Dorcet Guillaume, Benaiteau Marie, Pariente Jérémie, Ory-Magne Fabienne, Cheuret Emmanuel, Rafiq Marie, Brooks Wesley, Puissant-Lubrano Bénédicte, Fortenfant Françoise, Renaudineau Yves, Bost Chloé
Département de Neurologie Hôpital Pierre Paul Riquet, CHU de Toulouse Toulouse France.
Laboratoire d'Immunologie Institut Fédératif de Biologie, CHU de Toulouse Toulouse France.
Clin Transl Immunology. 2023 Mar 15;12(3):e1439. doi: 10.1002/cti2.1439. eCollection 2023.
Because of its heterogeneity in clinical presentation and course, predicting autoimmune encephalitis (AIE) evolution remains challenging. Hence, our aim was to explore the correlation of several biomarkers with the clinical course of disease.
Thirty-seven cases of AIE were selected retrospectively and divided into active ( = 9), improved ( = 12) and remission ( = 16) AIE according to their disease evolution. Nine proteins were tested in both serum and cerebrospinal fluid (CSF) at diagnosis (T0) and during the follow-up (T1), in particular activated MMP-9 (MMP-9A) and YKL-40 (or chitinase 3-like 1).
From diagnosis to revaluation, AIE remission was associated with decreased YKL-40 and MMP-9A levels in the CSF, and with decreased NfL and NfH levels in the serum. The changes in YKL-40 concentrations in the CSF were associated with (1) still active AIE when increasing >10% (value = 0.0093); (2) partial improvement or remission when the changes were between +9% and -20% (value = 0.0173); and remission with a reduction > -20% value = 0.0072; overall difference between the three groups: value = 0.0088). At T1, the CSF YKL-40 levels were significantly decreased between active and improved as well as improved and remission AIE groups but with no calculable threshold because of patient heterogeneity.
The concentration of YKL-40, a cytokine-like proinflammatory protein produced by glial cells, is correlated in the CSF with the clinical course of AIE. Its introduction as a biomarker may assist in following disease activity and in evaluating therapeutic response.
由于自身免疫性脑炎（AIE）临床表现和病程存在异质性，预测其病情演变仍具有挑战性。因此，我们的目的是探讨几种生物标志物与疾病临床病程的相关性。
回顾性选取37例AIE患者，并根据疾病演变情况将其分为活动期（n = 9）、改善期（n = 12）和缓解期（n = 16）AIE。在诊断时（T0）和随访期间（T1）检测血清和脑脊液（CSF）中的9种蛋白质，特别是活化基质金属蛋白酶-9（MMP-9A）和YKL-40（或几丁质酶3样蛋白1）。
从诊断到重新评估，AIE缓解与脑脊液中YKL-40和MMP-9A水平降低以及血清中神经丝轻链（NfL）和神经丝重链（NfH）水平降低相关。脑脊液中YKL-40浓度的变化与以下情况相关：（1）增加>10%时仍为活动期AIE（P值 = 0.0093）；（2）变化在+9%至-20%之间时部分改善或缓解（P值 = 0.0173）；降低> -20%时缓解（P值 = 0.0072）；三组之间的总体差异：P值 = 0.0088）。在T1时，活动期与改善期以及改善期与缓解期AIE组之间脑脊液YKL-40水平显著降低，但由于患者异质性，无可计算的阈值。
神经胶质细胞产生的细胞因子样促炎蛋白YKL-40的浓度在脑脊液中与AIE的临床病程相关。将其作为生物标志物可能有助于跟踪疾病活动和评估治疗反应。
