CSF-Neurofilament Light Chain Levels in NMDAR and LGI1 Encephalitis: A National Cohort Study

• DOI: 10.3389/fimmu.2021.719432
• Publication Date: 2021-12-16T12:59:06Z
• Authors: Mette Scheller Ni...; Matias Ryding; Anna Christine Ni...; Jonna Skov Madsen; Dorte Aalund Olsen; Ulrich Halekoh; Magnus Lydolph; Zsolt Illes; Morten Blaabjerg
• Keywords: Adult; Male; Adolescent; Leukocytosis; Denmark; Immunology; autoimmune encephalitis (AE); 03 medical and health sciences; 0302 clinical medicine; Neurofilament Proteins; Limbic Encephalitis; Neoplasms; Humans; Child; Aged; Aged, 80 and over; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; neurofilament light (NfL) chain; Intracellular Signaling Peptides and Proteins; RC581-607; Middle Aged; 3. Good health; NMDAR encephalitis (NMDARE); outcome; biomarker; LGI1 encephalitis; Female; Encephalitis, Herpes Simplex; Immunologic diseases. Allergy; Biomarkers; Demyelinating Diseases; Follow-Up Studies

Background and ObjectivesThe two most common autoimmune encephalitides (AE), N-methyl-D-Aspartate receptor (NMDAR) and Leucine-rich Glioma-Inactivated 1 (LGI1) encephalitis, have been known for more than a decade. Nevertheless, no well-established biomarkers to guide treatment or estimate prognosis exist. Neurofilament light chain (NfL) has become an unspecific screening marker of axonal damage in CNS diseases, and has proven useful as a diagnostic and disease activity marker in neuroinflammatory diseases. Only limited reports on NfL in AE exist. We investigated NfL levels at diagnosis and follow-up in NMDAR and LGI1-AE patients, and evaluated the utility of CSF-NfL as a biomarker in AE.MethodsPatients were included from the National Danish AE cohort (2009-present) and diagnosed based upon autoantibody positivity and diagnostic consensus criteria. CSF-NfL was analyzed by single molecule array technology. Clinical and diagnostic information was retrospectively evaluated and related to NfL levels at baseline and follow-up. NMDAR-AE patients were subdivided into: idiopathic/teratoma associated or secondary NMDAR-AE (post-viral or concomitant with malignancies/demyelinating disease).ResultsA total of 74 CSF samples from 53 AE patients (37 NMDAR and 16 LGI1 positive) were included in the study. Longitudinal CSF-NfL levels was measured in 21 patients. Median follow-up time was 23.8 and 43.9 months for NMDAR and LGI1-AE respectively. Major findings of this study are: i) CSF-NfL levels were higher in LGI1-AE than in idiopathic/teratoma associated NMDAR-AE at diagnosis; ii) CSF-NfL levels in NMDAR-AE patients distinguished idiopathic/teratoma cases from cases with other underlying etiologies (post-viral or malignancies/demyelinating diseases) and iii) Elevated CSF-NfL at diagnosis seems to be associated with worse long-term disease outcomes in both NMDAR and LGI1-AE.DiscussionCSF-NfL measurement may be beneficial as a prognostic biomarker in NMDAR and LGI1-AE, and high CSF-NfL could foster search for underlying etiologies in NMDAR-AE. Further studies on larger cohorts, using standardized methods, are warranted.