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Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis

Westman, Gabriel; Sohrabian, Azita; Aurelius, Elisabeth; Ahlm, Clas; Schliamser, Silvia LU ; Sund, Fredrik; Studahl, Marie and Rönnelid, Johan (2018) In Journal of Clinical Virology 103. p.75-80
Abstract

Background: Herpes simplex encephalitis (HSE) is a devastating disease, often leaving patients with severe disabilities. It has been shown that IgG anti-N-methyl-D-aspartate receptor (NMDAR) antibodies appear in approximately 25% of HSE patients and could be associated with impaired recovery of cognitive performance. Objectives: To characterize the prevalence of IgM and IgA anti-NMDAR antibodies in HSE patients, in relation to subsequent development of IgG anti-NMDAR and correlation to cognitive performance. Study design: A total of 48 subjects were included from a previously described cohort of patients with HSE verified by HSV-1 PCR. Cerebrospinal fluid (CSF) and serum samples drawn close to onset of disease, after 14–21 days of iv... (More)

Background: Herpes simplex encephalitis (HSE) is a devastating disease, often leaving patients with severe disabilities. It has been shown that IgG anti-N-methyl-D-aspartate receptor (NMDAR) antibodies appear in approximately 25% of HSE patients and could be associated with impaired recovery of cognitive performance. Objectives: To characterize the prevalence of IgM and IgA anti-NMDAR antibodies in HSE patients, in relation to subsequent development of IgG anti-NMDAR and correlation to cognitive performance. Study design: A total of 48 subjects were included from a previously described cohort of patients with HSE verified by HSV-1 PCR. Cerebrospinal fluid (CSF) and serum samples drawn close to onset of disease, after 14–21 days of iv aciclovir treatment and after 90 days of follow-up, were analyzed for the presence of IgM and IgA anti-NMDAR, and related to IgG anti-NMDAR. Antibody levels were correlated to the recovery of cognitive performance, as estimated by the Mattis Dementia Rating Scale (MDRS), for a total of 24 months. Results: In total, 27 of 48 (56%) study subjects were anti-NMDAR positive, defined as the presence of IgG (12/48, 25%), IgM (14/48, 29%) or IgA (13/48, 27%) antibodies in CSF and/or serum. IgM or IgA anti-NMDAR did not predict subsequent IgG autoimmunization and did not correlate to cognitive outcome. IgG anti-NMDAR serostatus, but not antibody titers, correlated to impaired recovery of cognitive performance. Conclusions: A majority of HSE patients develop IgG, IgM or IgA anti-NMDAR antibodies. However, the predictive value and clinical relevance of non-IgG isotypes remains to be shown in this setting.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Herpes simplex encephalitis, HSV-1, IgA, IgM, N-methyl-D-aspartate receptor antibodies, NMDAR
in
Journal of Clinical Virology
volume
103
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85046011811
ISSN
1386-6532
DOI
10.1016/j.jcv.2018.04.007
language
English
LU publication?
yes
id
5adb8f02-9c4d-4072-b4f7-0ead0c620965
date added to LUP
2018-05-07 14:41:04
date last changed
2019-11-13 05:07:38
@article{5adb8f02-9c4d-4072-b4f7-0ead0c620965,
  abstract     = {<p>Background: Herpes simplex encephalitis (HSE) is a devastating disease, often leaving patients with severe disabilities. It has been shown that IgG anti-N-methyl-D-aspartate receptor (NMDAR) antibodies appear in approximately 25% of HSE patients and could be associated with impaired recovery of cognitive performance. Objectives: To characterize the prevalence of IgM and IgA anti-NMDAR antibodies in HSE patients, in relation to subsequent development of IgG anti-NMDAR and correlation to cognitive performance. Study design: A total of 48 subjects were included from a previously described cohort of patients with HSE verified by HSV-1 PCR. Cerebrospinal fluid (CSF) and serum samples drawn close to onset of disease, after 14–21 days of iv aciclovir treatment and after 90 days of follow-up, were analyzed for the presence of IgM and IgA anti-NMDAR, and related to IgG anti-NMDAR. Antibody levels were correlated to the recovery of cognitive performance, as estimated by the Mattis Dementia Rating Scale (MDRS), for a total of 24 months. Results: In total, 27 of 48 (56%) study subjects were anti-NMDAR positive, defined as the presence of IgG (12/48, 25%), IgM (14/48, 29%) or IgA (13/48, 27%) antibodies in CSF and/or serum. IgM or IgA anti-NMDAR did not predict subsequent IgG autoimmunization and did not correlate to cognitive outcome. IgG anti-NMDAR serostatus, but not antibody titers, correlated to impaired recovery of cognitive performance. Conclusions: A majority of HSE patients develop IgG, IgM or IgA anti-NMDAR antibodies. However, the predictive value and clinical relevance of non-IgG isotypes remains to be shown in this setting.</p>},
  author       = {Westman, Gabriel and Sohrabian, Azita and Aurelius, Elisabeth and Ahlm, Clas and Schliamser, Silvia and Sund, Fredrik and Studahl, Marie and Rönnelid, Johan},
  issn         = {1386-6532},
  keyword      = {Herpes simplex encephalitis,HSV-1,IgA,IgM,N-methyl-D-aspartate receptor antibodies,NMDAR},
  language     = {eng},
  month        = {06},
  pages        = {75--80},
  publisher    = {Elsevier},
  series       = {Journal of Clinical Virology},
  title        = {Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis},
  url          = {http://dx.doi.org/10.1016/j.jcv.2018.04.007},
  volume       = {103},
  year         = {2018},
}