URRIS, Unité de Recherche Clinique Cote d'Azur-UR2CA, CRCSEP, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France.
Internal Medicine Department, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France.
Front Immunol. 2021 May 13;12:673021. doi: 10.3389/fimmu.2021.673021. eCollection 2021.
Most of our knowledge into autoimmune encephalitis (AE) comes from N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis. The concentrations of cytokines in cerebrospinal fluid (CSF) including IL-17A have been found to be increased and associated with poor outcome. However, data on the cytokine concentration in CSF and its correlation with outcome is lacking for other types of AE.
To report the concentrations of CSF sIL-2R, IL-6, IL-8, IL-10 and IL-17A and to correlate it with acute disease severity and the 1-year outcome in non-NMDAR AE.
We measured the CSF concentration of each cytokine in 20 AE patients, and compared IL-6 and IL-17A concentrations with 13 patients with CNS demyelinating diseases and 20 non-inflammatory controls. Patients were > 18yr and had at least 1-year clinical follow-up. Intracellular and NMDAR antibody (Ab) -mediated encephalitis were excluded. A mRS ≤ 2 was retained as a 1-year good outcome.
The IL-17A concentration in CSF was higher in AE patients than in both control groups (<0.01). No difference was observed in CSF concentration of IL-6 between groups. At disease onset, a high CSF IL-17A concentration correlated with a high modified Rankin Scale (<0.05), a high Clinical Assessment Scale for Autoimmune Encephalitis score (<0.001) and ICU admission (<0.01). There was no correlation between the concentration of all CSF cytokines and the 1-year clinical outcome.
Our results show that CSF IL-17A could be interesting to assess initial severity in non-NMDAR AE. Thus, CSF IL-17A could be an interesting therapeutic target and be useful to assess early selective immunosuppressive therapy.
我们对自身免疫性脑炎（AE）的大部分认识来自于 N-甲基-D-天冬氨酸受体（NMDAR）脑炎。已发现脑脊液（CSF）中细胞因子（包括 IL-17A）的浓度升高与不良预后相关。然而，其他类型的 AE 中 CSF 细胞因子浓度及其与预后的相关性的数据尚缺乏。
报告非 NMDAR AE 患者 CSF 可溶性白细胞介素 2 受体（sIL-2R）、白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、白细胞介素 10（IL-10）和白细胞介素 17A（IL-17A）的浓度，并将其与急性疾病严重程度和 1 年预后相关联。
我们测量了 20 例 AE 患者 CSF 中每种细胞因子的浓度，并将 IL-6 和 IL-17A 浓度与 13 例中枢神经系统脱髓鞘疾病患者和 20 例非炎症性对照患者进行比较。患者年龄>18 岁且有至少 1 年的临床随访。排除细胞内和 NMDAR 抗体（Ab）介导的脑炎。将 mRS≤2 保留为 1 年的良好预后。
AE 患者 CSF 中 IL-17A 浓度高于两组对照组（<0.01）。各组 CSF 中 IL-6 浓度无差异。疾病发作时，高 CSF IL-17A 浓度与改良 Rankin 量表评分较高（<0.05）、临床自身免疫性脑炎评估量表评分较高（<0.001）和 ICU 入院率较高（<0.01）相关。所有 CSF 细胞因子的浓度与 1 年临床结局均无相关性。
我们的结果表明，CSF IL-17A 可用于评估非 NMDAR AE 的初始严重程度。因此，CSF IL-17A 可能是一个有趣的治疗靶点，可用于评估早期选择性免疫抑制治疗。
