A comparison of NMDAR-antibody detection methods

N-Methyl-D-Aspartate receptor antibody (NMDAR-ab) encephalitis is the most common antibody-mediated encephalitis. We compared four NMDAR-Ab assay methods: 1) live (a, L-CBA) or fixed (b, F-CBA) cell-based assays (CBA); 2) immunohistochemistry (IHC); 3) a commercially available CBA (C-CBA, Euroimmun...

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Main Authors: Thouin, A, Gastaldi, M, Woodhall, M, Jacobson, L, Irani, S, Vincent, A
Format: Conference item
Language:English
Published: BMJ Publishing Group 2017
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author Thouin, A
Gastaldi, M
Woodhall, M
Jacobson, L
Irani, S
Vincent, A
author_facet Thouin, A
Gastaldi, M
Woodhall, M
Jacobson, L
Irani, S
Vincent, A
author_sort Thouin, A
collection OXFORD
description N-Methyl-D-Aspartate receptor antibody (NMDAR-ab) encephalitis is the most common antibody-mediated encephalitis. We compared four NMDAR-Ab assay methods: 1) live (a, L-CBA) or fixed (b, F-CBA) cell-based assays (CBA); 2) immunohistochemistry (IHC); 3) a commercially available CBA (C-CBA, Euroimmun AG). 180 sera and 48 CSFs were tested. Sera previously positive by the Oxford L-CBA but with unlikely phenotypes were intentionally over-represented. The results of the four assays agreed in only 55.6% of sera and 82% of CSFs. C-CBA was least likely to agree with other methods (37.7% in serum). Diagnosis was available, so far, for 54 patients (NMDAR ab-encephalitis ‘definite’ in 34, ‘unlikely’ in 20). In serum, L-CBA detected NMDAR-abs in 88% of ‘definite’ patients, but had a high false-positive rate (consistent with the biased selection). IHC was negative in all unlikely patients, but positive in only 73.5% ‘definite’ patients. F-CBA and C-CBA had intermediate performances. There was a worrying lack of concordance between tests. Assay results should be interpreted in the light of clinical information and a combination of L-CBA and IHC may give the most useful results. Further clinical information is being made available in order to increase the serum numbers and determine assay performance using CSF alone.
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spelling oxford-uuid:0e67b295-a433-4471-9c10-58d53fc0457d2022-03-26T09:45:49ZA comparison of NMDAR-antibody detection methodsConference itemhttp://purl.org/coar/resource_type/c_c94fuuid:0e67b295-a433-4471-9c10-58d53fc0457dEnglishSymplectic ElementsBMJ Publishing Group2017Thouin, AGastaldi, MWoodhall, MJacobson, LIrani, SVincent, AN-Methyl-D-Aspartate receptor antibody (NMDAR-ab) encephalitis is the most common antibody-mediated encephalitis. We compared four NMDAR-Ab assay methods: 1) live (a, L-CBA) or fixed (b, F-CBA) cell-based assays (CBA); 2) immunohistochemistry (IHC); 3) a commercially available CBA (C-CBA, Euroimmun AG). 180 sera and 48 CSFs were tested. Sera previously positive by the Oxford L-CBA but with unlikely phenotypes were intentionally over-represented. The results of the four assays agreed in only 55.6% of sera and 82% of CSFs. C-CBA was least likely to agree with other methods (37.7% in serum). Diagnosis was available, so far, for 54 patients (NMDAR ab-encephalitis ‘definite’ in 34, ‘unlikely’ in 20). In serum, L-CBA detected NMDAR-abs in 88% of ‘definite’ patients, but had a high false-positive rate (consistent with the biased selection). IHC was negative in all unlikely patients, but positive in only 73.5% ‘definite’ patients. F-CBA and C-CBA had intermediate performances. There was a worrying lack of concordance between tests. Assay results should be interpreted in the light of clinical information and a combination of L-CBA and IHC may give the most useful results. Further clinical information is being made available in order to increase the serum numbers and determine assay performance using CSF alone.
spellingShingle Thouin, A
Gastaldi, M
Woodhall, M
Jacobson, L
Irani, S
Vincent, A
A comparison of NMDAR-antibody detection methods
title A comparison of NMDAR-antibody detection methods
title_full A comparison of NMDAR-antibody detection methods
title_fullStr A comparison of NMDAR-antibody detection methods
title_full_unstemmed A comparison of NMDAR-antibody detection methods
title_short A comparison of NMDAR-antibody detection methods
title_sort comparison of nmdar antibody detection methods
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