Is there a correlation between MOG‐associated disorder and SARS‐CoV‐2 infection?

Abstract

Background and purpose Anti‐myelin oligodendrocyte glycoprotein antibodies (MOG‐Abs) distinguish a group of inflammatory disorders which can be preceded by specific or non‐specific infections. A few single cases have been reported in association with SARS‐CoV‐2 infection, but a specific study on the correlation between COVID‐19 and myelin oligodendrocyte glycoprotein (MOG)‐associated disorder (MOGAD) has not yet been performed. The aim of this study was to determine the impact of the pandemic on this condition. Methods We analysed SARS‐CoV‐2 serology in patients newly diagnosed with MOGAD (1 August 2020 to 31 May 2021). MOG‐Ab‐seronegative age‐ and time‐matched subjects were used as controls. SARS‐CoV‐2 immunoglobulin G (IgG) levels were analysed using an anti‐SARS‐CoV‐2 US Food and Drug Administration‐approved ELISA assay and confirmed with a trimeric anti‐SARS‐CoV‐2 S1/S2 IgG immunochemiluminescent test, concomitantly assaying the anti‐receptor binding domain (RBD) of spike protein IgG and anti‐RBD total Ig. We actually compared the number of cases referred in each of the last 3 years. Results Presence of SARS‐CoV‐2 IgG antibodies was more common (12/30, 40%) in MOGAD patients than in controls (6/30, 20%), although the difference was not significant (p = 0.16; odds ratio 2.67, 95% confidence interval 0.85–9.17). The most common clinical presentations of MOGAD SARS‐CoV‐2‐seropositive patients included optic neuritis (n = 6) and myelitis (n = 3). The number of diagnosed cases increased over the last 3 years, in particular, when including cases referred to us before the COVID‐19 pandemic, in the initial phase of the first wave and in the late phase of the second wave (n = 9, rate 10.6% in 2019; n = 13, rate 12.3% in 2020; n = 15, rate 14.7% in 2021). Conclusion Our findings provide preliminary data on SARS‐CoV‐2 as a potential trigger of MOGAD.

Author's response to the commentary: Neuromyelitis optica complicating COVID vaccinations and additional case reports

“…Apart from NMOSD, myelin oligodendrocytes glycoprotein antibody-associated disease (MOGAD) presenting after vaccination have been reported as well ( Francis et al, 2022 ). However, there was no difference in the frequency of serum SARS-CoV-2 IgG in the normal population and newly diagnosed MOGAD patients ( Mariotto et al, 2022 ). The association between infection/vaccination and CNS inflammatory demyelinating diseases is an interesting area for future studies.…”

Myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD) following SARS-CoV-2 infection: A case series

“…While the global incidence of MOGAD since the beginning of the SARS-CoV-2 pandemic remains unknown, there are reports of increased detection of MOGAD by some neuroimmunological laboratories. ( Mariotto et al, 2022 ) However, to date there has been a relative paucity of reported cases of MOGAD following SARS-CoV-2 infection, suggesting that clinicians have not observed a significant rise in the incidence of MOGAD during this time. Differences in the host response to SARS-CoV-2 may explain why only a small subgroup of individuals develop MOGAD following infection.…”

SARS‐COV‐2 a trigger of myelin oligodendrocyte glycoprotein‐associated disorder

“…8 One study concluded that SARS-CoV-2 may be a trigger of MOGAD as the authors found a higher occurrence of SARS-CoV-2 IgG antibodies in patients with MOGAD, but the difference was non-significant. 9 However, another study showed that only one out of 15 patients tested positive for anti-MOG in a group of post Covid-19 acute disseminated encephalomyelitis (ADEM) or acute hemorrhagic leukoencephalitis. 10 We report four cases with onset of MOGAD after SARS-CoV-2 infection and reviewed previously published case reports with similar associations suggesting a role of SARS-CoV-2 in the pathogenesis of MOGAD.…”