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Abstract Details

Myelin Alterations Within and Beyond Lesions in MOG Antibody-associated Disease: Insights from Ultra-high field (7T) MRI
Autoimmune Neurology
S6 - Autoimmune Neurology: NMOSD and MOGAD (1:12 PM-1:24 PM)
002

To analyze myelin content within lesions and in the normal-appearing (NA) brain tissue in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) versus multiple sclerosis (MS) and healthy controls (HC).

The phenomenon of T2-lesion resolution in patients with MOGAD has led to questioning of if such T2-lesions in attacks are due to true demyelination or transient myelin edema.

This cross-sectional observational study included patients with MOGAD (n=14) and age- and sex-matched patients with MS (n=6) and HC (n=15). All participants underwent a standardized brain MRI research protocol at 7T field strength including a quantitative T1 sequence (i.e., MP2RAGE). Patients were scanned during disease remission, and prior clinical MRI scans were analyzed for the presence of acute T2-lesions resolved. The longitudinal relaxation rate (R1=1/T1 relaxation time) was calculated from MP2RAGE and was used as proxy of myelin content (i.e., the higher the R1 the greater the myelin content).

MOGAD patients showed a trend towards reduced R1 in the NA deep grey matter compared to HC (0.651 vs 0.674, p=0.05), and overall similar to MS. When MOGAD patients were divided by history of cerebral MRI lesions, those with prior T2-lesions displayed significant reduction of R1 indicative of reduced myelin content in the NA deep grey matter (0.608 vs 0.674) and white matter (0.716 vs 0.765) compared to HC (p<0.01 for both), despite resolution of most acute T2-lesions. We found a total of 126 chronic T2-lesions in patients with MOGAD and 142 in patients with MS. The R1 was significantly reduced in MS lesions (0.528) compared to MOGAD’s (0.572, p=0.001).

Our data suggest that demyelination underlies T2-lesions in MOGAD but that myelin loss may be less than in MS. The reduction of the R1 may indicate either incomplete remyelination or a change in the magnetic tissue properties of the new myelin.

Authors/Disclosures
Laura Cacciaguerra, MD, PhD (Mayo Clinic)
PRESENTER 		Dr. Cacciaguerra has nothing to disclose.
Andrew Fagan, PhD Prof. Fagan has nothing to disclose.
John Port, MD, PhD The institution of Prof. Port has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clario.
Pearse Morris, kjsdfkshd Ms. Morris has nothing to disclose.
John Chen John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.
W. O. Tobin, PhD, MBBCh, BAO, FAAN (Mayo Clinic) Dr. Tobin has received publishing royalties from a publication relating to health care.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Jan-Mendelt Tillema, MD (Mayo Clinic) Dr. Tillema has nothing to disclose.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.