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Patterns and utility of myelin oligodendrocyte glycoprotein (MOG) antibody testing in cerebrospinal fluid

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Abstract

Background

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an idiopathic central nervous system (CNS) demyelinating disease gaining recognition with wider availability of cell-based assay (CBA) testing and recently published diagnostic criteria. However, uncertainty remains regarding the interpretation of antibody titers, particularly cerebrospinal fluid (CSF) MOG antibody titers.

Methods

All MOG IgG CBA results performed by the provincial MitogenDx laboratory in Alberta from July 2017 to July 2023 were retrieved. Chart review was performed in patients with both serum and CSF testing and ≥ 1 positive MOG antibody result. Demographics, antibody titers, clinical and imaging features, treatment, and diagnosis were analyzed based on serum/CSF status.

Results

Among 4494 MOG CBA assays, there were 413 CSF samples in 402 patients, and 268 patients had at least one associated serum sample. Mean time between CSF and serum testing was 20.9 days (range 0–870 days), most with testing within 30 days. Five of the 268 patients had serum positive/CSF positive MOG antibodies, 4 with acute disseminated encephalomyelitis and 1 with longitudinally extensive transverse myelitis. Twenty-three patients had serum positive/CSF negative MOG and 13/23 with optic neuritis. CSF MOG antibody positive patients were younger, and more likely to remain MOG seropositive versus CSF negative patients. No seronegative patient had MOG antibodies in CSF.

Conclusions

In province-wide testing, CSF MOG antibodies were rare, only in MOG seropositive patients and none with optic neuritis. Our study does not support a clear role for CSF MOG antibody testing in the majority of patients, although further study is required.

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Data availability

Limited, anonymized data (antibody titers, age, gender) are available upon appropriate request from the corresponding author.

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Funding

This study was funded in part by the Roy and Joan Allen Professorship for Sight Research (unrestricted) and supporting unrestricted funds from the University of Calgary.

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Authors and Affiliations

  1. Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cumming School of Medicine, Health Sciences Centre, Room 1007C, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada

    Jodie M. Burton & Fiona Costello

  2. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Jodie M. Burton

  3. Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada

    Jodie M. Burton & Fiona Costello

  4. Department of Surgery (Ophthalmology), University of Calgary, Cumming School of Medicine, Calgary, AB, Canada

    Saerom Youn, Abdullah Al-Ani & Fiona Costello

Authors
  1. Jodie M. Burton
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  2. Saerom Youn
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  3. Abdullah Al-Ani
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  4. Fiona Costello
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Contributions

JMB performed conceptualization, methodology, investigations, formal analysis, validation, data curation, writing—original draft and review and editing, visualization, project administration, funding acquisition, and supervision. SY provided conceptualization, investigations, formal analysis, data curation, and writing—review and editing. AA-A approved conceptualization, investigations, formal analysis, data curation, and writing—review and editing. FC developed conceptualization, methodology, writing—original draft and review and editing, visualization, project administration, funding acquisition, and supervision.

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Correspondence to Jodie M. Burton.

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Burton, J.M., Youn, S., Al-Ani, A. et al. Patterns and utility of myelin oligodendrocyte glycoprotein (MOG) antibody testing in cerebrospinal fluid. J Neurol 271, 2662–2671 (2024). https://doi.org/10.1007/s00415-024-12213-7

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  • DOI: https://doi.org/10.1007/s00415-024-12213-7

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