PT - JOURNAL ARTICLE AU - Melania Spadaro AU - Lisa Ann Gerdes AU - Markus Krumbholz AU - Birgit Ertl-Wagner AU - Franziska Sabrina Thaler AU - Elisabeth Schuh AU - Imke Metz AU - Astrid Blaschek AU - Andrea Dick AU - Wolfgang Brück AU - Reinhard Hohlfeld AU - Edgar Meinl AU - Tania Kümpfel TI - Autoantibodies to MOG in a distinct subgroup of adult multiple sclerosis AID - 10.1212/NXI.0000000000000257 DP - 2016 Oct 01 TA - Neurology - Neuroimmunology Neuroinflammation PG - e257 VI - 3 IP - 5 4099 - http://nn.neurology.org/content/3/5/e257.short 4100 - http://nn.neurology.org/content/3/5/e257.full SO - Neurol Neuroimmunol Neuroinflamm2016 Oct 01; 3 AB - Objectives: To evaluate the presence of antibodies to conformation-intact myelin oligodendrocyte glycoprotein (MOG) in a subgroup of adult patients with clinically definite multiple sclerosis (MS) preselected for a specific clinical phenotype including severe spinal cord, optic nerve, and brainstem involvement.Methods: Antibodies to MOG were investigated using a cell-based assay in 3 groups of patients: 104 preselected patients with MS (group 1), 55 age- and sex-matched, otherwise unselected patients with MS (group 2), and in 22 brain-biopsied patients with demyelinating diseases of the CNS (n = 19 with MS), 4 of whom classified as MS type II (group 3). Recognized epitopes were identified with mutated variants of MOG.Results: Antibodies to MOG were found in about 5% (5/104) of preselected adult patients with MS. In contrast, in groups 2 and 3, none of the patients tested positive for MOG antibodies. Patients with MS with antibodies to MOG predominantly manifested with concomitant severe brainstem and spinal cord involvement and had a severe disease course with high relapse rates and failure to several disease-modifying therapies. Three of them had been treated with plasma exchange with a favorable response. All anti-MOG–positive patients with MS showed typical MS lesions on brain MRI. Longitudinal analysis up to 9 years revealed fluctuations and reappearance of anti-MOG reactivity. Epitope mapping indicated interindividual heterogeneity, yet intraindividual stability of the antibody response.Conclusions: Antibodies to MOG can be found in a distinct subgroup of adult MS with a specific clinical phenotype and may indicate disease heterogeneity.Ab=antibody; cMRI=cerebral MRI; DMT=disease-modifying therapy; EGFP=enhanced green fluorescent protein; HLA=human leucocyte antigen; IgG=immunoglobulin G; IgM=immunoglobulin M; MFI=mean fluorescence intensity; MOG=myelin oligodendrocyte glycoprotein; MS=multiple sclerosis; NMOSD=neuromyelitis optica spectrum disorders; OCBs=oligoclonal bands; ON=optic neuritis