• Giacomo Greco, Mario Risi, Stefano Masciocchi, Pietro Businaro, Eleonora Rigoni, Elisabetta Zardini, Silvia Scaranzin, Chiara Morandi, Luca Diamanti, Thomas Foiadelli, Maria Pia Giannoccaro, Luana Morelli, Rocco Liguori, Paolo Barone, Alessandra Tozzo, Alice Passarini, Stefano Gelibter, Francesco Patti, Paola Banfi, Anna Maria Simone, Alvino Bisecco, Martino Ruggieri, Davide Maimone, Giorgia Bruno, Sabrina Siliquini, Stefania Bova, Massimiliano Di Filippo, Roberta Lanzillo, Antonio Gallo, Elena Colombo, Diego Franciotta, Matteo Gastaldi, and Neuroimmunology Platform (PNI) study group.
• Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
• J. Neurol. Neurosurg. Psychiatr. 2024 Jun 6.

BackgroundCerebrospinal fluid myelin oligodendrocyte glycoprotein IgG (CSF MOG-IgG) are found in a proportion of patients with MOG antibody-associated disorder (MOGAD) and have been associated with severe disease presentations. However, most studies did not systematically investigate the role of MOG-IgG intrathecal synthesis (ITS).MethodsWe retrospectively studied 960 consecutive patients with paired serum and CSF samples screened for MOG-IgG using a live cell-based assays. MOG-IgG-specific antibody index (AIMOG) was systematically calculated using serum and CSF titres to assess MOG-IgG ITS, and clinical features were compared between MOG-IgG CSF+/CSF- and ITS+/ITS- patients.ResultsMOG-IgG were found in 55/960 patients (5.7%; serum+/CSF-: 58.2%, serum+/CSF+: 34.5%; serum-/CSF+: 7.3%). Serum/CSF MOG-IgG titres showed a moderate correlation in patients without ITS (ρ=0.47 (CI 0.18 to 0.68), p<0.001), but not in those with ITS (ρ=0.14 (CI -0.46 to -0.65), p=0.65). There were no clinical-paraclinical differences between MOG-IgG CSF+ vs CSF- patients. Conversely, patients with MOG-IgG ITS showed pyramidal symptoms (73% vs 32%, p=0.03), spinal cord involvement (82% vs 39%, p=0.02) and severe outcome at follow-up (36% vs 5%, p=0.02) more frequently than those without MOG-IgG ITS. A multivariate logistic regression model indicated that MOG-IgG ITS was an independent predictor of a poor outcome (OR: 14.93 (CI 1.40 to 19.1); p=0.03). AIMOG correlated with Expanded Disability Status Scale (EDSS) scores at disease nadir and at last follow-up (p=0.02 and p=0.01).ConclusionsConsistently with physiopathology, MOG-IgG ITS is a promising prognostic factor in MOGAD, and its calculation could enhance the clinical relevance of CSF MOG-IgG testing, making a case for its introduction in clinical practice.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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