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Abstract Details

Performance of Two Commercial Tissue-Based Assays for Detection of Antibodies Against Intracellular Neural Antigens in Immune-Mediated Neurological Syndromes
Autoimmune Neurology
P1 - Poster Session 1 (11:45 AM-12:45 PM)
8-004
To determine the performance of two commercial tissue-based assays (TBAs) to detect autoantibodies against neural intracellular antigens (IC-abs). 
Current strategies to detect IC-abs involve TBAs accompanied by line-blot or cell-based assays (CBAs) to confirm antigen specificity. Most clinical laboratories use commercially available TBAs, but their diagnostic yield has not been assessed. 
We examined samples from 100 patients with immune-mediated neurological syndromes harbouring IC-abs and from 50 healthy participants. The positivity of IC-abs had been previously established with highly sensitive and specific in-house TBAs accompanied by line blot or CBAs. The 100 patients’ samples included 10 sera of each: Hu, Yo, Ri, SOX1, CV2, Ma2, Tr, amphiphysin, GAD65, and 10 CSF with GFAP antibodies. Two commercial indirect immune-fluorescent TBAs (INOVA and Euroimmun) were assessed. Slides were read by two experienced investigators (JD, FG) blinded from information; discordant results were re-evaluated through interrater discussion.

The two raters showed substantial agreement (85% for INOVA, 83% for Euroimmun) on negative or positive results. After interrater discussion, they reached an agreement in >95% of cases. INOVA correctly identified 118/150 (79%) samples and misclassified 28/150 (19%): 2 false positive (FP), 26 false negative (FN), whereas Euroimmun correctly identified 105/150 (70%) samples and misclassified 40/150 (27%): 6 FP, 34 FN. Overall, sensitivity was 73% for INOVA and 66% for Euroimmun. Specificity was 96% for INOVA and 88% for Euroimmun. Among the positive samples, antibody-specific immunostaining patterns were correctly identified in 62/100 samples with INOVA and 55/100 with Euroimmun (p=0.39). Both TBAs failed to identify CV2 antibodies. INOVA TBA was better at identifying Ma2 antibodies (9/10 vs. 1/10, p=0.001), while Euroimmun TBA was better at identifying Hu/Ri antibodies (19/20 vs. 12/20, p=0.02).

This study indicates that the performance of commercial TBAs for IC-abs is suboptimal, particularly for CV2 (both kits), Ma2 (Euroimmun) and Hu/Ri (INOVA) antibodies.
Authors/Disclosures
Chiara Milano, MD
PRESENTER 		Dr. Milano has nothing to disclose.
Pietro Businaro Pietro Businaro has nothing to disclose.
Claudia Papi, MD (FRCB-IDIBAPS) Dr. Papi has nothing to disclose.
LAURA NARANJO, PhD Dr. NARANJO has nothing to disclose.
Raquel Ruiz García, PhD Dr. Ruiz García has nothing to disclose.
Lionel Arlettaz, MD-PhD The institution of Dr. Arlettaz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Dr. Arlettaz has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for GSK.
Matteo Gastaldi, MD, PhD (IRCCS Mondino Foundation) Dr. Gastaldi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for alexion, Roche, UCB, J&J. The institution of Dr. Gastaldi has received research support from Italian Ministry of Health, FISM, AE alliance.
Lidia Sabater, PhD The institution of Dr. Sabater has received research support from Instituto de Salud Carlos III.
Josep O. Dalmau, MD, PhD, FAAN Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astellas Research Institute of America. Dr. Dalmau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Research & Development . Dr. Dalmau 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 好色先生. An immediate family member of Dr. Dalmau has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Dalmau has received research support from Sage Therapeutics. The institution of Dr. Dalmau has received research support from Edmond J.Safra Foundation . The institution of Dr. Dalmau has received research support from La Caixa Foundation. The institution of Dr. Dalmau has received research support from Spanish Ministry of Health (ISCIII). The institution of Dr. Dalmau has received research support from Euroimmun, Inc. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Dalmau has received intellectual property interests from a discovery or technology relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care. Dr. Dalmau has received publishing royalties from a publication relating to health care.
Francesc R. Graus, MD (IDIBAPS) Dr. Graus has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MedLink. Dr. Graus has received intellectual property interests from a discovery or technology relating to health care.
Marianna Spatola, MD, PhD, FAAN (FUNDACIÓ DE RECERCA BIOMEDICA CLÍNIC IDIBAPS) The institution of Dr. Spatola has received research support from Spanish National Health Institute (Carlos III), FIS grant. The institution of Dr. Spatola has received research support from Spanish National Institute of Health - Miguel Servet Grant. The institution of Dr. Spatola has received research support from La Caixa Foundation. The institution of Dr. Spatola has received research support from European Research Coucil.