MOG-IgG assay methodology and reporting 1-3 So, you can have an antibody titer anywhere from 20 to 10,000. Then what we can do after that, is we can do an endpoint titer, where we will assess and dilute each sample at different dilutions to give us the strength of positivity, and in our laboratory, we start at 20 and then we go to 40, 100, 1,000, 10,000. Other laboratories might use an immunofluorescence technique to look at the antibody, where they look under the microscope for binding to the cell surface. In our laboratory, we use a flow cytometry called a FACS assay, and we're able to get a readout of the strength of positivity with that. Then, if you do have MOG binding, you have a secondary antibody that binds to the FC portion of the MOG antibody and helps you get a readout of how much positivity you have. We have a patient serum and we run it in our laboratory, and we look for binding to MOG on the surface of these cells versus not binding to cells that don't have MOG on the surface. When we think about the MOG antibody assay methodology, if we just look here, this is done by what we call a cell-based assay. This was a study led by Brenda Banwell and many of us were involved, and this is the international MOGAD panel proposed diagnostic criteria. This is focusing on a study that was recently published in the Lancet Neurology in early 2023. And today we're going to focus on the third well-defined disease, which is this myelin oligodendrocyte glycoprotein antibody-associated disorder or disease (MOGAD). We have aquaporin-4 antibody positive neuromyelitis optica spectrum disorder, which was the first antibody discovered as a biomarker of CNS demyelination. We have multiple sclerosis (MS), which ranges from radiologically isolated syndrome all the way to secondary progressive MS. When we think about inflammatory diseases of the central nervous system associated with demyelination, then there are three major ones that we can think about. Distinct inflammatory diseases of the CNS associated with demyelination These are my disclosures here, which are not too relevant to this talk, which will focus mostly on diagnosis. Today I'm going to talk about MOG antibody-associated disease (MOGAD) and in particular about the recent diagnostic criteria. I work in the Neuroimmunology Laboratory at the Mayo Clinic and the autoimmune neurology and multiple sclerosis clinics.
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