ZNAČAJ MOLEKULARNIH BIOMARKERA U DIJAGNOSTICI NEUROMIJELITIS OPTIKA SPEKTRA BOLESTI

  • Marko Andabaka Klinika za neurologiju i psihijatriju za decu i omladinu
  • Ivana Novaković Institut za humanu genetiku MFUB
  • Jelena Drulovic Klinika za neurologiju UKCS
Ključne reči: Neuromyelitis optica spectrum disorder, antibodies to aquaporin 4, laboratory analyses, ELISA, indirect immunofluorescence, cell assays, myelin oligodendrocyte glycoprotein, molecular biomarkers.

Sažetak


Otkriće antitela prema akvaporin 4 kanalima kao laboratorijskog odnosno molekularnog biomarkera za neuromijelitis optika spektar bolesti doprinelo je boljem razumevanju etiopatogeneze uz jasno izdvajanje kliničkih, neuroradioloških i laboratorijskih karakteristika ove bolesti što je rezultiralo definisanjem kriterijuma za postavljanje dijagnoze neuromijelitis optika spektra bolesti i jasnom distinkcijom u odnosu na multiplu sklerozu. Inflamatorne bolesti centralnog nervnog sistema, u okviru kliničke prezentacije, mogu imati simptome i znake koji se često preklapaju te je u procesu diferencijalno dijagnostičke eksploracije pored kliničke slike, neophodno razmotriti parakliničke karakteristike kao što su parametri neuroradiološkog ispitivanja i rezultati laboratorijskih nalaza krvi i vrlo cesto cerebrospinalne tečnosti. Kako je u neuromijelitis optika spektru bolesti jasno definisan dijagnostički biomarker tako su se razvijali različiti metodološki pristupi testiranju antitela na akvaporin 4 u okviru dijagnostičke i diferencijalno dijagnostičke eksploracije uzimajući u obzir specifičnost i senzitivnost samih testova. Jedan od prvih testova koji se rutinski primenjivao u kliničkoj praksi za detekciju antitela na akvaporin 4 bili su testovi u vidu imunoenzimskog eseja koji su pokazali veliku varijabilnost u stepenu specifičnosti i senzitivnosti. Druga grupa testova za detekciju antitela na akvaporin 4 primenjivala je tehniku indirektne imunofluorescencije na supstratu animalnog porekla čime je postignut viši stepen senzitivnosti i specifičnosti uz određene nedostatke kao što su nemogućnost precizne kvantifikacije kao i poteškoće u samoj interpretaciji rezultata. Posebni metodološki principi imunoprecipitacije kao što su fluorescentna i radioimunoprecipitacija nisu postigli zadovoljavajući stepen senzitivnosti u detekciji antitela na akvaporin 4. Razvojem metodologije ćelijskog eseja koja se bazira na primeni humanih akvaporin 4 transfektovanih ćelija bilo fiksiranih na biočipu sa negativnom kontrolom kada se antitela na akvaporin 4 iz seruma detektuju metodologijom indirektne imunofluorescencije ili posebnim ćelijskim esejima kada se ova antitela kvantifikuju metodom protočne citometrije postignut je najviši stepen senzitivnosti uz apsolutnu specifičnost što je od izuzetne važnosti u postavljanju dijagnoze seropozitivnog neuromijelitis optika spektra bolesti.

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