Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis
(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
- Westman, Gabriel ; Sohrabian, Azita ; Aurelius, Elisabeth ; Ahlm, Clas ; Schliamser, Silvia LU ; Sund, Fredrik ; Studahl, Marie and Rönnelid, Johan
- organization
- publishing date
- 2018-06-01
- 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
-
- pmid:29698873
- 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
- 2024-04-15 06:32:28
@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}},
keywords = {{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}},
doi = {{10.1016/j.jcv.2018.04.007}},
volume = {{103}},
year = {{2018}},
}