Case report: Concurrent MOG antibody-associated disease and latent infections in two patients

Laila Kulsvehagen; Tim Woelfle; Ana Beatriz Ayroza Galvão Ribeiro Gomes; Patrick Lipps; Tradite Neziraj; Julia Flammer; Karoline Leuzinger; Tobias Derfuss; Jens Kuhle; Athina Papadopoulou; Anne-Katrin Pröbstel

doi:10.3389/fimmu.2024.1455355

Case report: Concurrent MOG antibody-associated disease and latent infections in two patients

Front Immunol. 2024 Sep 4:15:1455355. doi: 10.3389/fimmu.2024.1455355. eCollection 2024.

Authors

Laila Kulsvehagen^#^{1

2}, Tim Woelfle^#^{1

3}, Ana Beatriz Ayroza Galvão Ribeiro Gomes^{1

2

4}, Patrick Lipps^{1

2}, Tradite Neziraj^{1

2}, Julia Flammer^{1

2}, Karoline Leuzinger⁵, Tobias Derfuss^{1

2}, Jens Kuhle^{1

2}, Athina Papadopoulou^{1

3}, Anne-Katrin Pröbstel^{1

2}

Affiliations

¹ Department of Neurology and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
² Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
⁴ Departamento de Neurologia, Instituto Central, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Brazil.
⁵ Clinical Virology, University Hospital Basel, Basel, Switzerland.

^# Contributed equally.

Abstract

Objectives: Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is frequently preceded by infections. The underlying pathomechanism, however, remains poorly understood. Here, we present the clinical data of two MOGAD patients with concurrent syphilis infection and investigate the reactivity of patient-derived antibodies to MOG and Treponema pallidum (T. pallidum).

Methods: Longitudinal serum samples and soluble immunoglobulins in single B cell supernatants were measured for MOG reactivity by a live cell-based assay. Reactivity against T. pallidum was assessed by enzyme-linked immunosorbent assay.

Results: The two patients presented MOGAD and concurrent latent syphilis infection, manifesting as cervical myelitis and unilateral optic neuritis, respectively. The first patient had been living with HIV on antiretroviral therapy, and the second was concomitantly diagnosed with chronic hepatitis B infection. Upon screening of B cell supernatants, we identified reactivity to MOG or T. pallidum. Notably, one B cell showed reactivity to both antigens.

Discussion: The coexistence of MOGAD diagnoses and latent syphilis, alongside the identification of antibody reactivity to MOG and T. pallidum, underscores the potential pathomechanistic link between syphilis infection and subsequent autoimmune neuroinflammation. Cross-reactivity between MOG and T. pallidum antibodies remains to be validated on a molecular level, and further characterization of infectious triggers associated with MOGAD is needed.

Keywords: B cells; antibodies; case report; infection; molecular mimicry; myelin oligodendrocyte glycoprotein; myelin oligodendrocyte glycoprotein antibody-associated disease; syphilis.

Publication types

Case Reports

MeSH terms

Adult
Autoantibodies* / blood
Autoantibodies* / immunology
B-Lymphocytes / immunology
Female
Humans
Latent Infection / diagnosis
Latent Infection / immunology
Male
Middle Aged
Myelin-Oligodendrocyte Glycoprotein* / immunology
Syphilis* / blood
Syphilis* / complications
Syphilis* / diagnosis
Syphilis* / immunology
Treponema pallidum* / immunology

Substances

Myelin-Oligodendrocyte Glycoprotein
Autoantibodies
MOG protein, human

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The study was funded by an ECTRIMS Clinical Fellowship and a Swiss Government Excellence Scholarship (to AA), a doctoral fellowship from the Goldschmidt Jacobson Foundation (to PL), and a Swiss Young Talents in Clinical Research Fellowship (to JF). The study was further funded by the Swiss National Science Foundation (SNF Eccellenza Professorship: 194609; SNF Starting Grant: 211318); the Swiss State Secretariat for Education, Research and Innovation (Horizon 2020 ID Dark Matter Consortium 101136582); the National MS Society (FG-1708-28871); the Fondation Pierre Mercier pour la Science; the Propatient Foundation; the Goldschmidt Jacobson Foundation; and the Gottfried and Julia Bangerter Rhyner Foundation (all to A-KP).