Low high-density lipoprotein cholesterol and high triglycerides lipid profile in neuromyelitis optica spectrum disorder: Associations with disease activity and disability

Abstract

Background: Altered lipid metabolism is a feature of systemic autoimmune diseases. Dyslipidemia is associated with the disease activity and progression in patients with multiple sclerosis. However, in neuromyelitis optica spectrum disorder (NMOSD), changes in the lipid profile and the associations between specific lipid levels and disease activity/disability are unknown.

Methods: Serum samples (N = 148) were collected from 53 patients with aquaporin-4 (AQP4)-positive NMOSD when they were not treated with lipid lowering agents. Fasting lipid (total cholesterol, triglyceride [TG], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol) levels were compared between 39 patients with NMOSD, not taking steroids, and 142 age-, sex-, and body mass index-matched healthy controls. In addition, we analyzed the differences in the lipid profile between attack and remission samples and the associations between lipid profiles and clinical outcome in all 148 samples from 53 patients. The generalized estimating equation was used.

Results: Patients with NMOSD showed lower HDL-C and higher TG levels compared to healthy controls (p = 0.017 and p < 0.001, respectively). HDL-C level was significantly lower during attack than remission (β = -7.851; p = 0.035), and TG level had positive correlation with EDSS scores (β = 0.014; p = 0.002) regardless of disease activity status. However, enhanced lesions on magnetic resonance imaging were not associated with lipid profiles.

Conclusion: Dyslipidemia with low HDL-C and high TG correlated disease activity and disability in AQP4-positive NMOSD. It remains to be elucidated whether altered lipid metabolism contributes to deleterious immune response, possibly through inflammation, or is secondary to neurological disability in NMOSD.