Limitations of a commercial assay as diagnostic test of autoimmune encephalitis

Detection of neuronal surface antibodies (NSAb) is important for the diagnosis of autoimmune encephalitis (AE). Although most clinical laboratories use a commercial diagnostic kit (Euroimmun, Lübeck, Germany) based on indirect immunofluorescence on transfected cells (IIFA), clinical experience sugge...

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Autores: Ruiz García, Raquel, Muñoz Sánchez, Guillermo, Naranjo, Laura, Guasp, Mar, Sabater Baudet, Lidia, Saiz Hinarejos, Albert, Dalmau Obrador, Josep, Graus Ribas, Francesc, Martinez Hernandez, Eugenia
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/184018
Acceso en línea:https://hdl.handle.net/2445/184018
Access Level:acceso abierto
Palabra clave:Encefalitis
Immunohistoquímica
Malalties autoimmunitàries
Encephalitis
Immunohistochemistry
Autoimmune diseases
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spelling Limitations of a commercial assay as diagnostic test of autoimmune encephalitisRuiz García, RaquelMuñoz Sánchez, GuillermoNaranjo, LauraGuasp, MarSabater Baudet, LidiaSaiz Hinarejos, AlbertDalmau Obrador, JosepGraus Ribas, FrancescMartinez Hernandez, EugeniaEncefalitisImmunohistoquímicaMalalties autoimmunitàriesEncephalitisImmunohistochemistryAutoimmune diseasesDetection of neuronal surface antibodies (NSAb) is important for the diagnosis of autoimmune encephalitis (AE). Although most clinical laboratories use a commercial diagnostic kit (Euroimmun, Lübeck, Germany) based on indirect immunofluorescence on transfected cells (IIFA), clinical experience suggests diagnostic limitations. Here, we assessed the performance of the commercial IIFA in serum and CSF samples of patients with suspected AE previously examined by rat brain immunohistochemistry (Cohort A). Of 6213 samples, 404 (6.5%) showed brain immunostaining suggestive of NSAb: 163 (40%) were positive by commercial IIFA and 241 (60%) were negative. When these 241 samples were re-assessed with in-house IIFA, 42 (18%) were positive: 21 (9%) had NSAb against antigens not included in the commercial IIFA and the other 21 (9%) had NSAb against antigens included in the commercial kit (false negative results). False negative results occurred more frequently with CSF (29% vs 10% in serum) and predominantly affected GABABR (39%), LGI1 (17%) and AMPAR (11%) antibodies. Results were reproduced in a separate cohort (B) of 54 AE patients with LGI1, GABABR or AMPAR antibodies in CSF which were missed in 30% by commercial IIFA. Patients with discordant GABABR antibody results (positive in-house but negative commercial IIFA) were less likely to develop full-blown clinical syndrome; no significant clinical differences were noted for the other antibodies. Overall, NSAb testing by commercial IIFA led to false negative results in a substantial number of patients, mainly those affected by anti-LG1, GABABR or AMPAR encephalitis. If these disorders are suspected and commercial IIFA is negative, more comprehensive antibody studies are recommendedFrontiers Media2022202220212022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion8 p.application/pdfapplication/pdfhttps://hdl.handle.net/2445/184018Articles publicats en revistes (Medicina)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.3389/fimmu.2021.691536Frontiers in Immunology, 2021, vol. 12, num. 691536https://doi.org/10.3389/fimmu.2021.691536cc-by (c) Ruiz García, Raquel et al., 2021https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1840182026-05-29T05:05:01Z
dc.title.none.fl_str_mv Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
title Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
spellingShingle Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
Ruiz García, Raquel
Encefalitis
Immunohistoquímica
Malalties autoimmunitàries
Encephalitis
Immunohistochemistry
Autoimmune diseases
title_short Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
title_full Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
title_fullStr Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
title_full_unstemmed Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
title_sort Limitations of a commercial assay as diagnostic test of autoimmune encephalitis
dc.creator.none.fl_str_mv Ruiz García, Raquel
Muñoz Sánchez, Guillermo
Naranjo, Laura
Guasp, Mar
Sabater Baudet, Lidia
Saiz Hinarejos, Albert
Dalmau Obrador, Josep
Graus Ribas, Francesc
Martinez Hernandez, Eugenia
author Ruiz García, Raquel
author_facet Ruiz García, Raquel
Muñoz Sánchez, Guillermo
Naranjo, Laura
Guasp, Mar
Sabater Baudet, Lidia
Saiz Hinarejos, Albert
Dalmau Obrador, Josep
Graus Ribas, Francesc
Martinez Hernandez, Eugenia
author_role author
author2 Muñoz Sánchez, Guillermo
Naranjo, Laura
Guasp, Mar
Sabater Baudet, Lidia
Saiz Hinarejos, Albert
Dalmau Obrador, Josep
Graus Ribas, Francesc
Martinez Hernandez, Eugenia
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Encefalitis
Immunohistoquímica
Malalties autoimmunitàries
Encephalitis
Immunohistochemistry
Autoimmune diseases
topic Encefalitis
Immunohistoquímica
Malalties autoimmunitàries
Encephalitis
Immunohistochemistry
Autoimmune diseases
description Detection of neuronal surface antibodies (NSAb) is important for the diagnosis of autoimmune encephalitis (AE). Although most clinical laboratories use a commercial diagnostic kit (Euroimmun, Lübeck, Germany) based on indirect immunofluorescence on transfected cells (IIFA), clinical experience suggests diagnostic limitations. Here, we assessed the performance of the commercial IIFA in serum and CSF samples of patients with suspected AE previously examined by rat brain immunohistochemistry (Cohort A). Of 6213 samples, 404 (6.5%) showed brain immunostaining suggestive of NSAb: 163 (40%) were positive by commercial IIFA and 241 (60%) were negative. When these 241 samples were re-assessed with in-house IIFA, 42 (18%) were positive: 21 (9%) had NSAb against antigens not included in the commercial IIFA and the other 21 (9%) had NSAb against antigens included in the commercial kit (false negative results). False negative results occurred more frequently with CSF (29% vs 10% in serum) and predominantly affected GABABR (39%), LGI1 (17%) and AMPAR (11%) antibodies. Results were reproduced in a separate cohort (B) of 54 AE patients with LGI1, GABABR or AMPAR antibodies in CSF which were missed in 30% by commercial IIFA. Patients with discordant GABABR antibody results (positive in-house but negative commercial IIFA) were less likely to develop full-blown clinical syndrome; no significant clinical differences were noted for the other antibodies. Overall, NSAb testing by commercial IIFA led to false negative results in a substantial number of patients, mainly those affected by anti-LG1, GABABR or AMPAR encephalitis. If these disorders are suspected and commercial IIFA is negative, more comprehensive antibody studies are recommended
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/184018
url https://hdl.handle.net/2445/184018
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.3389/fimmu.2021.691536
Frontiers in Immunology, 2021, vol. 12, num. 691536
https://doi.org/10.3389/fimmu.2021.691536
dc.rights.none.fl_str_mv cc-by (c) Ruiz García, Raquel et al., 2021
https://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Ruiz García, Raquel et al., 2021
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 8 p.
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Frontiers Media
publisher.none.fl_str_mv Frontiers Media
dc.source.none.fl_str_mv Articles publicats en revistes (Medicina)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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