• Ding Liu, Pei-Hao Lin, Hui-Lu Li, Jie Yang, Yong You, Xiao Yang, Li-Hong Jiang, Cai-Yu Ma, Lu-Fen Xu, Qing-Xia Zhang, Sha Liao, Han Chen, Jia-Jia Yue, Yu-Ying Lu, Chun Lian, Yin Liu, Zhan-Hang Wang, Jin-Long Ye, Wei Qiu, Ya-Qing Shu, Hai-Yang Wang, Hong-Li Liu, Yue Wang, Chun-Mei Duan, Huan Yang, Xiu-Ling Wu, Lu Zhang, Hui-Yu Feng, Huan Chen, Hou-Shi Zhou, Qian-Hui Xu, Gui-Xian Zhao, Teng-Fei Ou, Jin-Liang Wang, Yu-Hua Lu, Zhi-Feng Mao, Cong Gao, Jun Guo, Hong-Ya Zhang, Sheng Chen, Jing Li, and You-Ming Long.
• Department of Neurology, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
• J. Neurol. Neurosurg. Psychiatr. 2023 Aug 1; 94 (8): 605613605-613.

UnlabelledTo explore the autoimmune response and outcome in the central nervous system (CNS) at the onset of viral infection and correlation between autoantibodies and viruses.MethodsA retrospective observational study was conducted in 121 patients (2016-2021) with a CNS viral infection confirmed via cerebrospinal fluid (CSF) next-generation sequencing (cohort A). Their clinical information was analysed and CSF samples were screened for autoantibodies against monkey cerebellum by tissue-based assay. In situ hybridisation was used to detect Epstein-Barr virus (EBV) in brain tissue of 8 patients with glial fibrillar acidic protein (GFAP)-IgG and nasopharyngeal carcinoma tissue of 2 patients with GFAP-IgG as control (cohort B).ResultsAmong cohort A (male:female=79:42; median age: 42 (14-78) years old), 61 (50.4%) participants had detectable autoantibodies in CSF. Compared with other viruses, EBV increased the odds of having GFAP-IgG (OR 18.22, 95% CI 6.54 to 50.77, p<0.001). In cohort B, EBV was found in the brain tissue from two of eight (25.0%) patients with GFAP-IgG. Autoantibody-positive patients had a higher CSF protein level (median: 1126.00 (281.00-5352.00) vs 700.00 (76.70-2899.00), p<0.001), lower CSF chloride level (mean: 119.80±6.24 vs 122.84±5.26, p=0.005), lower ratios of CSF-glucose/serum-glucose (median: 0.50[0.13-0.94] vs 0.60[0.26-1.23], p=0.003), more meningitis (26/61 (42.6%) vs 12/60 (20.0%), p=0.007) and higher follow-up modified Rankin Scale scores (1 (0-6) vs 0 (0-3), p=0.037) compared with antibody-negative patients. A Kaplan-Meier analysis revealed that autoantibody-positive patients experienced significantly worse outcomes (p=0.031).ConclusionsAutoimmune responses are found at the onset of viral encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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