title: Autoantibody to MOG suggests two distinct clinical subtypes of NMOSD.
abstract: We characterized a unique group of patients with neuromyelitis optica spectrum disorder (NMOSD) who carried autoantibodies of aquaporin-4 (AQP4) and myelin-oligodendrocyte glycoprotein (MOG). Among the 125 NMOSD patients, 10 (8.0%) were AQP4- and MOG-ab double positive, and 14 (11.2%) were MOG-ab single positive. The double-positive patients had a multiphase disease course with a high annual relapse rate (P=0.0431), and severe residual disability (P>0.0001). Of the double- positive patients, 70% had MS-like brain lesions, more severe edematous, multifocal regions on spinal magnetic resonance imaging (MRI), pronounced decreases of retinal nerve fiber layer thickness and atrophy of optic nerves. In contrast, patients with only MOG-ab had a higher ratio of monophasic disease course and mild residual disability. Spinal cord MRI illustrated multifocal cord lesions with mild edema, and brain MRIs showed more lesions around lateral ventricles. NMOSD patients carrying both autoantibodies to AQP4 and MOG existed and exhibited combined features of prototypic NMO and relapsing- remitting form of MS, whereas NMOSD with antibodies to MOG only exhibited an "intermediate" phenotype between NMOSD and MS. Our study suggests that antibodies against MOG might be pathogenic in NMOSD patients and that determination of anti-MOG antibodies maybe instructive for management of NMOSD patients.
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China. yaping.yan@tmu.edu.cn.
authors.forename: Yaping
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Yujing
authors.initials: Y
authors.lastname: Li
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Su
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Kaibin
authors.initials: K
authors.lastname: Shi
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Minshu
authors.initials: M
authors.lastname: Li
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.|Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, 85013, USA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, 85013, USA.
authors.forename: Aimee
authors.initials: A
authors.lastname: Borazanci
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China.
authors.forename: Yaou
authors.initials: Y
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, 80045, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Bennett
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, 80045, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Vollmer
authors.affiliation: Departments of Neurology and Immunology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China. fshi@tmu.edu.cn.|Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, 85013, USA. fshi@tmu.edu.cn.
authors.forename: Fu-Dong
authors.initials: FD
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001921:Brain / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D005260:Female; D057809:HEK293 Cells; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology*; D009471:Neuromyelitis Optica / Q000097:blood / Q000188:drug therapy / Q000276:immunology*; D009900:Optic Nerve / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D010865:Pilot Projects; D012008:Recurrence; D012165:Retinal Ganglion Cells / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology; D041623:Tomography, Optical Coherence
chemical_list: D051401:Aquaporin 4; D001323:Autoantibodies; D007155:Immunologic Factors; D063308:Myelin-Oligodendrocyte Glycoprotein
keywords: AQP4 antibody; MOG antibody; neuromyelitis optica spectrum disorder; phenotype