Antineonatal Fc Receptor Antibody Treatment Ameliorates MOG-IgG-Associated Experimental Autoimmune Encephalomyelitis.

BACKGROUND AND OBJECTIVES: Myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) is a rare, autoimmune demyelinating CNS disorder, distinct from multiple sclerosis and neuromyelitis optica spectrum disorder. Characterized by pathogenic immunoglobulin G (IgG) antibodies against MOG, a potential treatment strategy for MOGAD is to reduce circulating IgG levels, e.g., by interference with the IgG recycling pathway mediated by the neonatal Fc receptor (FcRn). Although the optic nerve is often detrimentally involved in MOGAD, the effect of FcRn blockade on the visual pathway has not been assessed. Our objective was to investigate effects of a monoclonal anti-FcRn antibody in murine MOG-IgG-associated experimental autoimmune encephalomyelitis (EAE). METHODS: We induced active MOG35-55 EAE in C57Bl/6 mice followed by the application of a monoclonal MOG-IgG (8-18C5) 10 days postimmunization (dpi). Animals were treated with either a specific monoclonal antibody against FcRn (α-FcRn, 4470) or an isotype-matched control IgG on 7, 10, and 13 dpi. Neurologic disability was scored daily on a 10-point scale. Visual acuity was assessed by optomotor reflex. Histopathologic hallmarks of disease were assessed in the spinal cord, optic nerve, and retina. Immune cell infiltration was visualized by immunohistochemistry, demyelination by Luxol fast blue staining and complement deposition and number of retinal ganglion cells by immunofluorescence. RESULTS: In MOG-IgG-augmented MOG35-55 EAE, anti-FcRn treatment significantly attenuated neurologic disability over the course of disease (mean area under the curve and 95% confidence intervals (CIs): α-FcRn [n = 27], 46.02 [37.89-54.15]; isotype IgG [n = 24], 66.75 [59.54-73.96], 3 independent experiments), correlating with reduced amounts of demyelination and macrophage infiltration into the spinal cord. T- and B-cell infiltration and complement deposition remained unchanged. Compared with isotype, anti-FcRn treatment prevented reduction of visual acuity over the course of disease (median cycles/degree and interquartile range: α-FcRn [n = 16], 0.50 [0.48-0.55] to 0.50 [0.48-0.58]; isotype IgG [n = 17], 0.50 [0.49-0.54] to 0.45 [0.39-0.51]). DISCUSSION: We show preserved optomotor response and ameliorated course of disease after anti-FcRn treatment in an experimental model using a monoclonal MOG-IgG to mimic MOGAD. Selectively targeting FcRn might represent a promising therapeutic approach in MOGAD.

Timing of concurrent visual stimuli determines modulation of saccadic amplitude.

The temporal relation of competing visual stimuli may determine the corresponding oculomotor response. In this study we systematically varied the temporal coincidence of two conflicting stimuli and investigated saccades that were elicited from such stimuli. We varied the time of presentation of two identical spatially separated stimuli between 0 and +165 ms and measured the amplitude of the saccade elicited by these stimuli using infrared eye tracking. In the first experiment, all stimuli were shown for 36 ms only. In the second experiment, stimuli remained on the screen until the subsequent stimulus appeared, whereas in the third experiment all stimuli were removed after saccade onset. Up to an interstimulus interval of 82 ms, we found a significant shift of the saccadic endpoint toward the location of the second stimulus as compared to saccades toward the first stimulus alone. The strongest saccadic bias was observed if a stimulus was shown 36 ms after or before another stimulus. In contrast, time intervals longer than 82 ms elicited saccade adaptation-that is, the saccadic landing point gradually moved toward the second location over time. In more than 99% of trials, the second stimulus appeared before the saccade reached its endpoint. The timing of a conflicting stimulus determines the associated saccadic response: Simultaneous presentation of two stimuli results in a saccadic endpoint at an averaged intermediate position, short interstimulus intervals result in a strong shift of the saccadic endpoint toward the location of the second of two consecutive stimuli, and longer interstimulus intervals elicit saccade adaptation. The timing of two stimuli thus is associated with distinct processes, which complement each other in order to provide an optimal oculomotor response.

The interaction of pupil response with the vergence system.

PURPOSE: A gaze shift from a target at distance to a target at near leads to pupillary constriction. The regulation of this pupillary near response is ill known. We investigated the impact of accommodation, convergence, and proximity on the pupillary diameter. METHODS: We recorded pupil size and vergence eye movements with the use of an infrared eye tracker. We determined the pupillary response in four conditions: (1) after a gaze shift from far to near without accommodation, (2) after a gaze shift from far to near with neither accommodation nor convergence, (3) after accommodation alone, and (4) after accommodation with convergence without a gaze shift to near. These responses were compared to the pupil response of a full near response and to a gaze shift from one far target to another. RESULTS: We found a reliable pupillary near response. The removal of both accommodation and convergence in gaze shift from far to near abolished the pupillary near response. Accommodation alone did not induce pupillary constriction, while convergence and accommodation together induced a pupil response similar to the full near response. CONCLUSIONS: The main trigger for the pupillary response seems to be convergence. Neither accommodation nor proximity alone induce a significant pupillary constriction. This suggests that the miosis of the near triad is closely coupled to the vergence system rather than being independently regulated.