Age and Sex Distributions of MOG-IgG and AQP4-IgG Positive Sera from a Large Neuroimmunology Laboratory Database
Nisa Vorasoot1, Amy Kunchok4, Matthew C. Edmond2, Jennifer McCombe5, Vyanka Redenbaugh1, Laura Cacciaguerra1, Smathorn Thakolwiboon1, Nanthaya Tisavipat1, Yahya Abdulrahman1, John Chen3, Sean Pittock1, Eoin Flanagan1
1Neurology, 2Laboratory Medicine and Pathology, 3Ophthalmology, Mayo Clinic, 4Neurology, Mellen Center, Neurological Institute, Cleveland Clinic, 5Division of Neurology, Department of Medicine, University of Alberta
Objective:

To determine the age and sex distribution of Myelin oligodendrocyte glycoprotein (MOG)-IgG seropositive and aquaporin-4 (AQP4)-IgG seropositive patients versus those testing negative.

Background:

MOG-IgG is a biomarker of MOG-antibody-associated-disease (MOGAD), a distinct central nervous system demyelinating disease with overlapping clinical features with AQP4-IgG-seropositive-neuromyelitis-optica-spectrum-disorders (AQP4+NMOSD). Knowledge of age and sex distribution from large cohorts tested for MOG-IgG and AQP4-IgG can provide useful epidemiology data to guide allocation of resources and healthcare delivery.

Design/Methods:

This is a retrospective laboratory-based study utilizing the Mayo Clinic neuroimmunology laboratory data on serum testing of MOG-IgG with live cell-based assay (2017-2022) and AQP4-IgG with fixed or live cell-based assay (2007-2021). Age, sex, and antibody titers were evaluated.

Results:

Of 96,373 patients’ sera tested for MOG-IgG, 7,367 (7.6%) were positive. Patients seropositive for MOG-IgG were younger than MOG-IgG seronegative patients (median age 34 [IQR 17-49] vs 42 [30-55] years, respectively; p<0.001). Among MOG-IgG seropositive patients, 1,167 (15.8%) were pediatric (aged <12 years), and 735 (10%) 12-17 years and 475 (6.5%) were elderly (aged ≥65 years). MOG-IgG seropositives had a female-to-male ratio of 1.6:1 while MOG-IgG seronegatives had a ratio of 2:1. The median MOG-IgG titer was 1:100 (IQR 1:40-1:100). Higher serum titers (≥1:1,000) were most frequent in pediatrics (42.8%) versus other groups (p<0.001).

Of 145,418 patients’ sera tested for AQP4-IgG, 5,505 (3.8%) were positive. The median age of AQP4-IgG seropositive and seronegative patients was 48 (IQR 33-60) and 42 (IQR 30-54) years, respectively; p<0.001. The female-to-male ratio in AQP4-IgG seropositives was 6.5:1 and greater than AQP4-IgG seronegatives (2:1) (p<0.001). The median AQP4-IgG serum titer was 1:1,000 (IQR 1:100-1:10,000).

Conclusions:

This large dataset shows the predilection of pediatric patients for both MOG-IgG positivity and higher titers while also revealing a slight female predominance. In comparison, AQP4-IgG positives were older and had a higher proportion of females.

10.1212/WNL.0000000000204098