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

Jarius, Sven; Pellkofer, Hannah; Siebert, Nadja; Korporal-Kuhnke, Mirjam; Huemmert, Martin W.; Ringelstein, Marius; Rommer, Paulus S.; Ayzenberg, Ilya; Ruprecht, Klemens; Klotz, Luisa; Asgari, Nasrin; Zrzavy, Tobias; Hoeftberger, Romana; Tobia, Rafik; Buttmann, Mathias; Fechner, Kai; Schanda, Kathrin; Weber, Martin; Asseyer, Susanna; Haas, Jürgen; Lechner, Christian; Kleiter, Ingo; Aktas, Orhan; Trebst, Corinna; Rostasy, Kevin; Reindl, Markus; Kuempfel, Tania; Paul, Friedemann und Wildemann, Brigitte (2020): Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. Part 1: Results from 163 lumbar punctures in 100 adult patients. In: Journal of Neuroinflammation, Bd. 17, Nr. 1, 261

Abstract

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;CSFl-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/mu l;mostly lymphocytes and monocytes;> 100/mu l 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. CSFl-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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch