Abstract Details

Title Elevated Influenza Antibodies in Recent Onset Type-one Narcolepsy

Topic Sleep

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 14-012

Objective To test whether recent onset type-1 narcolepsy patients have increased flu antibodies titers comparing with well-matched controls.

Background Epidemiological studies have shown associations between pandemic H1N1 2009 influenza-A infection and vaccination (only using Pandemrix®) and the onset of narcolepsy, an autoimmune disease associated with HLA-DQB1*0602.

Design/Methods Sera of 173 recent-onset type-1 narcolepsy patients (12 [1-25] months) and 185 healthy controls matched by sex, age, and year and season of sample collection were used. Sera were tested for Influenza-A and B antibodies using hemagglutinin inhibition (HAI) assays and neuraminidase inhibition (NAI) assay against the dominant strains known to circulate at the time of collection. Antibody titers were log2 transformed to geometric mean titers (GMT), with zero being <1/10 dilution, 1 as 1/10, 2 as 1/20, etc., so that every dilution represents an increment of 1 unit. Further analysis using multiple variable linear and logistic regression were done to analyze the association between confounding factors and disease status and HA/NA antibody titers.

Results Increasing GMT of HA antibody against H1N1pdm09 [OR=1.77(1.001, 3.10), p=0.05], H1N1pre2009 [OR=2.32(1.21-4.44), p=0.01] and B/Victoria [3.63 (1.17-11.1), p=0.03] was associated with narcolepsy by logistic regression. For NA antibodies, elevated GMT of NA antibody against H1N1pdm09 [β-coefficient=1.27(0.56, 1.99), p=0.001], and B/Victoria [β-coefficient=1.28 (0.74-1.83), p=0.00] was found in patients by multivariate linear regression, whereas no association was found with HA and/or NA antibodies against H3N2 and B/Yamagata. HA and NA antibody titers against different strains on the same samples were weakly correlated (Pearson coefficient [-0.01 – 0.26] ).

Conclusions Both H1N1 and B/Victoria, but not other strains, may trigger narcolepsy onset. This result is in line with a recent epidemiological study in Europe that reported a strong increase in narcolepsy onset in 2010 (following 2009 H1N1 pandemic) and a secondary peak in 2013 following a season with a dominant B/Victoria infection.

Authors/Disclosures
Bruna de Freitas Dias, MD (Stanford university) PRESENTER	Dr. Dias has nothing to disclose.
Jason H. Yan, BA	Mr. Yan has nothing to disclose.
Kendall Lin, BS	Mr. Lin has nothing to disclose.
Jenny Zhang, OMS II	Miss Zhang has nothing to disclose.
Giorgio C. Ricciardiello Mejia	Mr. Ricciardiello Mejia has nothing to disclose.
Emmanuel Mignot, MD, PhD (Stanford University)	Dr. Mignot has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Takeda. Dr. Mignot has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharmaceutical. Dr. Mignot has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Pharmaceuticals, Inc. . Dr. Mignot has received personal compensation in the range of $0-$499 for serving as a Consultant for EcoR1. Dr. Mignot has received personal compensation in the range of $0-$499 for serving as a Consultant for ApneaCo. Dr. Mignot has received personal compensation in the range of $0-$499 for serving as a Consultant for Eisai Pharmaceuticals. Dr. Mignot has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Centessa .

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