Contribution of cerebrospinal fluid antibody titers and sex to acute cerebral blood flow in patients with anti-NMDAR autoimmune encephalitis

Front Immunol. 2024 Mar 1:15:1299898. doi: 10.3389/fimmu.2024.1299898. eCollection 2024.

Abstract

Objective: The objective of this study was to elucidate the contribution of cerebrospinal fluid (CSF) antibody titers (AT) and sex to acute cerebral blood flow (CBF) in patients diagnosed with anti-N-methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE).

Methods: Forty-five patients diagnosed with NMDAR AE were recruited from December 2016 to January 2023. The acute CBF in patients with NMDAR AE at the early stage of the disease was analyzed using arterial spin labeling. The groups were compared based on CSF AT and sex. The connectivity of the CBF in the region of interest was also compared between groups.

Results: The patients with different CSF AT exhibited varied brain regions with CBF abnormalities compared to the healthy subjects (p = 0.001, cluster-level FWE corrected). High antibody titers (HAT) in CSF contributed to more brain regions with CBF alterations in female patients than in female patients with low antibody titers (LAT) in CSF (p = 0.001, cluster-level FWE corrected). Female patients with HAT in CSF displayed more decreased CBF in the left post cingulum gyrus, left precuneus, left calcarine, and left middle cingulum gyrus than the male patients with the same AT in CSF (p = 0.001, cluster-level FWE corrected). All patients with NMDAR AE showed increased CBF in the left putamen (Putamen_L) and left amygdala (Amygdala_L) and decreased CBF in the right precuneus (Precuneus_R), which suggests that these are diagnostic CBF markers for NMDAR AE.

Conclusion: CSF AT and sex contributed to CBF abnormalities in the patients diagnosed with NMDAR AE. Altered CBF might potentially serve as the diagnostic marker for NMDAR AE.

Keywords: CSF antibody titers; anti-NMDAR autoimmune encephalitis; arterial spin labeling; cerebral blood flow; sex.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / diagnosis
  • Brain / diagnostic imaging
  • Cerebrovascular Circulation
  • Encephalitis*
  • Female
  • Hashimoto Disease*
  • Humans
  • Male
  • Receptors, N-Methyl-D-Aspartate

Substances

  • Receptors, N-Methyl-D-Aspartate

Supplementary concepts

  • Hashimoto's encephalitis

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The work was supported Young Scientists Fund of the National Natural Science Foundation of China (No. 81501126), Science and Development Foundation of Nanjing Medical University (No. 2014NJMU050), Young Medical Key Talents Foundation of Jiangsu Province (No. QNRC2016053), Training Project for Young Talents of Nanjing Brain Hospital, and General project of Nanjing Municipal Health Commission (No.YKK21110), General project of Jiangsu Provincial Health Commission (M2022065).