Useful For:
Additional Resource: Mayo Central Nervous System Demyelinating Disease Diagnostic Algorithm
Testing Algorithm: When the results of this assay require further evaluation of myelin oligodendrocyte glycoprotein (MOG-IgG1) or neuromyelitis optica (NMO)/Aquaporin-4-IgG, a titer will be performed at additional charge.
Ordering Notes: Aquaporin-4 IgG Antibody, Serum (Sendout) [RAQP4A] and MOG Antibodies [RMOG] are also available for individual ordering.
Patient Preparation: For optimal antibody detection, it is recommended to collect the specimen before initiation of immunosuppressant medication.
Flow Cytometry
Reference Values:
MOG FACS: | Negative |
NMO/AQP4 FACS: | Negative |
Interpretation:
A positive value for aquaporin-4 (AQP4)-IgG is consistent with an autoimmune astrocytopathy/neuromyelitis optica spectrum disorder (NMOSD) and justifies initiation of appropriate immunosuppressive therapy at the earliest possible time. This allows early initiation and maintenance of optimal therapy. Recommend follow-up in 3 to 6 months if NMOSD is suspected.
A positive value for myelin oligodendrocyte glycoprotein (MOG)-IgG is consistent with an neuromyelitis optica (NMO)-like phenotype, and in the setting of acute disseminated encephalomyelitis (ADEM), optic neuritis (ON) and transverse myelitis (TM) indicates an autoimmune oligodendrogliopathy with potential for relapsing course. Identification of MOG-IgG allows distinction from multiple sclerosis (MS) and may justify initiation of appropriate immunosuppressive therapy (not MS disease-modifying agents) at the earliest possible time. This allows early initiation and maintenance of optimal therapy. Recommend follow-up in 3 to 6 months as persistence of MOG-IgG seropositivity predicts a relapsing course.
Detection of both antibodies is rare and unusual.
AQP4-IgG and MOG-IgG are not found in MS or healthy subjects.
Cautions: Aquaporin-4 (AQP4)-IgG and myelin oligodendrocyte glycoprotein (MOG)-IgG antibodies may drop below detectable levels in setting of therapies for acute attack (IV methylprednisolone or plasmapheresis) or attack prevention (immunosuppressants).
Collect 9 mL blood in RED TOP tube or GOLD SST
Outside Laboratories: Centrifuge sample and transfer serum to a separate plastic vial. Refrigerate serum.
Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.
Reject Due To: Gross hemolysis, lipemia, or icterus.
Centrifuge sample and transfer serum to a separate plastic vial. Refrigerate serum.
Login: SEND1-;REFRIG
Sendouts:
Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.
Reject Due To: Gross hemolysis, lipemia, or icterus.
Sendout |
Mayo Clinic Laboratories
800-533-1710 200 First Street Southwest |
---|
CPTs: 86053, 86363.
Reflex titers: 86053 (if appropriate) 86363 (if appropriate).