Liao Yuqiao, Wen Linxin, Zheng Ruoyi, Shen Yinan, Ha Teng-Ai, Lin Mingkai, Cheng Ruogu, Gao Ye, Shang Pei
Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nanfang Hospital, Southern Medical University, Guangzhou, China.
Mol Neurobiol. 2025 May;62(5):6179-6194. doi: 10.1007/s12035-024-04660-0. Epub 2024 Dec 28.
Virus encephalitis (VE), recognized as one of the common kinds of central nervous system (CNS) diseases after virus infection, has a surprising correlation with autoimmune encephalitis (AE) when autoimmune antibodies emerge in cerebrospinal fluid (CSF) or serum. Herpes simplex virus and Epstein-Barr virus are the most critical agents worldwide. By molecular mimicry, herpes viruses can invade the brain directly or indirectly. As a type-III intermediate filament, glial fibrillary acidic protein (GFAP) can be seen in both the central and peripheral nervous system and is regarded as a marker of astrocyte activation. Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A), an autoimmune inflammatory CNS disorder with unearthed pathogenic mechanism yet, is correlated with CD8 + T cells and AQP4 astrocytopathy in TNF signaling. It brings a new concept of VE and GFAP coexisting, which has been documented in several case reports. Considering the infectious role of herpes viruses in CNS, EBV contributes to GFAP-IgG significantly and may result in GFAP-A. Coincidently, the existence of GFAP-IgG in patients with infection of herpes viruses has been documented as well. There exist multiple diagnoses of VE, ranging from traditional diagnostic criteria, such as CSF examination and electronic techniques, to a novel approach, according to case reports, the detection of GFAP-lgG. In terms of treatment, except for (IVIG), the explorations for new curative targets and optimal diagnostic time are of great necessity. In conclusion, emphasis given to the CNS autoimmune effect brought by the virus infection is highly worthy.
病毒性脑炎（VE）是病毒感染后常见的中枢神经系统（CNS）疾病之一，当脑脊液（CSF）或血清中出现自身免疫抗体时，它与自身免疫性脑炎（AE）有着惊人的关联。单纯疱疹病毒和爱泼斯坦 - 巴尔病毒是全球最主要的致病原。通过分子模拟，疱疹病毒可直接或间接侵入大脑。作为III型中间丝，胶质纤维酸性蛋白（GFAP）可见于中枢和外周神经系统，被视为星形胶质细胞活化的标志物。自身免疫性胶质纤维酸性蛋白星形细胞病（GFAP - A）是一种致病机制尚未明确的自身免疫性炎症性CNS疾病，与CD8 + T细胞及TNF信号通路中的水通道蛋白4星形细胞病相关。它提出了VE和GFAP共存的新概念，已有多篇病例报告对此进行了记载。考虑到疱疹病毒在CNS中的感染作用，EBV对GFAP - IgG有显著影响，可能导致GFAP - A。巧合的是，疱疹病毒感染患者中GFAP - IgG的存在也有文献记载。VE的诊断方法多样，从传统的诊断标准如CSF检查和电子技术，到根据病例报告的新方法即检测GFAP - IgG。在治疗方面，除了静脉注射免疫球蛋白（IVIG）外，探索新的治疗靶点和最佳诊断时间非常必要。总之，高度重视病毒感染带来的CNS自身免疫效应是非常值得的。
