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2008-09-16

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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/127545

Neuronal surface antigen antibodies in limbic encephalitis: clinical-immunologic associations

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https://doi.org/10.1212/01.wnl.0000325917.48466.55

Resum

Objective: To report the frequency and type of antibodies against neuronal surface antigens (NSA-ab) in limbic encephalitis (LE). Methods: Analysis of clinical features, neuropathologic findings, and detection of NSA-ab using immunochemistry on rat tissue and neuronal cultures in a series of 45 patients with paraneoplastic (23) or idiopathic (22) LE. Results: NSA-ab were identified in 29 patients (64%; 12 paraneoplastic, 17 idiopathic). Thirteen patients had voltage-gated potassium channels (VGKC)-ab, 11 novel NSA (nNSA)-ab, and 5 NMDA receptor (NMDAR)-ab. nNSA-ab did not identify a common antigen and were more frequent in paraneoplastic than idiopathic LE (39% vs 9%; p = 0.03). When compared with VGKC-ab or NMDAR-ab, the nNSA associated more frequently with intraneuronal antibodies (11% vs 73%; p = 0.001). Of 12 patients (9 nNSA-ab, 2 VGKC-ab, 1 NMDAR-ab) with paraneoplastic LE and NSA-ab, concomitant intraneuronal antibodies occurred in 9 (75%). None of these 12 patients improved with immunotherapy. The autopsy of three of them showed neuronal loss, microgliosis, and cytotoxic T cell infiltrates in the hippocampus and amygdala. These findings were compatible with a T-cell mediated neuronal damage. In contrast, 13 of 17 (76%) patients with idiopathic LE and NSA-ab (8 VGKC-ab, 4 NMDAR-ab, 1 nNSA-ab) and 1 of 5 (20%) without antibodies had clinical improvement (p = 0.04). Conclusions: In paraneoplastic limbic encephalitis (LE), novel antibodies against neuronal surface antigens (nNSA-ab) occur frequently, coexist with antibodies against intracellular antigens, and these cases are refractory to immunotherapy. In idiopathic LE, the likelihood of improvement is significantly higher in patients with NSA-ab than in those without antibodies.

Matèries

Encefalitis, Immunoglobulines, Immunoteràpia

Matèries (anglès)

Encephalitis, Immunoglobulins, Immunotheraphy

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Col·leccions

Articles publicats en revistes (Fonaments Clínics)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

Citació

GRAUS RIBAS, Francesc, SAIZ HINAREJOS, Albert, LAI, Marina, BRUNA, Jordi, LÓPEZ, Francisca, SABATER BAUDET, Lidia, BLANCO, Yolanda, REY, María jesús, RIBALTA FARRÉS, Teresa maría, DALMAU OBRADOR, Josep. Neuronal surface antigen antibodies in limbic encephalitis: clinical-immunologic associations. _Neurology_. 2008. Vol. 71, núm. 12, pàgs. 930-936. [consulta: 8 de gener de 2026]. ISSN: 0028-3878. [Disponible a: https://hdl.handle.net/2445/127545]

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