time showed the loss of AQP4 in acute inflammatory lesions of NMO.5,6