Seroprevalence of neuronal antibodies in diseases mimicking autoimmune encephalitis

Detection of neuronal antibodies for autoimmune encephalitis and paraneoplastic neurological syndromes relies on commercially available cell-based assays and lineblots. However, lineblots may reveal the presence of neuronal antibodies in patients with various non-autoimmune etiologies. Herein we describe patients with non-autoimmune etiologies (cohort B) and detectable neuronal antibodies and compare them to definite cases of autoimmune encephalitis (cohort A) for differences in clinical data. All patients positive for at least one neuronal antibody were retrospectively evaluated for autoimmune encephalitis and/or paraneoplastic neurological syndrome between 2016 and 2022. 39 cases in cohort B and 23 in cohort A were identified. In cohort B, most common diagnoses were neurodegenerative disorders in 9/39 (23.1%), brain tumors in 6/39 (15.4%) while most common detected antibodies were anti-titin (N10), anti-recoverin (N11), anti-Yo (N8) and all were detected in serum only. Differential aspects between cohort A and B were CSF pleocytosis (14/23 (60.8%) vs 11/35 (31.4%), p = 0.042, respectively), MRI features suggestive of encephalitis (6/23 (26.1%) vs 0 (0%), p = 0.002, respectively) and epilepsy restricted to temporal lobes (14/23 (60.9%) vs 2/30 (6.7%), p = 0.0003, respectively). A large proportion of lineblot results were non-specific when only serum was tested and were frequently found in non-autoimmune neurological conditions.

Association between PYTPN22 rs2476601, VEGF rs833070, TNFAIP3 rs6920220 Polymorphisms and Risk for Rheumatoid Arthritis in Early Undifferentiated Arthritis Patients: A Pilot Study

Background and Objectives: About 40% of early undifferentiated arthritis (UA) progresses to rheumatoid (RA) or other chronic arthritis. Novel diagnostic tools predicting the risk for this progression are needed to identify the patients who would benefit from early aggressive treatment. Evidence on the role of single-nucleotide polymorphisms (SNPs) in the development of RA has emerged. The aim of our study was to investigate the association between rs2476601, rs833070, and rs6920220 SNPs and UA progression to RA. Materials and Methods: Ninety-two UA patients were observed for 12 months. At study entry, demographic and clinical characteristics were recorded, musculoskeletal ultrasonography was performed, and blood samples were drawn to investigate levels of inflammatory markers, rheumatoid factor (RF), anti-citrullinated protein antibodies (anti-CCP)detect SNPs. After 12 months, UA outcomes were assessed, and patients were divided into two (RA and non-RA) groups. The association between the risk of progression to chronic inflammatory arthritis and analyzed SNPs was measured by computing odds ratios (OR). Results: After a 12-month follow-up, 27 (29.3%) patients developed RA, and 65 (70.7%) patients were assigned to the non-RA group. The arthritis of 21 patients (22.8%) from the non-RA group resolved completely, while the other 44 (47.2%) patients were diagnosed with another rheumatic inflammatory disease. The patients who developed RA had a significantly greater number of tender and swollen joints (p = 0.010 and p = 0.021 respectively) and were more frequently RF or anti-CCP (p < 0.001), and both RF and anti-CCP positive (p < 0.001) at the baseline as compared with the patients in the non-RA group. No significant association between rs2476601 (OR = 0.99, p = 0.98), rs833070 (OR = 1.0, p = 0.97), and rs6920220 (OR = 0.48, p = 0.13) polymorphisms and the risk of developing RA were found. Conclusions: No association between analyzed SNPs and a greater risk to progress from UA to RA was confirmed, although patients with rs6920220 AA + AG genotypes had fewer tender joints at the disease onset.

Growth differentiation factor-15 significantly improves prognostication of short-term mortality in acute settings

Introduction

Acute dyspnoea is one of the most common complaints in the emergency department with a diverse range of diagnoses and a vastly different prognosis. There is still a need for a reliable biomarker for prognostication in acute settings.

Purpose

To evaluate and compare the role of three biomarkers, which represent different pathophysiological pathways, in stratifying short-term mortality risk in patients admitted to the emergency department with acute dyspnoea.

Methods

Prospective observational cohort enrolled 1455 acute dyspnoea patients admitted to emergency departments of two university centres from 2015 to 2017. The present study included 867 (71 [62–79] years, 40% female) patients who had N-terminal pro–B-type natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT) and growth differentiation factor 15 (GDF-15) measured at admission. Clinical variables known to affect prognosis (age, gender, use of beta blockers, angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers at admission, history of chronic heart failure, diabetes and coronary artery disease, systolic blood pressure, heart rate, creatinine, sodium, haemoglobin and C-reactive protein levels) were used to build a baseline model for all-cause 3-month mortality risk prediction in acute dyspnoea [“Clinical score”]. The ability of each biomarker to improve risk prediction on top of the Clinical score was evaluated by area under the curve (AUC), comparing AUC of the model with the biomarker to the AUC of the clinical model alone using the DeLong test. The clinical benefit in risk prediction of adding a biomarker was further assessed by reclassification analysis, including the net reclassification improvement (NRI) and the integrated discrimination index (IDI). The statistical analyses were performed using R statistical software. P value of &lt;0.05 was considered statistically significant.

Results

Mortality at 3 months was 16% (143 patients). The AUC of the Clinical score was 0.787 [95% confidence interval (CI) 0.735 - 0.836]. GDF-15 was the only biomarker that significantly improved risk prediction on top of the Clinical score. The results of the individual biomarkers are displayed in Figure 1A. GDF-15 significantly reclassified 3-month mortality risk with an NRI of 32% [13%-51%] and an IDI of 0.026 [0.011–0.042]; other biomarkers had lower reclassification rates (Figure 1B).

Conclusions

This study demonstrates that the cellular stress biomarker GDF-15 taken at admission provides a substantial additive value to conventional clinical parameters for risk stratification in patients with acute dyspnoea.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The work was supported by the Research Council of Lithuania (Lietuvos mokslo taryba), grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, no. L-15-01. Roche Diagnostics supported the research with measurement of NT-proBNP, high-sensitivity troponin T and growth differentiation factor-15

Markers of endothelial dysfunction after cardiac surgery: soluble forms of vascular-1 and intercellular-1 adhesion molecules

Endothelium forms an inner layer of vascular wall. It plays an important role in inflammatory process, regulation of vascular tone, and synthesis of thromboregulatory substances. Leukocyte and endothelium interactions during inflammation are regulated by different families of adhesion molecules. Increased levels of soluble forms of adhesion molecules have been detected in the circulating blood in conditions such as autoimmune diseases, transplant rejection, ischemia-reperfusion injury in addition to neutrophil- and endothelial membrane-bound forms reflecting the level of endothelial dysfunction. It is known that endothelial dysfunction is a risk factor for ischemic events such as stroke, myocardial infarction, unstable angina pectoris, ventricle fibrillation, necessity of revascularisation procedures, and death from cardiovascular reasons. Clinical studies showed that cardiac surgery has an impact on vascular endothelial function as well. The amount of endothelium-derived soluble forms of vascular-1 and intercellular-1 adhesion molecules increases after cardiopulmonary bypass suggesting endothelial dysfunction. However, further investigations are needed to be done to support the evidence that endothelial dysfunction proceeding heart surgery is one of the reasons of tissue ischemia-reperfusion injury.