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AAN 2023 | IgA: a new biomarker of demyelinating disease

Anne-Katrin Pröbstel, MD, University Hospital of Basel, University of Basel, Basel, Switzerland, discusses the use of IgA as a biomarker of demyelinating disease. One of the largest recent advancements has been the identification of aquaporin-4 (a water channel protein present in astrocytes) (AQP-4) and myelin oligodendrocyte glycoprotein (a protein found in the myelin sheath of neuronal cells) (MOG) IgG in patients with myelinating disease. These biomarkers are useful for treating patients with more tailored therapy according to their subgroup, as AQP-4 antibodies are often found in patients with neuromyelitis optica spectrum disorder (NMOSD), whilst MOG-IgG is found in cases of myelin oligodendrocyte glycoprotein antibody disorders (MOGAD). However, these biomarkers cannot sufficiently identify all subgroups of patients with demyelinating diseases, meaning that another biomarker is needed. Due to the autoimmune nature of different demyelinating diseases, experts believe that patients express high numbers of autoantibodies. In particular, IgA is produced by B-cells in mucosal linings such as the gut and lungs. IgA can be produced in response to the microbiota, which is a current topic of research in neuroimmunology. An assay has been developed to screen for these antibodies and can be used to identify a subset of patients that express IgA in the absence of AQP-4 and MOG-IgG. In the future, researchers hope to identify clinical features associated with these autoantibodies. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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