title: Standardized method for the detection of antibodies to aquaporin-4 based on a highly sensitive immunofluorescence assay employing recombinant target antigen.
abstract: BACKGROUND
  Recently, a highly specific serum autoantibody was discovered in patients with neuromyelitis optica, called NMO-IgG, and aquaporin-4, the most abundant water channel in the CNS, was identified as the target antigen. Several assays for the detection of NMO-IgG/AQP4-Ab have been described. Tests based on recombinant human AQP4 have been repeatedly demonstrated to be more sensitive than the previous gold standard assay, i.e. immunohistochemistry (IHC) on mouse brain tissue. However, the sophisticated techniques applied restrict their availability to few laboratories worldwide.
  
  
  OBJECTIVE
  To develop an easy-to-use, recombinant immunofluorescence assay (rIFA) suitable for standardized and high-throughput detection of NMO-IgG/AQP4-Ab.
  
  
  METHODS
  HEK293 cells seeded on cover glasses were transfected with full-length recombinant human AQP4 at large scale. Cover glasses with the immobilized cells were cut into millimetre-sized fragments and transferred to microscopy slides. 151 serum samples from patients with NMO spectrum disorders (NMOSD) and controls were analysed both in the standard IHC assay and in the newly developed rIFA.
  
  
  RESULTS
  25/32 (78.1%) patients with clinically definite NMO and 36/51 (70.6%) of total patients with NMOSD were positive for NMO-IgG/AQP4-Ab in the rIFA compared to 65.6% and 58.8%, respectively, in the IHC assay.
  
  
  CONCLUSIONS
  The recombinant IFA presented here provides laboratories familiar with indirect immunofluorescence microscopy with a highly sensitive and reproducible diagnostic tool for standardized detection of antibodies to AQP4. This new approach could make AQP4-Ab testing, which is of high clinical relevance, more widely available.
authors.affiliation: Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Jarius
authors.forename: C
authors.initials: C
authors.lastname: Probst
authors.forename: K
authors.initials: K
authors.lastname: Borowski
authors.forename: D
authors.initials: D
authors.lastname: Franciotta
authors.forename: B
authors.initials: B
authors.lastname: Wildemann
authors.forename: W
authors.initials: W
authors.lastname: Stoecker
authors.forename: K P
authors.initials: KP
authors.lastname: Wandinger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D002460:Cell Line; D005260:Female; D005455:Fluorescent Antibody Technique / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D008297:Male; D051379:Mice; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000097:blood / Q000276:immunology; D009471:Neuromyelitis Optica / Q000097:blood / Q000276:immunology; D009902:Optic Neuritis / Q000097:blood / Q000276:immunology; D011994:Recombinant Proteins / Q000276:immunology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D011994:Recombinant Proteins