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BREAKING NEWS: Past HSV-1 infection Shows Association in Development of anti-NMDAr Autoimmune Enceph

Tabitha Andrews Orth
Apr 18, 2018
3 min read

Introducing the Teams in these 2 cohort Studies~

When Dr. Josep Dalmau was doing research at UPENN he identified the anti-NMDAr antibody when he came across his first cases in 2005 and published about them in 2007. This discovery gave birth to what we now know as “Antibody Mediated Autoimmune Encephalitis”. Since 2007 a completely new area of specialty in neurology has emerged called “Autoimmune Neurology”. Neurologist with special interest in these types of disorders are now focusing on and receiving special training and education about these disorders. Since 2007, 1 – 3 antibodies in autoimmune encephalitis have been identified each year. Dr. Eric Lancaster was working with Dr. Dalmau at the time of his discovery and since that time, these two leading neurologists have published several research papers together and separately about autoimmune encephalitis. Their work is highly regarded worldwide.

Dr. Lancaster works with adult patients at The Center for Autoimmune Neurology at UPENN, while other researchers on this ground breaking paper work at (CHOP) Children’s Hospital of Pennsylvania handling pediatric cases. Some researchers such as Dr. David Lynch are now focusing on research alone and no longer seeing patients. Although Dr. Dalmau works primarily in Barcelona at IDIBAPS-Hospital Clinic, he is also the Director of the program at UPENN.

Studies from these two esteemed groups are highly regarded which is why the results of these two cohort studies is so very important. The conclusion that that suggests a meaningful association between nonencephalitic HSV-1 infection and development of anti-NMDARE.

Antibody testing was performed using samples from 2 cohorts in a case-control observational study. The cohort “Philadelphia” included 16 serum samples of pediatric anti-NMDARE cases and 42 age-matched controls (patients) with other neuroinflammatory disorders studied at the Children's Hospital of Philadelphia and University of Pennsylvania. The cohort “Barcelona” contained 23 anti-NMDARE patient samples and 26 age-matched participants with other neuroinflammatory disorders studied at IDIBAPS-Hospital Clinic, University of Barcelona.

The presence of HSV-1 IgG antibodies was examined. As an additional control, IgG antibodies to cytomegalovirus (CMV) and Epstein-Barr virus viral capsid antigen (EBV-VCA) were also tested for.

Results:

In each cohort, more participants with anti-NMDARE than patients with other neuroinflammatory disorders had anti-HSV-1 IgG antibodies. In the Philadelphia cohort (58 participants), 44% of anti-NMDARE cases had antibodies to HSV-1 compared with 14% patients with other neuroinflammatory disorders

In the Barcelona cohort (49 participants), 52% of participants with anti-NMDARE had antibodies to HSV-1 compared with 31% of patients with other neuroinflammatory disorders.

In both cohorts there was no difference in IgG positivity between cases of anti-NMDAr encephalitis patients and patients with other neuroimflammatory disorders for either cytomegalovirus (CMV) or Epstein-Barr virus (EBV) or (EBV-VCA).

Overall, 49% of anti-NMDARE cases have antibodies to HSV-1 in these 2 combined cohorts compared with 21% of controls

Conclusion:

Past HSV-1 infection was found in significantly more anti-NMDARE cases than patients with other neuroinflammatory disorders. This suggests a meaningful association between nonencephalitic HSV-1 infection and development of anti-NMDAR encephalitis.

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