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Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study.
JAMA Neurol 2014; 71(3):276-83JN

Abstract

IMPORTANCE

Most patients with neuromyelitis optica (NMO) and many with NMO spectrum disorder have autoantibodies against aquaporin-4 (AQP4-Abs), but recently, myelin-oligodendrocyte glycoprotein antibodies (MOG-Abs) have been found in some patients. Here, we showed that patients with NMO/NMOSD with MOG-Abs demonstrate differences when compared with patients with AQP4-Abs.

OBJECTIVE

To characterize the features of patients with NMO/NMOSD with MOG-Abs and compare them with patients with AQP4-Ab-positive NMO/NMOSD.

DESIGN, SETTING, AND PARTICIPANTS

This observational study was conducted at a single UK specialist center for NMO. Patients with a first demyelinating event between January 1, 2010, and April 1, 2013, seen within the Oxford NMO service and who tested positive for MOG-Abs or AQP4-Abs were included in the study.

EXPOSURE

Cell-based assays using C-terminal-truncated human MOG and full-length M23-AQP4 were used to test patient serum samples for AQP4-Abs and MOG-Abs.

MAIN OUTCOMES AND MEASURES

Demographic, clinical, and disability data, and magnetic resonance imaging findings.

RESULTS

Twenty AQP4-Ab-positive patients and 9 MOG-Ab-positive patients were identified. Most patients in both groups were white. Ninety percent of AQP4-Ab-positive patients but only 44% MOG-Ab-positive patients were females (P = .02) with a trend toward older age at disease onset in AQP4-Ab-positive patients (44.9 vs 32.3 years; P = .05). MOG-Ab-positive patients more frequently presented with simultaneous/sequential optic neuritis and myelitis (44% vs 0%; P = .005). Onset episode severity did not differ between the 2 groups, but patients with MOG-Abs had better outcomes from the onset episode, with better recovery Expanded Disability Status Scale scores and a lower risk for visual and motor disability. Myelin-oligodendrocyte glycoprotein antibody-positive patients were more likely to have conus involvement on spinal magnetic resonance imaging (75% vs 17%; P = .02) and involvement of deep gray nuclei on brain magnetic resonance imaging (P = .03). Cerebrospinal fluid characteristics were similar in the 2 groups. A higher proportion of AQP4-Ab-positive patients relapsed (40% vs 0%; P = .03) despite similar follow-up durations.

CONCLUSIONS AND RELEVANCE

Despite the fact that patients with MOG-Abs can fulfill the diagnostic criteria for NMO, there are differences when compared with those with AQP4-Abs. These include a higher proportion of males, younger age, and greater likelihood of involvement of the conus and deep gray matter structures on imaging. Additionally, patients with MOG-Abs had more favorable outcomes. Patients with AQP4-Ab-negative NMO/NMOSD should be tested for MOG-Abs.

Authors+Show Affiliations

Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Department of Neuroradiology, Oxford University Hospitals National Health Service Trust, Oxford, England.Children's Hospital, Oxford University Hospitals National Health Service Trust, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.Nuffield Department of Clinical Neurosciences, Oxford University Hospitals National Health Service Trust, University of Oxford, Oxford, England.

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24425068

Citation

Kitley, Joanna, et al. "Neuromyelitis Optica Spectrum Disorders With Aquaporin-4 and Myelin-oligodendrocyte Glycoprotein Antibodies: a Comparative Study." JAMA Neurology, vol. 71, no. 3, 2014, pp. 276-83.
Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurol. 2014;71(3):276-83.
Kitley, J., Waters, P., Woodhall, M., Leite, M. I., Murchison, A., George, J., ... Palace, J. (2014). Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurology, 71(3), pp. 276-83. doi:10.1001/jamaneurol.2013.5857.
Kitley J, et al. Neuromyelitis Optica Spectrum Disorders With Aquaporin-4 and Myelin-oligodendrocyte Glycoprotein Antibodies: a Comparative Study. JAMA Neurol. 2014;71(3):276-83. PubMed PMID: 24425068.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. AU - Kitley,Joanna, AU - Waters,Patrick, AU - Woodhall,Mark, AU - Leite,M Isabel, AU - Murchison,Andrew, AU - George,Jithin, AU - Küker,Wilhelm, AU - Chandratre,Saleel, AU - Vincent,Angela, AU - Palace,Jacqueline, PY - 2014/1/16/entrez PY - 2014/1/16/pubmed PY - 2014/5/16/medline SP - 276 EP - 83 JF - JAMA neurology JO - JAMA Neurol VL - 71 IS - 3 N2 - IMPORTANCE: Most patients with neuromyelitis optica (NMO) and many with NMO spectrum disorder have autoantibodies against aquaporin-4 (AQP4-Abs), but recently, myelin-oligodendrocyte glycoprotein antibodies (MOG-Abs) have been found in some patients. Here, we showed that patients with NMO/NMOSD with MOG-Abs demonstrate differences when compared with patients with AQP4-Abs. OBJECTIVE: To characterize the features of patients with NMO/NMOSD with MOG-Abs and compare them with patients with AQP4-Ab-positive NMO/NMOSD. DESIGN, SETTING, AND PARTICIPANTS: This observational study was conducted at a single UK specialist center for NMO. Patients with a first demyelinating event between January 1, 2010, and April 1, 2013, seen within the Oxford NMO service and who tested positive for MOG-Abs or AQP4-Abs were included in the study. EXPOSURE: Cell-based assays using C-terminal-truncated human MOG and full-length M23-AQP4 were used to test patient serum samples for AQP4-Abs and MOG-Abs. MAIN OUTCOMES AND MEASURES: Demographic, clinical, and disability data, and magnetic resonance imaging findings. RESULTS: Twenty AQP4-Ab-positive patients and 9 MOG-Ab-positive patients were identified. Most patients in both groups were white. Ninety percent of AQP4-Ab-positive patients but only 44% MOG-Ab-positive patients were females (P = .02) with a trend toward older age at disease onset in AQP4-Ab-positive patients (44.9 vs 32.3 years; P = .05). MOG-Ab-positive patients more frequently presented with simultaneous/sequential optic neuritis and myelitis (44% vs 0%; P = .005). Onset episode severity did not differ between the 2 groups, but patients with MOG-Abs had better outcomes from the onset episode, with better recovery Expanded Disability Status Scale scores and a lower risk for visual and motor disability. Myelin-oligodendrocyte glycoprotein antibody-positive patients were more likely to have conus involvement on spinal magnetic resonance imaging (75% vs 17%; P = .02) and involvement of deep gray nuclei on brain magnetic resonance imaging (P = .03). Cerebrospinal fluid characteristics were similar in the 2 groups. A higher proportion of AQP4-Ab-positive patients relapsed (40% vs 0%; P = .03) despite similar follow-up durations. CONCLUSIONS AND RELEVANCE: Despite the fact that patients with MOG-Abs can fulfill the diagnostic criteria for NMO, there are differences when compared with those with AQP4-Abs. These include a higher proportion of males, younger age, and greater likelihood of involvement of the conus and deep gray matter structures on imaging. Additionally, patients with MOG-Abs had more favorable outcomes. Patients with AQP4-Ab-negative NMO/NMOSD should be tested for MOG-Abs. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/24425068/Neuromyelitis_optica_spectrum_disorders_with_aquaporin_4_and_myelin_oligodendrocyte_glycoprotein_antibodies:_a_comparative_study_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2013.5857 DB - PRIME DP - Unbound Medicine ER -