{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T16:13:12Z","timestamp":1783008792690,"version":"3.54.5"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Glial fibrillary acidic protein\u2013immunoglobulin G (GFAP-IgG) can coexist with aquaporin-4\u2013IgG (AQP4-IgG) or myelin oligodendrocyte glycoprotein\u2013IgG (MOG-IgG). We aimed to investigate the clinical characteristics of patients with GFAP-IgG coexisting with AQP4-IgG or MOG-IgG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively collected data from 81 GFAP-IgG-positive patients and described and compared the clinical characteristics of those with GFAP-IgG coexisting with AQP4-IgG or MOG-IgG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>(1) Among the 81 GFAP-IgG-positive patients, nine (11.1%) were positive for AQP4-IgG and seven (8.6%) were positive for MOG-IgG. The clinical manifestations of overlapping syndromes were diverse; all patients met the clinical phenotype of autoimmune GFAP astrocytopathy (A-GFAP-A) and also fulfilled the diagnostic criteria for neuromyelitis optica spectrum disorders or MOG antibody-associated disorders. Compared with the GFAP-AQP4 overlapping syndrome, the GFAP-MOG overlapping syndrome had a higher frequency of seizures (57.1% vs. 0, <jats:italic>p<\/jats:italic> = 0.019). (2) Compared with the nonoverlapping syndrome group, the overlapping syndrome group had more women (68.6% vs. 32.3%, <jats:italic>p<\/jats:italic> = 0.008), a higher incidence of optic neuritis (ON) (43.8% vs. 4.6%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), lower CSF white blood cell counts (median: 30 cells\/mm<jats:sup>3<\/jats:sup> vs. 94 cells\/mm<jats:sup>3<\/jats:sup>, <jats:italic>p<\/jats:italic> = 0.001) and protein levels (median: 0.375 g\/L vs. 0.78 g\/L, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), and a higher proportion of patients receiving long-term immunotherapy (68.8% vs.13.8%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with A-GFAP-A, 20% had concurrent AQP4-IgG or MOG-IgG, exhibiting distinct clinical features that suggest a different disease phenotype driven by overlapping autoimmune mechanisms.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1610486","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T04:10:40Z","timestamp":1753330240000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical characteristics of patients with GFAP-IgG coexisting with AQP4-IgG or MOG-IgG"],"prefix":"10.3389","volume":"16","author":[{"given":"Qingchen","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.2549","article-title":"Autoimmune glial fibrillary acidic protein astrocytopathy: a novel 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