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Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients

dc.contributor.authorJarius, Sven
dc.contributor.authorPellkofer, Hannah
dc.contributor.authorSiebert, Nadja
dc.contributor.authorKorporal-Kuhnke, Mirjam
dc.contributor.authorHümmert, Martin W
dc.contributor.authorRingelstein, Marius
dc.contributor.authorRommer, Paulus S
dc.contributor.authorAyzenberg, Ilya
dc.contributor.authorRuprecht, Klemens
dc.contributor.authorKlotz, Luisa
dc.contributor.authorAsgari, Nasrin
dc.contributor.authorZrzavy, Tobias
dc.contributor.authorHöftberger, Romana
dc.contributor.authorTobia, Rafik
dc.contributor.authorButtmann, Mathias
dc.contributor.authorFechner, Kai
dc.contributor.authorSchanda, Kathrin
dc.contributor.authorWeber, Martin
dc.contributor.authorAsseyer, Susanna
dc.contributor.authorHaas, Jürgen
dc.contributor.authorLechner, Christian
dc.contributor.authorKleiter, Ingo
dc.contributor.authorAktas, Orhan
dc.contributor.authorTrebst, Corinna
dc.contributor.authorRostasy, Kevin
dc.contributor.authorReindl, Markus
dc.contributor.authorKümpfel, Tania
dc.contributor.authorPaul, Friedemann
dc.contributor.authorWildemann, Brigitte
dc.date.accessioned2020-09-06T04:05:05Z
dc.date.available2020-09-06T04:05:05Z
dc.date.issued2020
dc.identifier.urihttp://resolver.sub.uni-goettingen.de/purl?gs-1/17535
dc.description.abstractAbstract Background New-generation cell-based assays have demonstrated a robust association of serum autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis, and brainstem encephalitis, as well as with neuromyelitis optica (NMO)-like or acute-disseminated encephalomyelitis (ADEM)-like presentations. However, only limited data are yet available on cerebrospinal fluid (CSF) findings in MOG-IgG-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD). Objective To describe systematically the CSF profile in MOG-EM. Material and methods Cytological and biochemical findings (including white cell counts and differentiation; frequency and patterns of oligoclonal bands; IgG/IgM/IgA and albumin concentrations and CSF/serum ratios; intrathecal IgG/IgA/IgM fractions; locally produced IgG/IgM/IgA concentrations; immunoglobulin class patterns; IgG/IgA/IgM reibergrams; Link index; measles/rubella/zoster (MRZ) reaction; other anti-viral and anti-bacterial antibody indices; CSF total protein; CSF l-lactate) from 163 lumbar punctures in 100 adult patients of mainly Caucasian descent with MOG-EM were analyzed retrospectively. Results Most strikingly, CSF-restricted oligoclonal IgG bands, a hallmark of multiple sclerosis (MS), were absent in almost 90% of samples (N = 151), and the MRZ reaction, the most specific laboratory marker of MS known so far, in 100% (N = 62). If present, intrathecal IgG (and, more rarely, IgM) synthesis was low, often transient and mostly restricted to acute attacks. CSF WCC was elevated in > 50% of samples (median 31 cells/μl; mostly lymphocytes and monocytes; > 100/μl in 12%). Neutrophils were present in > 40% of samples; activated lymphocytes were found less frequently and eosinophils and/or plasma cells only very rarely (< 4%). Blood–CSF barrier dysfunction (as indicated by an elevated albumin CSF/serum ratio) was present in 48% of all samples and at least once in 55% of all patients (N = 88) tested. The frequency and degree of CSF alterations were significantly higher in patients with acute myelitis than in patients with acute ON and varied strongly depending on attack severity. CSF l-lactate levels correlated significantly with the spinal cord lesion load in patients with acute myelitis (p < 0.0001). Like pleocytosis, blood–CSF barrier dysfunction was present also during remission in a substantial number of patients. Conclusion MOG-IgG-positive EM is characterized by CSF features that are distinct from those in MS. Our findings are important for the differential diagnosis of MS and MOG-EM and add to the understanding of the immunopathogenesis of this newly described autoimmune disease.
dc.language.isoen
dc.publisherBioMed Central
dc.identifier.bibliographicCitationJournal of Neuroinflammation. 2020 Sep 03;17(1):261
dc.rightsopenAccess
dc.titleCerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients
dc.typejournalArticle
dc.identifier.doi10.1186/s12974-020-01824-2
dc.type.versionpublishedVersion
dc.date.updated2020-09-06T04:05:05Z
dc.rights.holderThe Author(s)
dc.bibliographicCitation.volume17
dc.bibliographicCitation.issue1
dc.type.subtypejournalArticle
dc.bibliographicCitation.articlenumber261
dc.bibliographicCitation.journalJournal of Neuroinflammation


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