A better future for patients with neuromyelitis optica
Date: April 30, 2012
When neurologist Michael Levy began his medical training, neuromyelitis optica (NMO) “was off most doctors’ radar screens,” he says. The autoimmune disease, affecting just a few thousand people in the United States and characterized by inflammation of the optic nerve and spinal cord, mimics features of many conditions that lead to blindness and paralysis—leaving physicians with no definitive way to distinguish it from other diseases with some of the same presentations.
“Very few patients were diagnosed correctly,” he says.
In 2004, when Levy was a resident at The Johns Hopkins Hospital, the future for NMO took a pivotal turn. Researchers released a blood test that accurately detects antibodies associated with the disease in about 60 percent to 70 percent of NMO patients.
Although this tool was handy in the clinic, it led to many more questions for the lab, Levy says. Inspired by trying to figure out the detected antibodies’ function, Levy set out on a career of treating NMO patients and researching the disease.
Today, Levy directs the Johns Hopkins Center for NMO. There, he sees patients in the clinic once a month and spends the rest of his time seeking to better understand NMO in the lab.
Because NMO is a rare disease, Levy says, very few centers around the country are equipped to treat patients with this condition. Johns Hopkins remains the only hospital on the East Coast with a specialized NMO center and takes referrals from hospitals across the country.
Many patients who arrive here have been definitively diagnosed through the blood test. Those who haven’t receive a full workup with imaging to look for signs of inflammation. If those tests suggest NMO, Levy says, patients are placed on a preventive protocol that typically includes immunosuppressant drugs to avert future degenerative attacks.
“Preventing attacks isn’t a cure,” Levy explains, “but it can stop the disease in its tracks and avoids future disability.”
In the meantime, he spends his lab time seeking a true cure for NMO by investigating the disease’s cause and consequences. His team’s research has shown that NMO doesn’t appear to be genetic in origin, but instead is triggered by some environmental cause. One potential trigger is molecular mimicry between bacteria and nerve cells, leading the immune system to attack the nervous system after patients suffer an infection.
Levy and his colleagues are also studying what role the specific antibodies detected by the blood test play in this disease. Although 30 percent to 40 percent of patients eventually diagnosed with NMO don’t show these antibodies, those who do have a more severe presentation of the disease. The antibodies also worsen inflammation in the spinal cords of animal models, suggesting that they play an important autoimmune role.
A third question the team is hoping to answer is whether stem cells could eventually serve as an effective NMO treatment. To that end, the researchers are working with a biotechnology company to develop possible stem cell therapies for this disease. Before this treatment becomes a viable option, however, Levy says researchers will need to make sure that the stem cells aren’t vulnerable to the same immune attacks that harm a patient’s native nerve cells.
Together, through clinic and lab work, Levy says he believes he and his colleagues have a real foothold on improving the odds for patients with NMO.
“We’re making solid steps forward with this disease,” he says.
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