From the Guidelines
Anti-MOG antibodies are primarily detected in serum rather than cerebrospinal fluid (CSF). When testing for MOG antibody-associated disease, blood samples are the preferred specimen for analysis. While these antibodies can occasionally be found in CSF, their concentration is typically much lower there than in serum, making serum testing more sensitive and reliable for diagnosis 1. The standard diagnostic approach involves using cell-based assays on serum samples to detect these antibodies. This testing preference exists because MOG antibodies are produced peripherally by B cells and then cross the blood-brain barrier to cause inflammation in the central nervous system.
Key Points to Consider
- The antibodies target myelin oligodendrocyte glycoprotein, a protein expressed on the surface of myelin sheaths, oligodendrocytes, and some neurons, leading to demyelination and neurological symptoms.
- For optimal diagnostic accuracy, serum samples should be collected before initiating immunotherapy, as treatment can reduce antibody levels and potentially lead to false-negative results.
- CSF analysis may be helpful in rare, selected cases, such as when there is a strong background due to co-existing high-titer non-MOG serum antibodies 1.
Diagnostic Approach
- Serum is the recommended specimen for MOG antibody testing, with shipment at 4 °C or on dry ice advisable if samples do not arrive within 1–2 days 1.
- Cell-based assays are the standard method for detecting MOG antibodies in serum.
- CSF testing may be considered in specific cases, but it is not usually required due to the lower concentration of MOG antibodies in CSF compared to serum 1.
From the Research
Anti-MOG Antibody Detection
- Anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies can be found in both serum and cerebrospinal fluid (CSF) 2, 3, 4.
- Studies have shown that MOG antibodies are present in the CSF of patients with multiple sclerosis (MS) and other inflammatory neurological disorders 3.
- The presence of MOG antibodies in CSF can be used as a diagnostic tool to differentiate MOGAD from MS 2.
- MOG antibodies can be detected in CSF using enzyme-linked immunosorbent assay (ELISA) or live cell-based assays 2, 3.
Comparison of Anti-MOG Antibody Detection in Serum and CSF
- Some studies have found that MOG antibodies are more frequently detected in CSF than in serum 3.
- However, other studies have found that MOG antibodies can be detected in both serum and CSF, and that the presence of antibodies in one does not necessarily predict their presence in the other 2, 4.
- The sensitivity and specificity of MOG antibody detection in serum and CSF can vary depending on the assay used and the population being studied 2, 4.
Clinical Implications of Anti-MOG Antibody Detection
- The detection of MOG antibodies in serum or CSF can be used to support a diagnosis of MOGAD 2, 4.
- The presence of MOG antibodies in CSF can also be used to monitor disease activity and response to treatment 3.
- However, the clinical implications of MOG antibody detection are still being studied, and more research is needed to fully understand their role in MOGAD and other neurological disorders 2, 4.