PMID- 37225405
OWN - NLM
STAT- MEDLINE
DCOM- 20230717
LR  - 20240118
IS  - 1468-330X (Electronic)
IS  - 0022-3050 (Print)
IS  - 0022-3050 (Linking)
VI  - 94
IP  - 8
DP  - 2023 Aug
TI  - Early autoimmunity and outcome in virus encephalitis: a retrospective study based 
      on tissue-based assay.
PG  - 605-613
LID - 10.1136/jnnp-2022-330626 [doi]
AB  - To explore the autoimmune response and outcome in the central nervous system 
      (CNS) at the onset of viral infection and correlation between autoantibodies and 
      viruses. METHODS: A retrospective observational study was conducted in 121 
      patients (2016-2021) with a CNS viral infection confirmed via cerebrospinal fluid 
      (CSF) next-generation sequencing (cohort A). Their clinical information was 
      analysed and CSF samples were screened for autoantibodies against monkey 
      cerebellum by tissue-based assay. In situ hybridisation was used to detect 
      Epstein-Barr virus (EBV) in brain tissue of 8 patients with glial fibrillar 
      acidic protein (GFAP)-IgG and nasopharyngeal carcinoma tissue of 2 patients with 
      GFAP-IgG as control (cohort B). RESULTS: Among cohort A (male:female=79:42; 
      median age: 42 (14-78) years old), 61 (50.4%) participants had detectable 
      autoantibodies in CSF. Compared with other viruses, EBV increased the odds of 
      having GFAP-IgG (OR 18.22, 95% CI 6.54 to 50.77, p<0.001). In cohort B, EBV was 
      found in the brain tissue from two of eight (25.0%) patients with GFAP-IgG. 
      Autoantibody-positive patients had a higher CSF protein level (median: 1126.00 
      (281.00-5352.00) vs 700.00 (76.70-2899.00), p<0.001), lower CSF chloride level 
      (mean: 119.80+/-6.24 vs 122.84+/-5.26, p=0.005), lower ratios of 
      CSF-glucose/serum-glucose (median: 0.50[0.13-0.94] vs 0.60[0.26-1.23], p=0.003), 
      more meningitis (26/61 (42.6%) vs 12/60 (20.0%), p=0.007) and higher follow-up 
      modified Rankin Scale scores (1 (0-6) vs 0 (0-3), p=0.037) compared with 
      antibody-negative patients. A Kaplan-Meier analysis revealed that 
      autoantibody-positive patients experienced significantly worse outcomes 
      (p=0.031). CONCLUSIONS: Autoimmune responses are found at the onset of viral 
      encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.
CI  - (c) Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Liu, Ding
AU  - Liu D
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
AD  - Department of Neurology, The Third Xiangya Hospital of Central South University, 
      Changsha, Hunan, China.
FAU - Lin, Pei-Hao
AU  - Lin PH
AUID- ORCID: 0000-0002-0775-795X
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Li, Hui-Lu
AU  - Li HL
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Yang, Jie
AU  - Yang J
AUID- ORCID: 0000-0001-5524-8925
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - You, Yong
AU  - You Y
AD  - Department of Neurology, The Second Affiliated Hospital of Hainan Medical 
      University, Haikou, Hainan, China.
FAU - Yang, Xiao
AU  - Yang X
AUID- ORCID: 0000-0003-3065-7225
AD  - Department of Neurology, General Hospital of Ningxia Medical University, 
      Yinchuan, Ningxia, China.
FAU - Jiang, Li-Hong
AU  - Jiang LH
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Ma, Cai-Yu
AU  - Ma CY
AD  - Department of Neurology, The Third Xiangya Hospital of Central South University, 
      Changsha, Hunan, China.
FAU - Xu, Lu-Fen
AU  - Xu LF
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Zhang, Qing-Xia
AU  - Zhang QX
AD  - Department of Neurology, The Third Xiangya Hospital of Central South University, 
      Changsha, Hunan, China.
FAU - Liao, Sha
AU  - Liao S
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Chen, Han
AU  - Chen H
AD  - Department of Neurology, The Third Xiangya Hospital of Central South University, 
      Changsha, Hunan, China.
FAU - Yue, Jia-Jia
AU  - Yue JJ
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Lu, Yu-Ying
AU  - Lu YY
AD  - Key Laboratory of Microbial Molecular Biology of Hunan Province, Hunan Provincial 
      Center for Disease Control and Prevention, Changsha, Hunan, China.
FAU - Lian, Chun
AU  - Lian C
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Liu, Yin
AU  - Liu Y
AUID- ORCID: 0000-0003-3388-2575
AD  - Department of Radiology, The Third Xiangya Hospital of Central South University, 
      Changsha, Hunan, China.
FAU - Wang, Zhan-Hang
AU  - Wang ZH
AD  - Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, Guangdong, 
      China.
FAU - Ye, Jin-Long
AU  - Ye JL
AD  - Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, Guangdong, 
      China.
FAU - Qiu, Wei
AU  - Qiu W
AD  - Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 
      Guangzhou, Guangdong, China.
FAU - Shu, Ya-Qing
AU  - Shu YQ
AD  - Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 
      Guangzhou, Guangdong, China.
