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Myelin Oligodendrocyte Glycoprotein Antibody

Myelin oligodendrocyte glycoprotein (MOG) is a CNS antigen expressed on the myelin sheath. Approximately 5% of patients with neuromyelitis optica spectrum disorder (NMOSD) test negative for anti-neuromyelitis optica antibody (anti-AQP4) but have detectable antibodies against myelin oligodendrocyte glycoprotein (anti-MOG). The presence of anti-MOG antibodies appears to define a different subset of patients with NMOSD. Patients with anti-MOG antibodies have some different clinical features than patients who are positive for anti-NMO antibodies such as:

  • Proportionally more men affected
  • More frequent simultaneous bilateral optic neuritis
  • Fewer painful tonic spasms
  • Spinal cord lesions mainly occur in the lower portion of the spinal cord

Patients who are positive for anti-MOG antibody tend to have better outcomes than those who are anti-AQP4-positive.

The presence of anti-MOG is also helpful to distinguish NMOSD from multiple sclerosis (MS). Detection of MOG-IgG implies an inflammatory demyelinating disorder distinct from MS. This distinction is important because MS therapies may worsen MOG-IgG associated NMOSD.

Seropositivity for MOG-IgG in NMOSD disorders including optic neuritis (OT), transverse myelitis (TM), and acute disseminated encephalomyelitis (ADEM) is predictive of relapse and supports aggressive therapy with IV steroids and therapeutic plasma exchange.

References

Kitley J, Woodhall M, Waters P, et al. Myelin-oligodendrocyte glycoprotein antibodies in adults with a neuromyelitis optica phenotype. Neurology 2012; 79:1273.

Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology 2014; 82:474.

Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurol 2014; 71:276.

Wang JJ, Jaunmuktane Z, Mummery C, et al. Inflammatory demyelination without astrocyte loss in MOG antibody-positive NMOSD. Neurology 2016; 87:229.

Weinshenker BG, Wingerchuk DM. The two faces of neuromyelitis optica. Neurology 2014; 82:466.

Levy M. Does aquaporin-4-seronegative neuromyelitis optica exist? JAMA Neurol 2014; 71:271.

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