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However, only limited data are yet available on cerebrospinal fluid (CSF) findings in MOG-IgG-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To describe systematically the CSF profile in MOG-EM.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material and methods<\/jats:title>\n                <jats:p>Cytological and biochemical findings (including white cell counts and differentiation; frequency and patterns of oligoclonal bands; IgG\/IgM\/IgA and albumin concentrations and CSF\/serum ratios; intrathecal IgG\/IgA\/IgM fractions; locally produced IgG\/IgM\/IgA concentrations; immunoglobulin class patterns; IgG\/IgA\/IgM reibergrams; Link index; measles\/rubella\/zoster (MRZ) reaction; other anti-viral and anti-bacterial antibody indices; CSF total protein; CSF <jats:sc>l<\/jats:sc>-lactate) from 163 lumbar punctures in 100 adult patients of mainly Caucasian descent with MOG-EM were analyzed retrospectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Most strikingly, CSF-restricted oligoclonal IgG bands, a hallmark of multiple sclerosis (MS), were absent in almost 90% of samples (<jats:italic>N<\/jats:italic> = 151), and the MRZ reaction, the most specific laboratory marker of MS known so far, in 100% (<jats:italic>N<\/jats:italic> = 62). If present, intrathecal IgG (and, more rarely, IgM) synthesis was low, often transient and mostly restricted to acute attacks. CSF WCC was elevated in &gt; 50% of samples (median 31 cells\/\u03bcl; mostly lymphocytes and monocytes; &gt; 100\/\u03bcl in 12%). Neutrophils were present in &gt; 40% of samples; activated lymphocytes were found less frequently and eosinophils and\/or plasma cells only very rarely (&lt; 4%). Blood\u2013CSF barrier dysfunction (as indicated by an elevated albumin CSF\/serum ratio) was present in 48% of all samples and at least once in 55% of all patients (<jats:italic>N<\/jats:italic> = 88) tested. The frequency and degree of CSF alterations were significantly higher in patients with acute myelitis than in patients with acute ON and varied strongly depending on attack severity. CSF <jats:sc>l<\/jats:sc>-lactate levels correlated significantly with the spinal cord lesion load in patients with acute myelitis (<jats:italic>p<\/jats:italic> &lt; 0.0001). Like pleocytosis, blood\u2013CSF barrier dysfunction was present also during remission in a substantial number of patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>MOG-IgG-positive EM is characterized by CSF features that are distinct from those in MS. Our findings are important for the differential diagnosis of MS and MOG-EM and add to the understanding of the immunopathogenesis of this newly described autoimmune disease.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12974-020-01824-2","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T16:04:09Z","timestamp":1599149049000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":134,"title":["Cerebrospinal fluid findings in patients with myelin oligodendrocyte glycoprotein (MOG) antibodies. 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Patients gave written informed consent.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"S.J. was indirectly supported by research grants from the Dietmar Hopp Stiftung and from Merck Serono to the Department of Neurology, University Hospital Heidelberg, Germany (B. Wildemann). H.P. has received speaker honoraria from Biogen and has served on advisory boards for Roche. N.S. has received travel funding from Sanofi-Aventis\/Genzyme. M.K.K. reports no conflicts of interest. M.W.H. reports no conflicts of interest. M.Ri. has received speaker honoraria from Novartis, Bayer Vital GmbH and Ipsen, has served on scientific advisory boards for Roche, and received travel reimbursement from Bayer Schering, Biogen Idec, Merz, Genzyme, Teva, Merck and the Guthy-Jackson Charitable Foundation, none related to this study. P.S.R. reports speaker honoraria from Abbvie, Daiichi-Sankyo, Merck, Roche, Biogen, Novartis, Shire; he reports consultancy honoraria from Roche, Merck, Teva, Sandoz\/Hexal; and research grants from Biogen, Merck, Roche; none