Anti–Myelin Oligodendrocyte Glycoprotein Antibodies in Pediatric Patients With Optic Neuritis

Abstract

To study the humoral immune response directed at myelin oligodendrocyte glycoprotein (MOG) in pediatric patients with isolated and recurrent optic neuritis (ON).Design: Observational prospective case series.Setting: Six pediatric hospitals in Germany and Austria.Patients: Thirty-seven patients 18 years or younger with single or recurrent episodes of ON were recruited from 6 different hospitals.Main Outcome Measures: Clinical features, magnetic resonance imaging findings, intrathecal IgG synthesis, and outcome were recorded. A live cell-based immunofluorescence assay was used to measure serum IgG antibodies to MOG and aquaporin 4.Results: A single episode of ON was observed in 10 patients, and 15 experienced 2 to 12 episodes. The acute episode of ON was part of a clinically isolated syndrome in 12 patients, of whom 8 were subsequently classified as having multiple sclerosis. High-titer serum MOG-IgG antibodies (Ն1:160) were detected in 17 patients (46%). In addition, high titers of MOG-IgG antibodies were more frequently observed in 12 of the 15 patients with recurrent episodes of ON (80%; median titer, 1:640) compared with 2 of the 10 patients with monophasic ON (20%; median titer, 0) and 3 of the 12 patients with ON as part of a clinically isolated syndrome (25%; median titer, 0). Conclusion:High-titer MOG-IgG antibodies are predominantly detected in pediatric patients with recurrent ON, indicating that anti-MOG-specific antibodies may exert a direct role in the pathogenesis of ON in this subgroup.

Clinical Profile of Anti-Myelin Oligodendrocyte Glycoprotein Antibody Seropositive Cases of Optic Neuritis

“…Furthermore, high MOG-Ab titre has been detected predominantly in patients with recurrent ON. 7 We have previously reported that concomitant presence of MOG-Abs in AQP4-Ab seropositive optic neuritis is associated with severe visual function impairment. However, MOG-Ab seropositive optic neuritis has not been elucidated using new methods such as cell-based assay.…”

“…5 Recent studies have shown that among AQP4-Ab seronegative ON cases with relatively good prognosis but repeated relapses, some are seropositive for myelin oligodendrocyte glycoprotein (MOG) antibodies. 6,7 In addition, MOG is known to be a causative protein of experimental autoimmune encephalitis (EAE). 8 MOG derived from oligodendrocytes induces ON in mouse, suggesting that MOG antigen may be a cause of multiple sclerosisassociated ON.…”

Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis

“…[14][15][16][17][18] In contrast, the clinical relevance of MOG antibodies in adults is unclear, as only a minority of patients with MS and NMO/NMOSD are seropositive. 16,[18][19][20][21][22][23][24] Herein, we provide evidence that MOG antibodies are a clinical biomarker of bilateral and/ or recurrent optic neuritis (BON) in adults and describe the characteristic clinical course, response to therapy, and visual outcomes of this condition.…”

“…23,24 The presence of relapses has been observed in pediatric patients with MOG antibodies and LETM or recurrent or bilateral ON. 15,21 Notably, a number of our MOG antibody-positive patients had previous treatment with short courses of pulsed steroids alone and had a propensity to relapse. This may indicate that early and sustained immunotherapy with multiple agents, including steroidsparing maintenance immunosuppression, may be more effective in maintaining disease remission.…”

Myelin-Oligodendrocyte Glycoprotein Antibodies Spectrum Disorders

“…A study on 37 cases, 18 or under 18 years old with recurrent or single episodes of optic neuritis, suggested that generally these patients had high titer serum anti-MOG antibodies from the subclass of IgG, especially in patients suffering from recurrent episodes of optic neuritis (31). In a group of pediatrics suffering from recurrent or monophasic ADEM, optic neuritis was diagnosed.…”