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Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay

OBJECTIVE: Aquaporin-4 (AQP4) serum autoantibodies are detected by a variety of methods. The highest sensitivity is achieved with cell-based assays, but the enzyme-linked immunosorbent assay (ELISA) is still commonly utilized by clinicians worldwide. METHODS: We performed a retrospective review to i...

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Autores principales: Williams, Jon P., Abbatemarco, Justin R., Galli, Jonathan J., Rodenbeck, Stefanie J., Peterson, Lisa K., Haven, Thomas R., Street, Meagan, Rose, John W., Greenlee, John E., Soldan, M. Mateo Paz, Clardy, Stacey L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8492278/
https://www.ncbi.nlm.nih.gov/pubmed/34621549
http://dx.doi.org/10.1155/2021/8692328
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author Williams, Jon P.
Abbatemarco, Justin R.
Galli, Jonathan J.
Rodenbeck, Stefanie J.
Peterson, Lisa K.
Haven, Thomas R.
Street, Meagan
Rose, John W.
Greenlee, John E.
Soldan, M. Mateo Paz
Clardy, Stacey L.
author_facet Williams, Jon P.
Abbatemarco, Justin R.
Galli, Jonathan J.
Rodenbeck, Stefanie J.
Peterson, Lisa K.
Haven, Thomas R.
Street, Meagan
Rose, John W.
Greenlee, John E.
Soldan, M. Mateo Paz
Clardy, Stacey L.
author_sort Williams, Jon P.
collection PubMed
description OBJECTIVE: Aquaporin-4 (AQP4) serum autoantibodies are detected by a variety of methods. The highest sensitivity is achieved with cell-based assays, but the enzyme-linked immunosorbent assay (ELISA) is still commonly utilized by clinicians worldwide. METHODS: We performed a retrospective review to identify all patients at the University of Utah who had AQP4 ELISA testing at ARUP Laboratories from 2010 to 2017. We then reviewed their diagnostic evaluation and final diagnosis based on the ELISA titer result. RESULTS: A total of 750 tests for the AQP4 ELISA were analyzed, and 47 unique patients with positive titers were identified. Less than half of these patients (49%) met the clinical criteria for neuromyelitis optica spectrum disorder (NMOSD). In cases of low positive titers (3.0–7.9 U/mL, n = 19), the most common final diagnosis was multiple sclerosis (52.6%). In the moderate positive cohort (8.0–79.9 U/mL, n = 14), only a little more than half the cohort (64.3%) had NMOSD. In cases with high positives (80–160 U/mL, n = 14), 100% of patients met clinical criteria for NMOSD. CONCLUSIONS: Our data illustrates diagnostic uncertainty associated with the AQP4 ELISA, an assay that is still commonly ordered by clinicians despite the availability of more sensitive and specific tests to detect AQP4 autoantibodies in patients suspected of having NMOSD. In particular, low positive titer AQP4 ELISA results are particularly nonspecific for the diagnosis of NMOSD. The importance of accessibility to both sensitive and specific AQP4 testing cannot be overemphasized in clinical practice.
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spelling pubmed-84922782021-10-06 Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay Williams, Jon P. Abbatemarco, Justin R. Galli, Jonathan J. Rodenbeck, Stefanie J. Peterson, Lisa K. Haven, Thomas R. Street, Meagan Rose, John W. Greenlee, John E. Soldan, M. Mateo Paz Clardy, Stacey L. Mult Scler Int Research Article OBJECTIVE: Aquaporin-4 (AQP4) serum autoantibodies are detected by a variety of methods. The highest sensitivity is achieved with cell-based assays, but the enzyme-linked immunosorbent assay (ELISA) is still commonly utilized by clinicians worldwide. METHODS: We performed a retrospective review to identify all patients at the University of Utah who had AQP4 ELISA testing at ARUP Laboratories from 2010 to 2017. We then reviewed their diagnostic evaluation and final diagnosis based on the ELISA titer result. RESULTS: A total of 750 tests for the AQP4 ELISA were analyzed, and 47 unique patients with positive titers were identified. Less than half of these patients (49%) met the clinical criteria for neuromyelitis optica spectrum disorder (NMOSD). In cases of low positive titers (3.0–7.9 U/mL, n = 19), the most common final diagnosis was multiple sclerosis (52.6%). In the moderate positive cohort (8.0–79.9 U/mL, n = 14), only a little more than half the cohort (64.3%) had NMOSD. In cases with high positives (80–160 U/mL, n = 14), 100% of patients met clinical criteria for NMOSD. CONCLUSIONS: Our data illustrates diagnostic uncertainty associated with the AQP4 ELISA, an assay that is still commonly ordered by clinicians despite the availability of more sensitive and specific tests to detect AQP4 autoantibodies in patients suspected of having NMOSD. In particular, low positive titer AQP4 ELISA results are particularly nonspecific for the diagnosis of NMOSD. The importance of accessibility to both sensitive and specific AQP4 testing cannot be overemphasized in clinical practice. Hindawi 2021-09-28 /pmc/articles/PMC8492278/ /pubmed/34621549 http://dx.doi.org/10.1155/2021/8692328 Text en Copyright © 2021 Jon P. Williams et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Williams, Jon P.
Abbatemarco, Justin R.
Galli, Jonathan J.
Rodenbeck, Stefanie J.
Peterson, Lisa K.
Haven, Thomas R.
Street, Meagan
Rose, John W.
Greenlee, John E.
Soldan, M. Mateo Paz
Clardy, Stacey L.
Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title_full Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title_fullStr Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title_full_unstemmed Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title_short Aquaporin-4 Autoantibody Detection by ELISA: A Retrospective Characterization of a Commonly Used Assay
title_sort aquaporin-4 autoantibody detection by elisa: a retrospective characterization of a commonly used assay
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8492278/
https://www.ncbi.nlm.nih.gov/pubmed/34621549
http://dx.doi.org/10.1155/2021/8692328
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