Autoimmune central nervous system disorders: Antibody testing and its clinical utility

Clin Biochem. 2024 Mar 8:110746. doi: 10.1016/j.clinbiochem.2024.110746. Online ahead of print.ABSTRACTA rapidly expanding repertoire of neural antibody biomarkers exists for autoimmune central nervous system disorders. Following clinical recognition of an autoimmune CNS disorder, the detection of a neural antibody facilitates diagnosis and informs prognosis and management. This review considers the phenotypes, diagnostic assay methodologies, and clinical utility of neural antibodies in autoimmune CNS disorders. Autoimmune CNS disorders may present with a diverse range of clinical features. Clinical phenotype should inform the neural antibodies selected for testing via the use of phenotype-specific panels. Both serum and CSF are preferred in the vast majority of cases but for some analytes either CSF (e.g. NMDA-receptor IgG) or serum (e.g. aquaporin-4-IgG) specimens may be preferred. Screening using 2 methods is recommended for most analytes, particularly paraneoplastic antibodies. We utilize murine tissue-based indirect immunofluorescence assay (TIFA) with subsequent confirmatory protein-specific testing. The cellular location of the target antigen informs choice of confirmatory diagnostic assay (e.g. blot for intracellular antigens such as Hu; cell-based assay for cell surface targets such as Lgi1). Titers of positive results have limited diagnostic utility with the exception of GAD65 IgG autoimmunity, which is associated with neurological disease at higher values. While no...
Source: Clinical Biochemistry - Category: Biochemistry Authors: Source Type: research