of them resultant in a conflict of interest with regards to the submitted work. I.A. has received travel grants from Biogen Idec and the Guthy-Jackson Charitable Foundation, has served on scientific advisory boards for Roche and Alexion and has received research support from Chugai Pharma. K.Ru. has received research support from Novartis, Merck Serono and the German Federal Ministry of Education and Research; speaker honoraria and travel grants from Bayer, Biogen Idec, Merck Serono, Sanofi-Aventis\/Genzyme, Teva, Roche, Novartis, and the Guthy Jackson Charitable Foundation. L.K. has received compensation for serving on scientific advisory boards for Genzyme, Janssen, Novartis and Roche; speaker honoraria and travel support from Biogen, Genzyme, Merck Serono, Novartis, Roche, and TEVA; research support from the German Federal Ministry for Education and Research, the German Research Foundation, the IZKF M\u00fcnster, IMF M\u00fcnster, Biogen, Novartis and Merck Serono. N.A. reports no conflicts of interest. T.Z. reports no conflicts of interest. R.H. received support for attending scientific meetings by Novartis and speaker honoraria from Euroimmun, Novartis, Sanofi Genzyme and Biogen; the Medical University of Vienna receives payments for antibody assays (AQP-4 and other anti-neuronal and anti-glial antibodies) and for antibody validation assays organized by Euroimmun (Luebeck, Germany). T.R. reports no conflcts of interest. B.B. reports no conflicts of interest. K.F. is an employee of Euroimmun AG, L\u00fcbeck, Germany. K.S. reports no conflicts of interest. M.W. reports no conflicts of interest. S.A. reports no conflicts of interest. J.H. reports no conflicts of interest. C.L. reports no conflicts of interest. I.K. has received travel funding and\/or speaker honoraria from Biogen, Merck, Mylan, Novartis, Sanofi, Roche, has consulted for Alexion, Bayer, Chugai, Roche, Shire, has received research support from Chugai and Diamed, and is Associate Editor of BMC Neurology. O.A. has received grants from the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF) as part of the \u2018German Competence Network Multiple Sclerosis\u2019 (KKNMS; FKZ 01GI1602B); grants from Biogen, Merck Serono, Novartis, Sanofi and Teva; personal fees from Biogen, Merck Serono, Novartis, Sanofi, Roche, and Teva. C.T. has received honoraria for consultation and expert testimony from Biogen Idec\/GmbH, Genzyme GmbH, Novartis Pharma GmbH and Merck. None of this interfered with the current report. K.Ro. reports no conflicts of interest related to this work. M.Re. was supported by research grants from the Austrian Science Funds (FWF), Austrian Science Promotion Agency (FFG) and the Austrian Multiple Sclerosis Research Society. The University Hospital and Medical University of Innsbruck (Austria; M.R.) receives payments for antibody assays (MOG, AQP4, and other autoantibodies) and for MOG and AQP4 antibody validation experiments organized by Euroimmun (L\u00fcbeck, Germany). T.K. has received travel expenses and speaker honoraria from Bayer Vital, Teva Pharma, Merck, Novartis Pharma, Sanofi-Aventis\/Genzyme, CLS Behring, Roche Pharma and Biogen as well as grant support\/donation from Bayer-Schering AG, Novartis and Chugai Pharma. F.P. has received honoraria and research support from Alexion, Bayer, Biogen, Chugai, MerckSerono, Novartis, Genyzme, MedImmune, Shire, Teva, and serves on scientific advisory boards for Alexion, MedImmune and Novartis; he has received funding from Deutsche Forschungsgemeinschaft (DFG Exc 257), the German Federal Ministry of Education and Research (Competence Network Multiple Sclerosis), the Guthy Jackson Charitable Foundation, the EU Framework Program 7, and the National Multiple Sclerosis Society of the USA. B.W. has received research grants and\/or honoraria from Merck Serono, Biogen, Teva, Novartis, Sanofi Genzyme, and Bayer Healthcare, and research grants from the Dietmar Hopp Foundation, the Klaus Tschira Foundation, the German Federal Ministry of Education and Research (BMBF; FKZ 01GI1602A), and Deutsche Forschungsgemeinschaft (DFG).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"261"}}