MOG-Antibody Testing and the Search for Effective Treatment in MOGAD: Eoin P. Flanagan, MB, BCh

WATCH TIME: 3 minutes

"For neurologists out there, if you have a patient with relapsing MOG-antibody associated disease (MOGAD), look out for clinical trial sites and try to enroll the patients in those trials so that we can get a proven treatment for them."

Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) associated disease (MOGAD), a rare autoimmune disease, is commonly associated with optic neuritis, acute disseminated encephalomyelitis, myelitis, cerebral monofocal or polyfocal deficits, and other symptoms. Research shows that cell-based assays are optimal for the detection of MOG-IgG in serum, and that live cell-based assays may have an advantage over fixed assays.¹ As of currently, MOG-IgG testing has primarily been observed in serum. Despite this, recent studies suggest that MOG-IgG in cerebrospinal fluid (CSF) may have diagnostic and prognostic utility for patients.²

Findings from a new study showed that CSF MOG-IgG testing had beneficial diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG.³ Published in Annals of Neurology, this testing approach also displayed positive diagnostic utility in patients with low positive serum MOG-IgG results and diagnostic uncertainty. Senior author Eoin P. Flanagan, MB, BCh, professor of neurology and chief of the Division of Multiple Sclerosis and Autoimmune Neurology at Mayo Clinic, and colleagues, noted that these findings provide evidence on the benefit of using CSF MOG-IgG testing as a tool in the clinical setting.

Flanagan, who also serves as the director of the Autoimmune Neurology Fellowship, recently had a conversation with NeurologyLive^® in an interview to further discuss the differences between live cell based and fixed cell-based assays for detecting MOG antibodies. He also spoke about the importance of trying to understand why some patients only have antibodies present in their spinal fluid. In addition, Flanagan talked about the challenges in finding effective treatments for MOG-antibody associated diseases compared with other autoimmune diseases like neuromyelitis optica spectrum disorder.

REFERENCES
1. Waters PJ, Komorowski L, Woodhall M, et al. A multicenter comparison of MOG-IgG cell-based assays. Neurology. 2019;92(11):e1250-e1255. doi:10.1212/WNL.0000000000007096
2. Hacohen Y, Kerr W, Waters P. Intrathecal Production of MOG-IgG: Highlighting the Need for CSF Testing in Clinical Practice. Neurology. 2021;97(1):12-13. doi:10.1212/WNL.0000000000012177
3. Redenbaugh V, Fryer JP, Cacciaguerra L, et al. Diagnostic Utility of MOG Antibody Testing in Cerebrospinal Fluid. Ann Neurol. Published online April 9, 2024. doi:10.1002/ana.26931