Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay
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Published:2023-05-24
Issue:8
Volume:94
Page:605-613
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ISSN:0022-3050
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Container-title:Journal of Neurology, Neurosurgery & Psychiatry
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language:en
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Short-container-title:J Neurol Neurosurg Psychiatry
Author:
Liu Ding, Lin Pei-HaoORCID, Li Hui-Lu, Yang JieORCID, You Yong, Yang XiaoORCID, Jiang Li-Hong, Ma Cai-Yu, Xu Lu-Fen, Zhang Qing-Xia, Liao Sha, Chen Han, Yue Jia-Jia, Lu Yu-Ying, Lian Chun, Liu YinORCID, Wang Zhan-Hang, Ye Jin-Long, Qiu Wei, Shu Ya-Qing, Wang Hai-Yang, Liu Hong-Li, Wang Yue, Duan Chun-Mei, Yang HuanORCID, Wu Xiu-Ling, Zhang Lu, Feng Hui-Yu, Chen Huan, Zhou Hou-Shi, Xu Qian-HuiORCID, Zhao Gui-Xian, Ou Teng-Fei, Wang Jin-Liang, Lu Yu-Hua, Mao Zhi-Feng, Gao Cong, Guo JunORCID, Zhang Hong-Ya, Chen ShengORCID, Li Jing, Long You-MingORCID
Abstract
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.MethodsA 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).ResultsAmong 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).ConclusionsAutoimmune responses are found at the onset of viral encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.
Funder
GFAP-AID Program of The Second Affiliated Hospital of GuangZhou Medical University National Natural Science Foundation of China the Wisdom Accumulation and Talent Cultivation Project of the Third xiangya hospital of Central South University
Subject
Psychiatry and Mental health,Neurology (clinical),Surgery
Cited by
9 articles.
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