Antibodies against neural antigens in patients with acute stroke: joint results of three independent cohort studies.
BACKGROUND AND PURPOSE
Ischemic stroke (IS) and hemorrhagic stroke (HemS) typically lead to a breakdown of the blood-brain barrier with neural antigen presentation. This presentation could potentially generate destructive auto-immune responses. Pre-existing antineuronal and antiglial antibodies (AA), predominantly NMDA receptor antibodies, have been reported in patients with stroke. This article summarizes three independent prospective studies, the Lübeck cohort (LC), Barcelona cohort (BC), and Heidelberg cohort (HC), exploring the frequency and clinical relevance of AA in patients with acute stroke (AS).


METHODS
In all cohorts together, 344 consecutive patients admitted with AS (322 × IS, 22 × HemS) were screened for AA in serum at admission. Clinical outcome parameters as well as a second AA screening were available at 30 days in the LC or at 90 days in the BC. A control group was included in the BC (20 subjects free from neurological disease) and the HC (78 neurological and ophthalmological patients without evidence for stroke).


RESULTS
The rate of positivity for AA was similar in control subjects and AS patients (13%, 95% CI [7%, 22%] vs. 13%, 95% CI [10%, 17%]; p = 0.46) with no significant difference between cohorts (LC 25/171, BC 12/75, HC 9/98). No patient had developed new AA after 30 days, whereas 2 out of 60 patients had developed new AA after 90 days. AA positive patients did not exhibit significant differences to AA negative patients in stroke subtype (LC, BC), initial stroke severity (BC, LC, HC), infarct volume (BC), and functional status at admission (BC, LC, HC) and follow-up (BC, LC).


CONCLUSIONS
AS does not induce AA to a relevant degree. Pre-existing AA can be found in the serum of stroke patients, but they do not have a significant association with clinical features and outcomes.
['Royl|Georg|G|', 'Fokou|Tsafack Judicael|TJ|', 'Chunder|Rittika|R|', 'Isa|Rakad|R|', 'Münte|Thomas F|TF|', 'Wandinger|Klaus-Peter|KP|', 'Schwaninger|Markus|M|', 'Herrmann|Oliver|O|', 'Valdueza|José Manuel|JM|', 'Brocke|Jan|J|', 'Willkomm|Martin|M|', 'Willemsen|Dietrich|D|', 'Auffarth|Gerd U|GU|', 'Mindorf|Swantje|S|', 'Brix|Britta|B|', 'Chamorro|Angel|A|', 'Planas|Anna|A|', 'Urra|Xabier|X|']
D001323:Autoantibodies D001324:Autoantigens D015331:Cohort Studies D006801:Humans D009457:Neuroglia D009474:Neurons D020521:Stroke
Stroke Anti-CASPR2 antibodies Anti-GAD65 antibodies Anti-NMDAR antibodies Anti-aquaporin antibodies Antineural antibodies