Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany.
Transl Psychiatry. 2020 Aug 12;10(1):279. doi: 10.1038/s41398-020-00967-3.
The central role played by cerebrospinal-fluid (CSF) examinations including antineuronal autoantibody (Ab) testing is increasingly recognized in psychiatry. The rationale of this study was to present a multimodally investigated group of patients. In total, 992 patients were analyzed for CSF alterations: 456 patients with schizophreniform and 536 with affective syndromes. Ab measurement included testing for established antineuronal IgG-Abs against intracellular antigens in serum (Yo/Hu/Ri/cv2[CRMP5]/Ma1/Ma2/SOX1/TR[DNER]/Zic4/amphiphysin/GAD65) and for cell surface antigens in the CSF (NMDAR/AMPA-1/2-R/GABA-B-R/LGI1/CASPR2/DPPX). In 30 patients with "red flags" for autoimmune psychosis, "tissue tests" were performed. Additional diagnostics included MRI and EEG analyses. CSF white-blood-cell counts were increased in 4% and IgG indices in 2%; CSF-specific oligoclonal bands were detected in 4%; overall, 8% displayed signs of neuroinflammation. In addition, 18% revealed increased albumin quotients. Antineuronal Abs against intracellular antigens were detected in serum in 0.6%. Antineuronal Abs against established cell surface antigens were detected in serum of 1% and in the CSF of 0.3% (CSF samples were only questionably positive). Abnormal IgG binding in "tissue tests" was detected in serum of 23% and in CSF of 27%. In total, 92% of the Ab-positive patients demonstrated at least one sign of brain involvement in additional diagnostics using CSF, MRI, EEG, and FDG-PET. In summary, CSF basic analyses revealed signs of blood-brain-barrier dysfunction and neuroinflammation in relevant subgroups of patients. Established antineuronal IgG-Abs were rare in serum and even rarer in the CSF. "Tissue tests" revealed frequent occurrences of Ab-binding; therefore, novel antineuronal Abs could play a relevant role in psychiatry.
中枢神经系统（CSF）检查，包括抗神经元自身抗体（Ab）检测，在精神病学中的核心作用正日益受到重视。本研究的目的是介绍一组多模式检查的患者。共分析了 992 例患者的 CSF 改变：456 例精神分裂样和 536 例情感综合征。Ab 测量包括检测血清中针对细胞内抗原的已建立的抗神经元 IgG-Ab（Yo/Hu/Ri/cv2[CRMP5]/Ma1/Ma2/SOX1/TR[DNER]/Zic4/ amphiphysin/GAD65）和 CSF 中针对细胞表面抗原的 Ab（NMDAR/AMPA-1/2-R/GABA-B-R/LGI1/CASPR2/DPPX）。在 30 例有自身免疫性精神病“危险信号”的患者中，进行了“组织检查”。额外的诊断包括 MRI 和 EEG 分析。CSF 白细胞计数增加 4%，IgG 指数增加 2%；CSF 中检测到特异性寡克隆带 4%；总体而言，8%表现出神经炎症迹象。此外，18%显示白蛋白比值增加。血清中检测到针对细胞内抗原的抗神经元 Ab 为 0.6%。血清中检测到针对已建立的细胞表面抗原的抗神经元 Ab 为 1%，CSF 中为 0.3%（CSF 样本仅可疑阳性）。血清中异常 IgG 结合在“组织检查”中检测到 23%，CSF 中检测到 27%。总体而言，在使用 CSF、MRI、EEG 和 FDG-PET 的额外诊断中，92%的 Ab 阳性患者至少有一个脑受累的迹象。CSF 基础分析显示，在相关亚组患者中存在血脑屏障功能障碍和神经炎症的迹象。在血清和脑脊液中，已建立的抗神经元 IgG-Ab 均较为罕见。“组织检查”显示 Ab 结合频繁发生，因此，新型抗神经元 Abs 可能在精神病学中发挥重要作用。
