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AQP4 is highly expressed in the foot processes of astrocytes, particularly in the domains that interacts with dystrophin-associated proteins and microvessels. The putative agent of NMO, aquaporin-4 antibodies (AQP4-IgG), was subsequently found to bind the AQP4 water channel ( 3). ( 2), that sera from patients with NMO outlined microvessels, pia, subpia, and Virchow-Robin spaces when tested on tissue-based indirect immunofluorescence. A major landmark in NMO history was the discovery, by Lennon et al. From Devic's first report until 2004, NMO remained an elusive condition that many thought was a monophasic, more aggressive variant of multiple sclerosis (MS). The term neuromyelitis optica (NMO) was first used in 1894 by Devic and his fellow, Fernand Gault, to propose a distinct disease entity characterized by simultaneous myelitis and bilateral optic neuritis ( 1). The aim of this review is to summarize current evidence regarding the role of emerging diagnostic and prognostic biomarkers in patients with NMOSD and MOGAD. These include antibody titers, cytokine profiles, complement factors, and markers of neuronal (e.g., neurofilament light chain) or astroglial (e.g., glial fibrillary acidic protein) damage. In this context, a number of serum and/or cerebrospinal fluid biomarkers are emerging as potentially useful in clinical practice for diagnostic and treatment purposes. Whilst major advances have been made in the diagnosis and treatment of these conditions, biomarkers that could help predict the risk of relapses, disease activity, and prognosis are still lacking. Despite important refinements in the accuracy of AQP4-IgG and MOG-IgG testing assays, a small proportion of patients with NMOSD still remain negative for both antibodies and are called “seronegative” NMOSD. More recently, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG), have been found to be a biomarker of a different entity, termed MOG antibody-associated disease (MOGAD), which has overlapping, but different pathogenesis, clinical features, treatment response, and prognosis when compared to AQP4-IgG-positive NMOSD. About 80% of patients harbor antibodies directed against the water channel aquaporin-4 (AQP4-IgG), expressed on astrocytes, which was found to be both a biomarker and a pathogenic cause of NMOSD. The term neuromyelitis optica spectrum disorder (NMOSD) describes a group of clinical-MRI syndromes characterized by longitudinally extensive transverse myelitis, optic neuritis, brainstem dysfunction and/or, less commonly, encephalopathy.