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Publications at Bielefeld University
Article . 2025
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Specific viral antibodies associate with anti-NMDAR encephalitis after herpes simplex encephalitis

Authors: Jakob Kreye; William R. Morgenlander; Manjusha Thakar; Poul M. Schulte-Frankenfeld; Sarah Schott; Isabel Bünger; Hans-Christian Kornau; +18 Authors

Specific viral antibodies associate with anti-NMDAR encephalitis after herpes simplex encephalitis

Abstract

Herpes simplex encephalitis (HSE) patients may develop secondary anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARE), associated with worsened long-term neurological outcome. Immunosuppressive treatment can limit NMDAR autoantibody-mediated pathology, but early predictive biomarkers for the risk of NMDARE are lacking. In a multicenter study, we performed unbiased antibody reactome profiling using Phage ImmunoPrecipitation Sequencing (PhIP-Seq). HSE patients with secondary NMDARE (n = 13) versus those without (n = 10) showed enhanced antibody responses against HSV-1, but not HSV-2, which comprised specific antibodies to five peptides of the HSV-1 UL42 and UL48 proteins. A score of these signature CSF antibodies identified HSE patients with secondary NMDARE with a sensitivity of 75%, a specificity of > 99%, a positive predictive value of 90%, a negative predictive value of > 97% and an odds ratio (OR) of 209 (CI: 28 - 1,582) across all individuals in this study, and with similar performance values in serum (>66%, >99%, >88%, >96%, OR 307 (15 - 6,089)). These signature antibodies represent a promising biomarker to identify HSE patients at risk for NMDARE development. In NMDARE patients without a history of HSE and in MS patients, no disease-associated HSV antibody reactivity patterns were detected. Furthermore, we introduced the Multiplexed Index Calculations of the Antibody Reactome (MICAR) metric to characterize proteomic targets of compartment-specific antibody responses, an approach that is applicable in neuroimmunology and other compartmentalized disease states.

Country
Germany
Keywords

Male, Adult, Antibodies, Viral: immunology, Herpesvirus 2, Human, Anti-N-Methyl-D-Aspartate Receptor Encephalitis: immunology, Encephalitis, Herpes Simplex: immunology, Antibodies, Viral: blood, Herpesvirus 1, Human, Antibodies, Viral, Antibody reactome, Receptors, N-Methyl-D-Aspartate, Young Adult, Anti-N-Methyl-D-Aspartate Receptor Encephalitis: virology, Herpesvirus 1, Human: immunology, Biomarkers: blood, HSE, Herpesvirus 2, Human: immunology, Humans, PhIP-Seq, Anti-N-Methyl-D-Aspartate Receptor Encephalitis: etiology, Autoantibodies, Encephalitis, Herpes Simplex: complications, Anti-N-Methyl-D-Aspartate Receptor Encephalitis, MICAR, info:eu-repo/classification/ddc/150, HSV, Middle Aged, Intrathecal synthesis, NMDAR, Antibodies, Viral: cerebrospinal fluid, Encephalitis, Receptors, N-Methyl-D-Aspartate: immunology, Female, Encephalitis, Herpes Simplex, Biomarkers

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
Green
hybrid