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Clinical significance of IgM and IgA class anti-NMDAR antibodies in herpes simplex encephalitis
Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
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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, 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:umu:diva-148728DOI: 10.1016/j.jcv.2018.04.007ISI: 000432698300014PubMedID: 29698873Scopus ID: 2-s2.0-85046011811OAI: oai:DiVA.org:umu-148728DiVA, id: diva2:1222547
Funder
Fredrik och Ingrid Thurings StiftelseAvailable from: 2018-06-21 Created: 2018-06-21 Last updated: 2018-06-21Bibliographically approved

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