title: BAFF/APRIL system in pediatric OMS: relation to severity, neuroinflammation, and immunotherapy.
abstract: BACKGROUND
  B-cell dysregulation has been implicated but not fully characterized in pediatric opsoclonus-myoclonus syndrome (OMS), a neuroblastoma-associated neuroinflammatory disorder.
  
  
  OBJECTIVE
  To assess the role of B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL), two critical B cell-modulating cytokines, as potential biomarkers of disease activity and treatment biomarkers in OMS.
  
  
  METHODS
  Soluble BAFF and APRIL were measured in cerebrospinal fluid (CSF) and serum by ELISA in 433 children (296 OMS, 109 controls, 28 other inflammatory neurological disorders (OIND)). BAFF-R receptors on circulating CD19+ B cells were measured by flow cytometry. A blinded scorer rated motor severity on the OMS Evaluation Scale. Immunotherapies were evaluated cross-sectionally and longitudinally.
  
  
  RESULTS
  The mean CSF BAFF concentration, which was elevated in untreated OMS and OIND, correlated with OMS severity category (P = 0.006), and reduction by adrenocorticotropic hormone or corticotropin (ACTH) (-61%) or corticosteroids (-38%) was seen at each level of severity. In contrast, CSF APRIL was normal in OMS and OIND and unaffected by immunotherapy. When the entire OMS dataset was dichotomized into 'high' versus 'normal' CSF BAFF concentration, the phenotype of the high group included greater motor severity and number of CSF oligoclonal bands, and a higher concentration of inflammatory chemokines CXCL13 and CXCL10 in CSF and CXCL9 and CCL21 in serum. Serum APRIL was 6.7-fold higher in the intravenous immunoglobulins (IVIg) group, whereas serum BAFF was 2.6-fold higher in the rituximab group. The frequency of B cell BAFF-R expression was similar in untreated and treated OMS. Longitudinal studies of CSF BAFF revealed a significant decline in ACTH-treated patients (with or without rituximab) (P < 0.0001). Longitudinal studies of serum APRIL showed a 2.9-fold increase after 1 to 2 g/kg IVIg monotherapy (P = 0.0003).
  
  
  CONCLUSIONS
  Striking distinctions in BAFF/APRIL signaling were found. OMS displayed heterogeneity in CSF BAFF expression, which met many but not all criteria as a potential biomarker of disease activity. We speculate that CSF BAFF may have more utility in a biomarker panel than as a stand-alone biomarker, and that the selective upregulation of both serum APRIL by IVIg and BAFF by rituximab, as well as downregulation of CSF BAFF by ACTH/steroids, may have utility as treatment biomarkers.
authors: Department of Neurology, National Pediatric Myoclonus Center and Neuroimmunology Laboratory, and Southern Illinois University School of Medicine, PO Box 19643, Springfield, IL 62794-9643, USA. mpranzatelli@siumed.edu
authors: Michael R
authors: MR
authors: Pranzatelli
authors: Elizabeth D
authors: ED
authors: Tate
authors: Nathan R
authors: NR
authors: McGee
authors: Anna L
authors: AL
authors: Travelstead
authors: Jerry A
authors: JA
authors: Colliver
authors: Jayne M
authors: JM
authors: Ness
authors: Richard M
authors: RM
authors: Ransohoff
mesh_terms: D000293:Adolescent; D053264:B-Cell Activating Factor / Q000097:blood* / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D007223:Infant; D018836:Inflammation Mediators / Q000097:blood* / Q000134:cerebrospinal fluid; D008137:Longitudinal Studies; D008297:Male; D053578:Opsoclonus-Myoclonus Syndrome / Q000097:blood* / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D012720:Severity of Illness Index; D053300:Tumor Necrosis Factor Ligand Superfamily Member 13 / Q000097:blood* / Q000134:cerebrospinal fluid
chemical_list: D053264:B-Cell Activating Factor; D015415:Biomarkers; D018836:Inflammation Mediators; C505719:TNFSF13B protein, human; D053300:Tumor Necrosis Factor Ligand Superfamily Member 13