Comment: Human papillomavirus vaccination, induced autoimmunity, and neuromyelitis optica
Neuromyelitis optica (NMO) was initially thought be an aggressive subtype of multiple sclerosis (MS), but evidence suggests the majority of NMO phenotypes are rather due to autoimmunity against aquaporin 4 (AQP4).(e1,e2) Infection preceding a first attack of NMO may occur in up to 30% of seropositive cases, although no specific agent has been identified(1, e3); similarly, NMO may follow immunization but causality has not been established.(2, e4,e5) Association of infection or vaccination and autoimmunity is well described in other neuroinflammatory conditions such as Guillain-Barré syndrome (GBS) and acute disseminated encephalomyelitis.(e6,e7) Endogenous human proteins share sequence homology with microbial antigens, implicating molecular mimicry as the putative mechanism for immunologic crossreactivity and thus autoimmunity.
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