National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory

Naperville, IL, United States

National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory

Naperville, IL, United States
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Pranzatelli M.R.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | Tate E.D.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | McGee N.R.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | Ransohoff R.M.,Cleveland Clinic
Cytokine | Year: 2013

Identifying and blocking chemokine inflammatory mediators in pediatric opsoclonus-myoclonus syndrome (OMS) is critical to the treatment of this autoimmune, paraneoplastic, neurological disorder. In a prospective, case-control, clinico-scientific study of children with OMS compared to non-inflammatory neurological controls and other inflammatory neurological disorders, CCL19 (n= 369) and CCL21 (n= 312) were quantified in CSF and serum, respectively, by ELISA. Both cross-sectional and longitudinal effects of OMS and various immunotherapies were evaluated. Significant upregulation of CCL21 concentration (mean. ±. SD) (+32%) was found in serum of untreated OMS (630. ±. 133. pg/mL), compared to controls (478. ±. 168. pg/mL), (p<. 0.0001). Both corticosteroids and ACTH (corticotropin) significantly lowered CCL21 to control levels, as they did in combination with IVIg, rituximab, cyclophosphamide or other treatments, without additional reduction attributable to the other agents. In a pilot longitudinal study of ACTH-based triple therapy, the mean serum CCL21 concentration fell 59% from elevated to less than 1 SD below controls 1. week after high-dose ACTH, gradually returning to the control mean with ACTH tapering by 3. weeks and out to 12. weeks (p<. 0.0001). In contrast, CCL19, detectable in CSF, was not significantly altered by OMS or various immunotherapies. In the "high" CCL21 subgroup, higher serum concentrations of CCL22 (+57%) and CXCL13 (+40%), as well as the CSF concentration of BAFF (+64%), also were found. Elevated serum CCL21, not CSF CCL19, correlates with OMS severity and duration in pediatric OMS. Corticosteroids and ACTH were the only immunotherapies evaluated that down-regulated CCL21 production. Validation studies are needed to assess treatment biomarker status. © 2013 Elsevier Ltd.


Pranzatelli M.R.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | Tate E.D.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | McGee N.R.,National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory | Colliver J.A.,University of Illinois at Springfield
Journal of Interferon and Cytokine Research | Year: 2013

To define cytokine concentrations and detectability in children with noninflammatory neurological disorders (NIND). The multiplex bead assay technology was used for simultaneous measurement of 34 soluble cytokines/chemokines in cerebrospinal fluid (CSF) from 73 NIND. Sera from 36 healthy children and 37 NIND also were analyzed. In CSF, CXCL10 had the highest concentration; CCL2, CXCL10, and interleukin (IL)-6 were detectable in all samples, and CXCL8, CCL22, CXCL1, IL-16, and IL-1 receptor antagonist were found in ≥50% of the samples. In serum, CXCL1 had the highest concentration; sIL-2Ra, CXCL1, CXCL10, and CCL22 were detectable in all samples, and CCL2, IL-12, CCL5, and granulocyte monocyte colony-stimulating factor (GM-CSF) were found in ≥50% of the samples. The mean CSF:serum ratio for CCL2 was several-fold higher than the rest, with the CXCL10 and CXCL8 ratios also >1. Intercorrelations between CSF cytokines included CCL2 versus CXCL8 and IL-6, and CXCL1 versus CCL22, reflecting both T-helper-1 (Th1)/Th1 and Th1/Th2 relations. Serum correlations included CCL11 versus CCL2, GM-CSF, and IL-4. For serum cytokines, the agreement between healthy children and NIND was good, with the exception of higher CCL4 in NIND. Cytokines in children varied greatly in concentration and detectability, with chemokines predominating in the CSF. These data allow investigators to select their own kit cytokines, instead of manufacturer-selected cytokines, for greater cost-effectiveness and interpretability. © Copyright 2013, Mary Ann Liebert, Inc.


PubMed | National Pediatric Myoclonus Center and Neuroimmunology Research Laboratory
Type: Journal Article | Journal: Clinical and experimental immunology | Year: 2013

Opsoclonus-myoclonus syndrome (OMS) is a neuroinflammatory disorder associated with remote cancer. To understand more clearly the role of inflammatory mediators, the concentration of CXCR3 ligands CXCL10, CXCL9 and CXCL11 was measured in 245 children with OMS and 81 paediatric controls using enzyme-linked immunosorbent assay (ELISA), and CXCR3 expression on CD4(+) T cells was measured by flow cytometry. Mean cerebrospinal fluid (CSF) CXCL10 was 27-fold higher in untreated OMS than controls. Intrathecal production was demonstrated by significantly different CXCL10 CSF:serum ratios. The dichotomized high CSF CXCL10 group had higher CSF leucocyte count (P=00007) and B cell activating factor (BAFF) and CXCL13 concentrations (P<00001). CSF CXCL10 did not correlate with clinical severity or relapse using grouped data, although it did in some patients. Among seven types of immunotherapy, including rituximab or chemotherapy, only adrenocorticotrophic hormone (ACTH) monotherapy showed reduced CSF CXCL10, but prospective longitudinal studies of ACTH combination therapies indicated no reduction in CXCL10 despite clinical improvement (P<00001). CXCL10 concentrations were 11-fold higher in CSF and twofold higher in serum by multiplexed fluorescent bead-based immunoassay than enzyme-linked immunosorbent assay, but the two correlated (r=07 and 083). In serum, no group differences for CXCL9 or CXCL11 were found. CXCR3 expression on CD4(+) T cells was fivefold higher in those from CSF than blood, but was not increased in OMS or altered by conventional immunotherapy. These data suggest alternative roles for CXCL10 in OMS. Over-expression of CXCL10 was not reduced by clinical immunotherapies as a whole, indicating the need for better therapeutic approaches.

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