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Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
Karolinska Inst, Dept Med, Infect Dis Unit, Solna, Sweden;Karolinska Univ Hosp, Dept Infect Dis, Solna, Sweden.
Umea Univ, Infect Dis, Dept Clin Microbiol, Umea, Sweden.
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2018 (English)In: Journal of Clinical Virology, ISSN 1386-6532, E-ISSN 1873-5967, Vol. 103, p. 75-80Article in journal (Refereed) Published
Abstract [en]

Background: Herpes simplex encephalitis (HSE) is a devastating disease, often leaving patients with severe disabilities. It has been shown that IgG anti-N-methyl-o-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.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV , 2018. Vol. 103, p. 75-80
Keywords [en]
Herpes simplex encephalitis, HSV-1, N-methyl-D-aspartate receptor antibodies, NMDAR, IgA, IgM
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:uu:diva-356622DOI: 10.1016/j.jcv.2018.04.007ISI: 000432698300014PubMedID: 29698873OAI: oai:DiVA.org:uu-356622DiVA, id: diva2:1236501
Funder
Fredrik och Ingrid Thurings StiftelseAvailable from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-08-02Bibliographically approved

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Westman, GabrielSohrabian, AzitaSund, FredrikRönnelid, Johan

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