Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica

Abstract Objective This study aimed to evaluate the diagnostic accuracy of dried blood spot (DBS) compared with conventional serum Aquaporin‐4‐IgG (AQP4‐IgG) testing. Methods Prospective multicenter diagnostic study was conducted between April 2018 and October 2023 across medical centers in the Unit...

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Main Authors: Nisa Vorasoot, Yahya J. Abdulrahman, Farrah Mateen, James P. Fryer, Vyanka Redenbaugh, Jessica A. Sagen, Abdu K. Musubire, Sarah M. Jenkins, Amy P. Gorsh, John J. Chen, Anastasia Zekeridou, Andrew McKeon, Eoin P. Flanagan, John R. Mills, Sean J. Pittock
Format: Article
Language:English
Published: Wiley 2024-11-01
Series:Annals of Clinical and Translational Neurology
Online Access:https://doi.org/10.1002/acn3.52178
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author Nisa Vorasoot
Yahya J. Abdulrahman
Farrah Mateen
James P. Fryer
Vyanka Redenbaugh
Jessica A. Sagen
Abdu K. Musubire
Sarah M. Jenkins
Amy P. Gorsh
John J. Chen
Anastasia Zekeridou
Andrew McKeon
Eoin P. Flanagan
John R. Mills
Sean J. Pittock
author_facet Nisa Vorasoot
Yahya J. Abdulrahman
Farrah Mateen
James P. Fryer
Vyanka Redenbaugh
Jessica A. Sagen
Abdu K. Musubire
Sarah M. Jenkins
Amy P. Gorsh
John J. Chen
Anastasia Zekeridou
Andrew McKeon
Eoin P. Flanagan
John R. Mills
Sean J. Pittock
author_sort Nisa Vorasoot
collection DOAJ
description Abstract Objective This study aimed to evaluate the diagnostic accuracy of dried blood spot (DBS) compared with conventional serum Aquaporin‐4‐IgG (AQP4‐IgG) testing. Methods Prospective multicenter diagnostic study was conducted between April 2018 and October 2023 across medical centers in the United States, Uganda, and the Republic of Guinea. Neuromyelitis optica spectrum disorder (NMOSD) patients and controls collected blood on filter paper cards along with concurrent serum samples. These samples underwent analysis using flow cytometric live‐cell‐based assays (CBA) and enzyme‐linked immunosorbent assay (ELISA) to determine AQP4 serostatus. The accuracy of AQP4‐IgG detection between DBS and serum (gold standard) was compared. Results Among 150 participants (47 cases, 103 controls), there was a strong correlation between DBS and serum samples (Spearman's correlation coefficient of 0.82). The AUC was 0.97 (95% CI: 0.92–0.99). AQP4‐IgG detection through DBS showed 87.0% sensitivity (95% CI: 0.74–0.95) and 100% specificity (95% CI: 0.96–1.00) using CBA, and 65.2% sensitivity (95% CI: 0.43–0.84) and 95.2% specificity (95% CI: 0.76–0.99) using ELISA. Serum ELISA demonstrated 69.6% sensitivity (95% CI: 0.47–0.87) and 98.4% specificity (95% CI: 0.91–0.99). The stability of DBS in detecting AQP4‐IgG persisted over 24 months for most cases. Interpretation The DBS represents a viable alternative for detecting AQP4‐IgG in resource‐limited settings to diagnose NMOSD, offering high sensitivity and specificity comparable to serum testing. Moreover, DBS has low shipping costs, is easy to administer, and is suitable for point‐of‐care testing.
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spelling doaj-art-550d0b1d41f6485f821401fdab5b8cc32024-11-18T17:52:33ZengWileyAnnals of Clinical and Translational Neurology2328-95032024-11-0111112855286510.1002/acn3.52178Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis opticaNisa Vorasoot0Yahya J. Abdulrahman1Farrah Mateen2James P. Fryer3Vyanka Redenbaugh4Jessica A. Sagen5Abdu K. Musubire6Sarah M. Jenkins7Amy P. Gorsh8John J. Chen9Anastasia Zekeridou10Andrew McKeon11Eoin P. Flanagan12John R. Mills13Sean J. Pittock14Department of Neurology Mayo Clinic Rochester Minnesota USADepartment of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USADepartment of Neurology Massachusetts General Hospital Boston Massachusetts USADepartment of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USACenter of MS and Autoimmune Neurology Mayo Clinic Rochester Minnesota USADepartment of Medicine School of Medicine, College of Health Sciences, Makerere University Kampala UgandaDepartment of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics Mayo Clinic Rochester Minnesota USADepartment of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USACenter of MS and Autoimmune Neurology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USADepartment of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USADepartment of Neurology Mayo Clinic Rochester Minnesota USAAbstract Objective This study aimed to evaluate the diagnostic accuracy of dried blood spot (DBS) compared with conventional serum Aquaporin‐4‐IgG (AQP4‐IgG) testing. Methods Prospective multicenter diagnostic study was conducted between April 2018 and October 2023 across medical centers in the United States, Uganda, and the Republic of Guinea. Neuromyelitis optica spectrum disorder (NMOSD) patients and controls collected blood on filter paper cards along with concurrent serum samples. These samples underwent analysis using flow cytometric live‐cell‐based assays (CBA) and enzyme‐linked immunosorbent assay (ELISA) to determine AQP4 serostatus. The accuracy of AQP4‐IgG detection between DBS and serum (gold standard) was compared. Results Among 150 participants (47 cases, 103 controls), there was a strong correlation between DBS and serum samples (Spearman's correlation coefficient of 0.82). The AUC was 0.97 (95% CI: 0.92–0.99). AQP4‐IgG detection through DBS showed 87.0% sensitivity (95% CI: 0.74–0.95) and 100% specificity (95% CI: 0.96–1.00) using CBA, and 65.2% sensitivity (95% CI: 0.43–0.84) and 95.2% specificity (95% CI: 0.76–0.99) using ELISA. Serum ELISA demonstrated 69.6% sensitivity (95% CI: 0.47–0.87) and 98.4% specificity (95% CI: 0.91–0.99). The stability of DBS in detecting AQP4‐IgG persisted over 24 months for most cases. Interpretation The DBS represents a viable alternative for detecting AQP4‐IgG in resource‐limited settings to diagnose NMOSD, offering high sensitivity and specificity comparable to serum testing. Moreover, DBS has low shipping costs, is easy to administer, and is suitable for point‐of‐care testing.https://doi.org/10.1002/acn3.52178
spellingShingle Nisa Vorasoot
Yahya J. Abdulrahman
Farrah Mateen
James P. Fryer
Vyanka Redenbaugh
Jessica A. Sagen
Abdu K. Musubire
Sarah M. Jenkins
Amy P. Gorsh
John J. Chen
Anastasia Zekeridou
Andrew McKeon
Eoin P. Flanagan
John R. Mills
Sean J. Pittock
Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
Annals of Clinical and Translational Neurology
title Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
title_full Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
title_fullStr Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
title_full_unstemmed Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
title_short Dried blood spot improves global access to aquaporin‐4‐IgG testing for neuromyelitis optica
title_sort dried blood spot improves global access to aquaporin 4 igg testing for neuromyelitis optica
url https://doi.org/10.1002/acn3.52178
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