FAU - Wang, Hai-Yang
AU  - Wang HY
AD  - Department of Neurology, Jining No. 1 People's Hospital, Jining, China.
FAU - Liu, Hong-Li
AU  - Liu HL
AD  - Department of Neurology, First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 
      China.
FAU - Wang, Yue
AU  - Wang Y
AD  - Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, 
      Army Medical University, Chongqing, China.
FAU - Duan, Chun-Mei
AU  - Duan CM
AD  - Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, 
      Army Medical University, Chongqing, China.
FAU - Yang, Huan
AU  - Yang H
AUID- ORCID: 0000-0003-1523-0338
AD  - Department of Neurology, Xiangya Hospital of Central South University, Changsha, 
      Hunan, China.
FAU - Wu, Xiu-Ling
AU  - Wu XL
AD  - Department of Neurology, Tangshan Gongren Hospital, Tangshan, Hebei, China.
FAU - Zhang, Lu
AU  - Zhang L
AD  - Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 
      Zhengzhou, Henan, China.
FAU - Feng, Hui-Yu
AU  - Feng HY
AD  - Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, 
      Guangzhou, Guangdong, China.
FAU - Chen, Huan
AU  - Chen H
AD  - Department of Neurology, Shantou Central Hospital, Shantou, Guangdong, China.
FAU - Zhou, Hou-Shi
AU  - Zhou HS
AD  - Department of Neurology, Shantou Central Hospital, Shantou, Guangdong, China.
FAU - Xu, Qian-Hui
AU  - Xu QH
AUID- ORCID: 0000-0001-9677-2897
AD  - Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical 
      College, Jinan University, The First Affiliated Hospital, Southern University of 
      Science and Technology, Shenzhen, China.
FAU - Zhao, Gui-Xian
AU  - Zhao GX
AD  - Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China.
FAU - Ou, Teng-Fei
AU  - Ou TF
AD  - Department of Neurology, The Second People's Hospital of Foshan, Foshan, 
      Guangdong, China.
FAU - Wang, Jin-Liang
AU  - Wang JL
AD  - Department of Neurology, The Second People's Hospital of Foshan, Foshan, 
      Guangdong, China.
FAU - Lu, Yu-Hua
AU  - Lu YH
AD  - Department of Neurology, People's Hospital of Chongqing Banan District, 
      Chongqing, China.
FAU - Mao, Zhi-Feng
AU  - Mao ZF
AD  - Neurimmunology Group, Institution of Kingmed, Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Gao, Cong
AU  - Gao C
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China.
FAU - Guo, Jun
AU  - Guo J
AUID- ORCID: 0000-0001-8053-881X
AD  - Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an, 
      Shaanxi, China.
FAU - Zhang, Hong-Ya
AU  - Zhang HY
AD  - Department of Neurology, Shenzhen University General Hospital, Shenzhen, 
      Guangdong, China.
FAU - Chen, Sheng
AU  - Chen S
AUID- ORCID: 0000-0001-7428-7153
AD  - Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of 
      Medicine, Shanghai, China.
FAU - Li, Jing
AU  - Li J
AD  - Department of Neurology, Xiangya Hospital of Central South University, Changsha, 
      Hunan, China youminglong@126.com lijing.neurology@aliyun.com.
FAU - Long, You-Ming
AU  - Long YM
AUID- ORCID: 0000-0002-4004-2948
AD  - Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of 
      Guangdong Province and The Ministry of Education of China, Institute of 
      Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, 
      Guangzhou, Guangdong, China youminglong@126.com lijing.neurology@aliyun.com.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230524
PL  - England
TA  - J Neurol Neurosurg Psychiatry
JT  - Journal of neurology, neurosurgery, and psychiatry
JID - 2985191R
RN  - 0 (Autoantibodies)
RN  - 0 (Immunoglobulin G)
SB  - IM
MH  - Male
MH  - Humans
MH  - Female
MH  - Autoimmunity
MH  - Retrospective Studies
MH  - *Epstein-Barr Virus Infections
MH  - Herpesvirus 4, Human
MH  - Autoantibodies
MH  - *Encephalitis
MH  - Immunoglobulin G
PMC - PMC10359542
OTO - NOTNLM
OT  - autoimmune encephalitis
OT  - clinical neurology
OT  - neuroimmunology
OT  - neurovirology
COIS- Competing interests: None declared.
EDAT- 2023/05/25 01:07
MHDA- 2023/07/17 06:42
PMCR- 2023/07/21
CRDT- 2023/05/24 21:13
PHST- 2022/10/26 00:00 [received]
PHST- 2023/02/28 00:00 [accepted]
PHST- 2023/07/17 06:42 [medline]
PHST- 2023/05/25 01:07 [pubmed]
PHST- 2023/05/24 21:13 [entrez]
PHST- 2023/07/21 00:00 [pmc-release]
AID - jnnp-2022-330626 [pii]
AID - 10.1136/jnnp-2022-330626 [doi]
PST - ppublish
SO  - J Neurol Neurosurg Psychiatry. 2023 Aug;94(8):605-613. doi: 
      10.1136/jnnp-2022-330626. Epub 2023 May 24.