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Distinct CSF cytokine/chemokine profiles in atopic myelitis and other causes of myelitis

From the Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Address correspondence and reprint requests to Dr. Jun-ichi Kira, Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582, Japan kira{at}neuro.med.kyushu-u.ac.jp

Background: We reported the emergence of a distinct myelitis in patients with atopic diathesis (atopic myelitis [AM]) by a nationwide survey throughout Japan. Similar cases have recently been reported in Caucasians. Pathologic studies of biopsied spinal cord specimens revealed chronic active inflammation with eosinophilic infiltration.

Objective: To clarify the cytokine/chemokine alterations in CSF from patients with AM in comparison to other causes of myelitis.

Methods: We measured 27 cytokines, chemokines, and growth factors simultaneously in CSF from 22 patients with AM, 20 with opticospinal multiple sclerosis (OSMS), 11 with HTLV-1–associated myelopathy (HAM), 9 with Sjögren syndrome–related myelitis (SM), and 20 with other noninflammatory neurologic diseases (OND), using a fluorescent bead-based immunoassay.

Results: In patients with AM, CCL11 and interleukin (IL)-9 were significantly increased as compared with patients with OND and other myelitis while in patients with OSMS interferon- and granulocyte-colony stimulating factor levels were significantly higher than in patients with OND and other causes of myelitis. Significant increase of IL-17 in comparison to patients with OND was found only in patients with OSMS, irrespective of presence or absence of anti-aquaporin-4 (AQP4) antibody. In patients with HAM, CXCL10 and CCL5 were higher than in patients with OND and other myelitis. In patients with SM, CCL3 and CCL4 were higher than in patients with OND. In patients with AM, CCL11, IL-9, and IL-1 receptor antagonist (IL-1ra) showed positive correlations with the final Kurtzke Expanded Disability Status Scale scores while IL-1ra and IL-12(p70) had positive correlations with disease duration.

Conclusion: Intrathecal upregulation of CCL11 and Th2 cytokines is characteristic of atopic myelitis, which is distinct from interleukin-17/ interferon-–related autoimmune condition of opticospinal multiple sclerosis.

Abbreviations: AM = atopic myelitis; bFGF = basic fibroblast growth factor; EDSS = Expanded Disability Status Scale; GM-CSF = granulocyte-macrophage colony stimulating factor; HAM = HTLV-1–associated myelopathy; IFN = interferon; IL = interleukin; IL-1ra = IL-1 receptor antagonist; MIP = macrophage inflammatory protein; MS = multiple sclerosis; NMO = neuromyelitis optica; OBs = oligoclonal IgG bands; OND = other noninflammatory neurologic diseases; OSMS = opticospinal multiple sclerosis; PDGF = platelet-derived growth factor; SM = Sjögren syndrome–related myelitis; TNF = tumor necrosis factor; VEGF = vascular endothelial growth factor.

Supplemental data at www.neurology.org

Supported in part by grants from the Research Committees of Neuroimmunological Diseases, the Ministry of Health, Labor and Welfare, Japan, and from the Ministry of Education, Culture, Sports, Science and Technology, Japan.

Disclosure: The authors report no disclosures.

Received February 20, 2007. Accepted in final form June 16, 2008.

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