Abstract
Neural antibodies have emerged as useful biomarkers in suspected autoimmune encephalitis. We reviewed results of neural antibody testing (anti-N-methyl D-aspartate receptor (NMDAR), leucine-rich glioma-inactivated protein (LGI1), contactin-associated protein-like 2 (CASPR2), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), γ-aminobutyric acid type B receptor (GABA(B)R), dipeptidyl-peptidase-like protein-6 (DPPX), IgLON family member 5 (IgLON5) and glutamic acid decarboxylase-65 (GAD65)) using cell-based assays (CBAs) and tissue indirect immunofluorescence (TIIF) at our centre. Our findings suggest increased clinical sensitivity of CBA compared to TIIF. However, this may come at some expense to clinical specificity, as evidenced by possible false-positive results when weak serum positivity by CBA was observed for certain antibodies (i.e. anti-NMDAR, CASPR2). In such cases, correlation with serum TIIF, as well as CSF CBA and TIIF, aids in identifying true-positive results.
Highlights
RÉSUMÉ : Utiliser des anticorps neuronaux de détection dans des cas d’encéphalite auto-immune : une expérience menée dans un établissement de santé canadien
Detection of antibodies against intracellular neural antigens, including well-characterised paraneoplastic or “onconeural” antibodies (anti-Hu, Yo, Ri, amphiphysin, CV2/collapsin response mediator protein 5 (CRMP5) and Ma2), typically does not require that the target antigen be in its native conformation, permitting the use of Western blot/line immunoblot (WB/LIB) as a second confirmatory assay alongside tissue indirect immunofluorescence (TIIF).[2]
Detection of antibodies against extracellular cell surface/synaptic antigens typically requires that critical epitopes remain in their native conformation, leading to the use of transfected cell-based assays (CBAs) expressing the antigen of interest on their surface as a second confirmatory assay alongside TIIF.[2]
Summary
RÉSUMÉ : Utiliser des anticorps neuronaux de détection dans des cas d’encéphalite auto-immune : une expérience menée dans un établissement de santé canadien. All Patients with serum and/or CSF submitted to London Health Sciences Centre for autoimmune encephalitis neural antibody testing (anti-NMDAR, LGI1, CASPR2, AMPAR, GABABR, DPPX, IgLON5 and GAD65) between March 2019 and March 2020 N = 373
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