Anti-NMDA-receptor antibody encephalitis: Performance evaluation and laboratory experience with the anti-NMDA-receptor IgG assay

作者：Suh Lailam Brenda B; Haven Thomas R; Copple Susan S; Knapp Diana; Jaskowski Troy D; Tebo Anne E^*

来源：Clinica Chimica Acta, 2013, 421: 1-6.

DOI：10.1016/j.cca.2013.02.010

• NMDAR
• Antibodies
• Diagnosis
• Encephalitis
• Autoimmune disease

Background: Antibodies targeting the NRI subunit of the N-methyl-o-aspartate-receptor (NMDAR) are considered diagnostic for novel form of autoimmune encephalitis. We report the validation of a qualitative indirect immunofluorescence antibody(IFA) test for the detection of anti-NMDAR IgG and describe the attributes of antibody-positive patients.
Methods: The anti-NMDAR IgG assay (Euroimmun Diagnosika, Lubeck, Germany) was validated with serum and cerebrospinal fluid (CSF) specimens from 30 healthy and 50 disease controls as well as 5 anti-NMDAR IgG-positive individuals. Consecutive specimens (n = 1671) for anti-NMDAR IgG antibodies were evaluated and positive specimens titrated to end-point [starting dilutions: CSF; 1:1 and serum; 1:10]. In a subset of antibody-positive patients, we sought clinical information for correlation with diagnostic and treatment outcomes.
Results: The assay demonstrated excellent performance characteristics in all groups evaluated. Of the 1671 specimens tested, 1389 were unique cases with a positivity rate of 9.0% (n = 123). For the antibody-positive samples, the female to male ratio was 2:1 with a prevalence of 46% in the pediatric population (<= 17 years). Antibody titers were titrated to end-point for 106/123 specimens [45 CSF, 41 sera, and 20 CSF and serum pairs] with more than 75% having titers greater than 1:10 (CSF) and 1:20 (serum). Overall, high levels of these antibodies showed correlation to disease severity with variable response to treatment in the subset of patients evaluated.
Conclusion: Our data suggests a high prevalence for anti-NMDAR antibody encephalitis irrespective of age and gender in our unselected disease cohort with support for measuring antibody titers in the evaluation of these patients. 2013 Elsevier B.V.

• 出版日期2013-6-5