MOG-IgG1 and co-existence of neuronal autoantibodies,Multiple Sclerosis Journal

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MOG-IgG1 and co-existence of neuronal autoantibodies
Multiple Sclerosis Journal ( IF 4.8 ) Pub Date : 2020-09-10 , DOI: 10.1177/1352458520951046
Amy Kunchok ₁ , Eoin P Flanagan ₁ , Karl N Krecke ₂ , John J Chen ₃ , J Alfredo Caceres ₄ , Justin Dominick ₅ , Ian Ferguson ₆ , Revere Kinkel ₇ , John C Probasco ₄ , Miguel Ruvalcaba ₈ , Jonathan D Santoro ₉ , Kurt Sieloff ₁₀ , Jeremy Timothy ₁₁ , Brian G Weinshenker ₁₂ , Andrew McKeon ₁ , Sean J Pittock ₁

Affiliation

Department of Neurology, Mayo Clinic, Rochester, MN, USA/Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA/Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA/Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA/Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, John Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Neurology, Sharp Rees-Stealy Medical Group, San Diego, CA, USA.
Department of Rheumatology, Yale University School of Medicine, New Haven, CT, USA.
Department of Neurology, University of San Diego, San Diego, CA, USA.
Department of Neurology, UC Davis Medical Center (UCDMC), Sacramento, CA, USA.
Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA/Department of Neurology, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
Department of Neurology, Wellspan Pediatric Neurology, Manchester, PA, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA/Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.

BACKGROUND The presence of co-existent neuronal antibodies (neuronal-IgG) in patients with myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG1) is not yet well understood. OBJECTIVES The aim of this study was to investigate the co-existence of a broad range of neuronal-IgG in MOG-IgG1+ patients. METHODS MOG-IgG1+ patients were tested for 17 neuronal-IgGs in cerebrospinal fluid (CSF) and serum including NMDA-R-IgG, AMPA-R-IgG, GABAB-R-IgG, LGI1-IgG, CASPR2-IgG, GABAA-R-IgG, GAD65-IgG, mGLUR1-IgG, DPPX-IgG, CRMP5-IgG, amphiphysin-IgG, PCA1,2,Tr, and ANNA1,2,3. Clinical and radiological features of MOG-IgG1+ with NMDA-R-IgG in CSF were compared to a control cohort of MOG-IgG1+ patients without NMDA-R-IgG. RESULTS A total of 376 MOG-IgG1+ patients underwent testing for neuronal-IgGs. Serum testing for neuronal-IgGs (113 adults, 142 children) identified one child with NMDA-R-IgG (0.7%), one child with CASPR2-IgG (0.7%), one adult with LGI1-IgG (0.9%) and one adult with GABAA-R-IgG (0.9%). CSF testing for neuronal-IgGs (97 adults, 169 children) identified seven children (4%) and seven adults (7%) with NMDA-R-IgG, and one adult with GABAA-R-IgG (1%). The MOG-IgG1+/NMDA-R-IgG+ patients had a median age of 17 (range: 2-39) years. Features associated with MOG-IgG1+/NMDA-R-IgG+ included encephalopathy (p = 0.001), seizures (p = 0.045), and leptomeningeal enhancement (p = 0.045). CONCLUSION NMDA-R-IgG was the most frequently detected neuronal-IgG to co-exist with MOG-IgG1. MOG-IgG1+/NMDA-R-IgG+ patients most often presented with encephalopathy and seizures. Testing for MOG-IgG1 and NMDA-R-IgG may be warranted in patients with encephalopathy and inflammatory demyelinating syndromes.

更新日期：2020-09-10

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