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Abstract Details

Autoimmune encephalitis antibody biomarkers: Frequency, age and sex associations
Autoimmune Neurology
Autoimmune Neurology Posters (7:00 AM-5:00 PM)
031

To utilize the Mayo Clinic Neuroimmunology Laboratory database the frequency, age and sex associations IgG-biomarkers of autoimmune encephalitis (AE).

Serological evaluation utilizing AE-autoantibodies (AE-Abs) has transformed AE diagnosis, however, epidemiological research data are limited. Big data enable analyses of rare cohorts otherwise be difficult to obtain, such as AE.

Interrogation of this database was interrogated to identify patients whose cerebrospinal fluid (CSF) and serum were evaluated January 2018-December 2019 for AE-Abs (NMDA-R-IgG, AMPA-R-IgG, GABAB-R-IgG, CASPR2-IgG, LGI1-IgG, GAD65-IgG [serum >20nmol0], CRMP5-IgG, amphiphysin-IgG, PCA1/2/Tr-IgGs, ANNA1/2/3-IgGs, GFAP-α-IgG, mGluR1-IgG, DPPX-IgG, MOG-IgG1). The proportional distribution of AE-Abs was examined and age and sex associations were analyzed using multivariate logistic regression.

41,666 patients underwent AE evaluation (CSF 23,770, serum 27,897).

 

Adult serum analysis (22,332 patients; 56% female) revealed 814 (4%) were positive: NMDA-R-IgG (25%) > GAD65-IgG (22%) > LGI1-IgG (21%) > others. Of children (5,565; 50% female), 250 (4%) were positive: NMDA-R-IgG (53%) > MOG-IgG1 (32%) > GAD65-IgG (7%) > others.

 

Adult CSF analysis (18,666 patients; 54% female) revealed 709 (4%) were positive; NMDA-R-IgG (45%) > GAD65-IgG (19%) > LGI1-IgG (13%) > others. Of children (5104; 50% female), 276 (5%) were positive: NMDA-R-IgG (90%) > GAD65-IgG (7%) > others.

 

Age <20 years was associated with NMDA-R-IgG and MOG-IgG1 (OR=8.11 and 7.73 respectively, p<0.001). Age >65 years was associated with GABAB-R-IgG, LGI1-IgG, CASPR2-IgG and ANNA1-IgG (OR=7.33, 14.98, 3.67, 14.53, p<0.001). Women accounted for 60% of NMDA-R-IgG positive (CSF) and 78% of GAD65-IgG positive (CSF/serum) cohorts (OR=1.32, p=0.002, OR=2.78, p<0.001, respectively). Men accounted for 62% of the LGI1-IgG cohort (OR=1.87, p <0.001). Age and sex interacted for NMDA-R-IgG, particularly in females sex <20 years (OR=7.72, p <0.001).

In this study the most commonly detected AE-Abs were NMDA-R-IgG, LGI1-IgG, GAD65-IgG and MOG-IgG1. Identified age and sex associations may be suggest specific paraneoplastic, endocrinological or aging influences on neurological autoimmunity.
Authors/Disclosures
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre)
PRESENTER 		Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .
Andrew McKeon, MD (Mayo Clinic) The institution of Dr. McKeon has received research support from National Institutes of Health. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received intellectual property interests from a discovery or technology relating to health care. Dr. McKeon has received publishing royalties from a publication relating to health care.
Divyanshu Dubey, MD, FAAN (Mayo Clinic) The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Dubey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from Department of Defense . Dr. Dubey has received research support from UCB. Dr. Dubey has received research support from David J. Tomassoni ALS Research Grant Program . Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care. Dr. Dubey has received intellectual property interests from a discovery or technology relating to health care.
Christopher J. Klein, MD, FAAN (Mayo Clinic) Dr. Klein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NMD Pharma.
Daniel H. Lachance, MD, FAAN (Mayo Clinic) Dr. Lachance has nothing to disclose.
John R. Mills, MD, PhD (Mayo Clinic) The institution of Dr. Mills has received research support from Werfen Diagnostics. Dr. Mills has received intellectual property interests from a discovery or technology relating to health care.
Anastasia Zekeridou, MD, PhD, FAAN (Neuroimmunology Laboratory, Mayo Clinic) The institution of Dr. Zekeridou has received research support from Roche/Genentech. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care. Dr. Zekeridou has received intellectual property interests from a discovery or technology relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
Vanda Lennon, MD, PhD (Mayo Clinic) The institution of Dr. Lennon has received research support from NIH. Dr. Lennon has received intellectual property interests from a discovery or technology relating to health care.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.