Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay

Liu，Ding1,2; Lin，Pei Hao1; Li，Hui Lu1; Yang，Jie1; You，Yong3; Yang，Xiao4; Jiang，Li Hong1; Ma，Cai Yu2; Xu，Lu Fen1; Zhang，Qing Xia2; Liao，Sha1; Chen，Han2; Yue，Jia Jia1; Lu，Yu Ying5; Lian，Chun1; Liu，Yin6; Wang，Zhan Hang7; Ye，Jin Long7; Qiu，Wei8; Shu，Ya Qing8; Wang，Hai Yang9; Liu，Hong Li10; Wang，Yue11; Duan，Chun Mei11; Yang，Huan12; Wu，Xiu Ling13; Zhang，Lu14; Feng，Hui Yu15; Chen，Huan16; Zhou，Hou Shi16; Xu，Qian Hui17; Zhao，Gui Xian18; Ou，Teng Fei19; Wang，Jin Liang19; Lu，Yu Hua20; Mao，Zhi Feng21; Gao，Cong1; Guo，Jun22; Zhang，Hong Ya23; Chen，Sheng24; Li，Jing12; Long，You Ming1

2023-08-01

10.1136/jnnp-2022-330626

Journal of Neurology, Neurosurgery and Psychiatry   Impact Factor & Quartile

0022-3050

1468-330X

To explore the autoimmune response and outcome in the central nervous system (CNS) at the onset of viral infection and correlation between autoantibodies and viruses. Methods A retrospective observational study was conducted in 121 patients (2016-2021) with a CNS viral infection confirmed via cerebrospinal fluid (CSF) next-generation sequencing (cohort A). Their clinical information was analysed and CSF samples were screened for autoantibodies against monkey cerebellum by tissue-based assay. In situ hybridisation was used to detect Epstein-Barr virus (EBV) in brain tissue of 8 patients with glial fibrillar acidic protein (GFAP)-IgG and nasopharyngeal carcinoma tissue of 2 patients with GFAP-IgG as control (cohort B). Results Among cohort A (male:female=79:42; median age: 42 (14-78) years old), 61 (50.4%) participants had detectable autoantibodies in CSF. Compared with other viruses, EBV increased the odds of having GFAP-IgG (OR 18.22, 95% CI 6.54 to 50.77, p<0.001). In cohort B, EBV was found in the brain tissue from two of eight (25.0%) patients with GFAP-IgG. Autoantibody-positive patients had a higher CSF protein level (median: 1126.00 (281.00-5352.00) vs 700.00 (76.70-2899.00), p<0.001), lower CSF chloride level (mean: 119.80±6.24 vs 122.84±5.26, p=0.005), lower ratios of CSF-glucose/serum-glucose (median: 0.50[0.13-0.94] vs 0.60[0.26-1.23], p=0.003), more meningitis (26/61 (42.6%) vs 12/60 (20.0%), p=0.007) and higher follow-up modified Rankin Scale scores (1 (0-6) vs 0 (0-3), p=0.037) compared with antibody-negative patients. A Kaplan-Meier analysis revealed that autoantibody-positive patients experienced significantly worse outcomes (p=0.031). Conclusions Autoimmune responses are found at the onset of viral encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.

autoimmune encephalitis clinical neurology neuroimmunology neurovirology

SCI

English

Others

Neurosciences & Neurology ; Psychiatry ; Surgery

Clinical Neurology ; Psychiatry ; Surgery

WOS:000998630500001

BMJ PUBLISHING GROUP

CLINICAL MEDICINE

2-s2.0-85164473248

Scopus

1.Department of Neurology,Key Lab. of Neurogenetics and Channelopathies of Guangdong Prov. and the Min. of Education of China,Institute of Neuroscience,The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong,China
2.Department of Neurology,The Third Xiangya Hospital of Central South University,Changsha,Hunan,China
3.Department of Neurology,The Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan,China
4.Department of Neurology,General Hospital of Ningxia Medical University,Yinchuan,Ningxia,China
5.Key Laboratory of Microbial Molecular Biology of Hunan Province,Hunan Provincial Center for Disease Control and Prevention,Changsha,Hunan,China
6.Department of Radiology,The Third Xiangya Hospital of Central South University,Changsha,Hunan,China
7.Department of Neurology,Guangdong 999 Brain Hospital,Guangzhou,Guangdong,China
8.Department of Neurology,The Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong,China
9.Department of Neurology,Jining No. 1 People's Hospital,Jining,China
10.Department of Neurology,First Hospital of Qinhuangdao,Qinhuangdao,Hebei,China
11.Department of Neurology,Xinqiao Hospital and the Second Affiliated Hospital,Army Medical University,Chongqing,China
12.Department of Neurology,Xiangya Hospital of Central South University,Changsha,Hunan,China
13.Department of Neurology,Tangshan Gongren Hospital,Tangshan,Hebei,China
14.Department of Neurology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,China
15.Department of Neurology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong,China
16.Department of Neurology,Shantou Central Hospital,Shantou,Guangdong,China
17.Department of Neurology,Shenzhen People's Hospital,The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology,Shenzhen,China
18.Department of Neurology,Huashan Hospital of Fudan University,Shanghai,China
19.Department of Neurology,The Second People's Hospital of Foshan,Foshan,Guangdong,China
20.Department of Neurology,People's Hospital of Chongqing Banan District,Chongqing,China
21.Neurimmunology Group,Institution of Kingmed,Guangzhou Medical University,Guangzhou,Guangdong,China
22.Department of Neurology,Tangdu Hospital,Air Force Medical University,Xi'an,Shaanxi,China
23.Department of Neurology,Shenzhen University General Hospital,Shenzhen,Guangdong,China
24.Department of Neurology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,China

Liu，Ding,Lin，Pei Hao,Li，Hui Lu,et al. Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay[J]. Journal of Neurology, Neurosurgery and Psychiatry,2023,94(8):605-613.

Liu，Ding.,Lin，Pei Hao.,Li，Hui Lu.,Yang，Jie.,You，Yong.,...&Long，You Ming.(2023).Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay.Journal of Neurology, Neurosurgery and Psychiatry,94(8),605-613.

Liu，Ding,et al."Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay".Journal of Neurology, Neurosurgery and Psychiatry 94.8(2023):605-613.