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