Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers

Bien C, Rohleder C, Mueller JK, Bien CI, Koethe D, Leweke FM (2021)
Frontiers in psychiatry 12: 654602.

Zeitschriftenaufsatz | Veröffentlicht | Englisch
 
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Bien, ChristianUniBi; Rohleder, Cathrin; Mueller, Juliane K; Bien, Corinna I; Koethe, Dagmar; Leweke, F Markus
Abstract / Bemerkung
The pathophysiological role of neural autoantibodies in acute psychotic disorders is receiving increased attention. However, there is still an ongoing debate, whether predominantly psychotic manifestations of autoimmune encephalitides exist that may remain undetected and, thus, untreated. Furthermore, it is discussed if such conditions can be diagnosed based on serum antibody results or if a reliable diagnosis requires additional cerebrospinal fluids (CSF) results. In this study, we screened pairs of serum and CSF samples from antipsychotic-naive individuals with first-episode schizophrenic psychosis (FEP, n = 103), clinical high risk for psychosis (CHR, n = 47), and healthy volunteers (HV, n = 40) for eight different antibodies against various antigens that have been shown to be associated with autoimmune encephalitides: N-methyl-D-aspartate receptor (NMDAR, NR1 subunits only), glutamic acid decarboxylase (GAD65), leucine-rich glioma inactivated protein 1 (LGI1), contactin-associated protein-like 2 protein (CASPR2), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) subunit 1, AMPAR subunit 2, gamma-aminobutyric acid-B receptors (GABABR), and glycine receptors. All patients were within the norm with regards to a careful neurological examination, a magnetic resonance imaging (MRI) of the brain, an electroencephalogram (EEG), and routine blood pathology. All CSF samples were autoantibody-negative. In three serum samples of individuals with FEP, we detected low-titer CASPR2 immunoglobulin (Ig) G antibodies (≤1:160, n = 2) and non-IgG antibodies against NMDAR (n = 1) (overall serum-autoantibody prevalence in FEP: 2.91%). However, the IgG titers were below the laboratory cut-off defined for positivity, and non-IgG antibodies are of no clinical relevance. This suggests that there were no cases of autoimmune encephalitis in our cohort. Our results highlight the importance and the high specificity of CSF analysis to reliably detect autoantibodies. They confirm the hypothesis that pure psychotic manifestations of antibody-associated autoimmune encephalitides without any additional neuropsychiatric findings are very rare. However, special attention must be paid to those presenting with atypical mental illnesses with additional neurological symptoms, evidence of clinically-significant cognitive involvement, profound sleep-wake perturbations, seizures, electroencephalographic, or magnetic resonance imaging pathologies to be able to identify cases with autoimmune-mediated psychiatric syndromes. Copyright © 2021 Bien, Rohleder, Mueller, Bien, Koethe and Leweke.
Stichworte
autoimmune-mediated psychosis; autoimmune encephalitis; anti-neural autoantibodies; at-risk mental state; clinical high at-risk mental state; ultra-high risk for psychosis; schizophrenia; healthy control
Erscheinungsjahr
2021
Zeitschriftentitel
Frontiers in psychiatry
Band
12
Art.-Nr.
654602
eISSN
1664-0640
Finanzierungs-Informationen
Open-Access-Publikationskosten wurden durch die Universität Bielefeld gefördert.
Page URI
https://pub.uni-bielefeld.de/record/2954080

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Bien C, Rohleder C, Mueller JK, Bien CI, Koethe D, Leweke FM. Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers. Frontiers in psychiatry. 2021;12: 654602.
Bien, C., Rohleder, C., Mueller, J. K., Bien, C. I., Koethe, D., & Leweke, F. M. (2021). Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers. Frontiers in psychiatry, 12, 654602. https://doi.org/10.3389/fpsyt.2021.654602
Bien, C., Rohleder, C., Mueller, J. K., Bien, C. I., Koethe, D., and Leweke, F. M. (2021). Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers. Frontiers in psychiatry 12:654602.
Bien, C., et al., 2021. Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers. Frontiers in psychiatry, 12: 654602.
C. Bien, et al., “Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers”, Frontiers in psychiatry, vol. 12, 2021, : 654602.
Bien, C., Rohleder, C., Mueller, J.K., Bien, C.I., Koethe, D., Leweke, F.M.: Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers. Frontiers in psychiatry. 12, : 654602 (2021).
Bien, Christian, Rohleder, Cathrin, Mueller, Juliane K, Bien, Corinna I, Koethe, Dagmar, and Leweke, F Markus. “Neural Autoantibodies in Cerebrospinal Fluid and Serum in Clinical High Risk for Psychosis, First-Episode Psychosis, and Healthy Volunteers”. Frontiers in psychiatry 12 (2021): 654602.
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2021-04-27T08:30:00Z
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