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Redenbaugh V, Fryer JP, Cacciaguerra L, Chen JJ, Greenwood TM, Gilligan M, Thakolwiboon S, Majed M, Chia NH, McKeon A, Mills JR, Lopez Chiriboga AS, Tillema JM, Yang B, Abdulrahman Y, Guo K, Vorasoot N, Sanchez CV, Tajfirouz DA, Toledano M, Zekeridou A, Dubey D, Gombolay GY, Caparó-Zamalloa C, Kister I, Pittock SJ, Flanagan EP. Diagnostic Utility of MOG Antibody Testing in Cerebrospinal Fluid. Ann Neurol 2024; 96:34-45. [PMID: 38591875 PMCID: PMC11186718 DOI: 10.1002/ana.26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic utility of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) testing. METHODS We retrospectively identified patients for CSF MOG-IgG testing from January 1, 1996, to May 1, 2023, at Mayo Clinic and other medical centers that sent CSF MOG-IgG for testing including: controls, 282; serum MOG-IgG positive MOG antibody-associated disease (MOGAD), 74; serum MOG-IgG negative high-risk phenotypes, 73; serum false positive MOG-IgG with alternative diagnoses, 18. A live cell-based assay assessed CSF MOG-IgG positivity (IgG-binding-index [IBI], ≥2.5) using multiple anti-human secondary antibodies and end-titers were calculated if sufficient sample volume. Correlation of CSF MOG-IgG IBI and titer was assessed. RESULTS The pan-IgG Fc-specific secondary was optimal, yielding CSF MOG-IgG sensitivity of 90% and specificity of 98% (Youden's index 0.88). CSF MOG-IgG was positive in: 4/282 (1.4%) controls; 66/74 (89%) serum MOG-IgG positive MOGAD patients; and 9/73 (12%) serum MOG-IgG negative patients with high-risk phenotypes. Serum negative but CSF positive MOG-IgG accounted for 9/83 (11%) MOGAD patients, and all fulfilled 2023 MOGAD diagnostic criteria. Subgroup analysis of serum MOG-IgG low-positives revealed CSF MOG-IgG positivity more in MOGAD (13/16[81%]) than other diseases with false positive serum MOG-IgG (3/15[20%]) (p = 0.01). CSF MOG-IgG IBI and CSF MOG-IgG titer (both available in 29 samples) were correlated (Spearman's r = 0.64, p < 0.001). INTERPRETATION CSF MOG-IgG testing has diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG, and those with low positive serum MOG-IgG results and diagnostic uncertainty. These findings support a role for CSF MOG-IgG testing in the appropriate clinical setting. ANN NEUROL 2024;96:34-45.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - James P. Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tammy M. Greenwood
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael Gilligan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Neurology, St Vincent’s University Hospital, Dublin, Ireland
| | - Smathorn Thakolwiboon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Masoud Majed
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nicholas H Chia
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John R. Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Jan-Mendelt Tillema
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Binxia Yang
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Yahya Abdulrahman
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kai Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nisa Vorasoot
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Deena A. Tajfirouz
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michel Toledano
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Anastasia Zekeridou
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Divyanshu Dubey
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Grace Y Gombolay
- Emory University, Children’s Healthcare of Atlanta: Pediatrics Institute, USA
| | - César Caparó-Zamalloa
- Basic Research Center in Dementia and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, New York, USA
| | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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