{"doi":"10.1002/ana.26931","title":"Diagnostic Utility of <scp>MOG</scp> Antibody Testing in Cerebrospinal Fluid","abstract":"OBJECTIVE: The aim of this study was to assess the diagnostic utility of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) testing. METHODS: We retrospectively identified patients for CSF MOG-IgG testing from January 1, 1996, to May 1, 2023, at Mayo Clinic and other medical centers that sent CSF MOG-IgG for testing including: controls, 282; serum MOG-IgG positive MOG antibody-associated disease (MOGAD), 74; serum MOG-IgG negative high-risk phenotypes, 73; serum false positive MOG-IgG with alternative diagnoses, 18. A live cell-based assay assessed CSF MOG-IgG positivity (IgG-binding-index [IBI], ≥2.5) using multiple anti-human secondary antibodies and end-titers were calculated if sufficient sample volume. Correlation of CSF MOG-IgG IBI and titer was assessed. RESULTS: The pan-IgG Fc-specific secondary was optimal, yielding CSF MOG-IgG sensitivity of 90% and specificity of 98% (Youden's index 0.88). CSF MOG-IgG was positive in: 4/282 (1.4%) controls; 66/74 (89%) serum MOG-IgG positive MOGAD patients; and 9/73 (12%) serum MOG-IgG negative patients with high-risk phenotypes. Serum negative but CSF positive MOG-IgG accounted for 9/83 (11%) MOGAD patients, and all fulfilled 2023 MOGAD diagnostic criteria. Subgroup analysis of serum MOG-IgG low-positives revealed CSF MOG-IgG positivity more in MOGAD (13/16[81%]) than other diseases with false positive serum MOG-IgG (3/15[20%]) (p = 0.01). CSF MOG-IgG IBI and CSF MOG-IgG titer (both available in 29 samples) were correlated (Spearman's r = 0.64, p < 0.001). INTERPRETATION: CSF MOG-IgG testing has diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG, and those with low positive serum MOG-IgG results and diagnostic uncertainty. These findings support a role for CSF MOG-IgG testing in the appropriate clinical setting. ANN NEUROL 2024;96:34-45.","journal":"Annals of Neurology","year":2024,"id":419105,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":43,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9258,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":238919,"name":"James P. 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Mills","orcid":"0000-0003-1025-4760","position":10,"is_corresponding":false},{"id":231251,"name":"A. Sebastian López‐Chiriboga","orcid":"0000-0001-5653-5600","position":11,"is_corresponding":false},{"id":252994,"name":"Jan‐Mendelt Tillema","orcid":null,"position":12,"is_corresponding":false},{"id":1075125,"name":"Binxia Yang","orcid":null,"position":13,"is_corresponding":false},{"id":1209060,"name":"Yahya Abdulrahman","orcid":null,"position":14,"is_corresponding":false},{"id":1208383,"name":"Kai Guo","orcid":"0000-0001-8972-2015","position":15,"is_corresponding":false},{"id":1208384,"name":"Nisa Vorasoot","orcid":"0000-0002-0751-8967","position":16,"is_corresponding":false},{"id":765832,"name":"Cristina Valencia-Sánchez","orcid":"0000-0003-0116-8035","position":17,"is_corresponding":false},{"id":1025552,"name":"Deena Tajfirouz","orcid":"0000-0001-8419-8728","position":18,"is_corresponding":false},{"id":1068907,"name":"Michel Toledano","orcid":"0000-0002-9046-7880","position":19,"is_corresponding":false},{"id":312359,"name":"Αναστασία Ζεκερίδου","orcid":"0000-0002-1960-9065","position":20,"is_corresponding":false},{"id":854269,"name":"Divyanshu Dubey","orcid":"0000-0002-4302-4075","position":21,"is_corresponding":false},{"id":250715,"name":"Grace Gombolay","orcid":"0000-0003-4830-7792","position":22,"is_corresponding":false},{"id":959480,"name":"César Caparó‐Zamalloa","orcid":"0000-0002-6896-3052","position":23,"is_corresponding":false},{"id":529976,"name":"Ilya Kister","orcid":"0000-0003-3549-949X","position":24,"is_corresponding":false},{"id":231254,"name":"Sean J. 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