Abstract
Background
Live cell-based assay (LCBA) is the gold standard for MOG-IgG detection, and fixed CBA (FCBA) is a widely used commercial alternative. Recent criteria attributed a diagnostic value to MOG-IgG titration with both LCBA and FCBA, with low-titre samples requiring additional supporting features for MOGAD diagnosis. However, FCBA titration is not validated. We aimed to assess the impact of the criteria-based MOG-IgG testing in MOGAD diagnosis.
Methods
Thirty-eight serum samples of LCBA MOG-IgG1-positive MOGAD patients were titred on MOG-IgG LCBA and FCBA, and the presence of supporting features for MOGAD assessed. MOGAD criteria were evaluated in four testing scenarios: (a) FCBA without titration; (b) FCBA with titration; c) LCBA without titration; (d) LCBA with titration.
Results
FCBA without titration failed to reach MOGAD diagnosis in 11/38 patients (28.9%, negative results in 5, lack of supporting features in 6). Patients with unconfirmed diagnosis had optic neuritis (ON, n = 8), or transverse myelitis (TM, n = 3). FCBA with titration allowed MOGAD diagnosis in 4 additional patients. Correlation between LCBA and FCBA titres was moderate (Spearman’s rho 0.6, p < 0.001).
Conclusions
FCBA yields high rate of misdiagnosis mainly due a lower analytical sensitivity. FCBA titration provides a moderate diagnostic advantage in FCBA positive patients.
Data availability
Raw data are available at the Zenodo repository (https://doi.org/10.5281/zenodo.10067022).
References
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Funding
The present study was supported by the Italian Ministry of Health, 'Ricerca Corrente' Grant to the IRCCS Mondino Foundation (code RC22012B).
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Conflicts of interest
MG and DF perform MOG assays for diagnostic purposes. The remaining authors declare that they have no conflict of interest.
Ethical approval
The current project has been approved by the local ethics review board (IRCCS San Matteo, code: 0020308/23).
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All patients provided informed consent for participation.
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Risi, M., Greco, G., Masciocchi, S. et al. MOG-IgG testing strategies in accordance with the 2023 MOGAD criteria: a clinical-laboratory assessment. J Neurol 271, 2840–2843 (2024). https://doi.org/10.1007/s00415-024-12180-z
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DOI: https://doi.org/10.1007/s00415-024-12180-z