DPB 1 *0501-associated opticomyelitis and atopic myelitis: Novel disease entities

To clarify the relationship between Th1/Th2 balance and clinical features, we studied the intracellular IFNγ-positive versus IL-4-positive cell ratio in peripheral blood CD 4 T cells by flow cytometry and measured total and allergen-specific IgE by ELISA in 227 patients with various neurologic diseases including multiple sclerosis (MS), myelitis and HAM/TSP, and 42 healthy hospital subjects. The intracellular IFNγ/IL-4 ratio in the patients with acute myelitis was significantly decreased, and the total serum IgE level and frequency of mite antigen-specific IgE were significantly elevated as compared with the controls. Patients with HAM/TSP, however, had a significantly higher intracellular IFNγ/IL- 4 ratio, lower total IgE level, and lower frequency of cedar pollen-specific IgE than did the controls. The patients with recurrent opticomyelitis (ROM) had a significantly higher frequency of relapse, higher EDSS score, and lower number of brain MRI lesions than the patients with conventional MS, and only those with ROM showed a significant association with the HLA-DPB 1 *0501 allele. The ROM patients had a significantly higher intracellular IFNγ/IL-4 ratio and IL- 4/IFN-γ cell percentages than the controls. These findings suggest that the Th2 cell response predominates in acute myelitis with hyperIgEaemia (atopic myelitis), whereas the Th1 cell response predominates in ROM and HAM/TSP.