Serum antineuronal antibodies in patients with post-COVID-19 condition − association to intensive care

IF 8.8 2区医学 Q1 IMMUNOLOGY

Brain, Behavior, and Immunity Pub Date : 2025-05-27 DOI:10.1016/j.bbi.2025.05.026

Tatiana Posharina , Mikko Varonen , Hanna Jarva , Mari Kanerva , Helena Liira , Sini M Laakso

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Abstract

Post-COVID-19 condition (PCC), characterized by persistent symptoms following SARS-CoV-2 infection, is a global health challenge. Neurological symptoms are common in PCC, and immune-mediated mechanisms have been proposed as potential contributors. We set out to systematically explore serum antineuronal antibodies in patients with PCC and clinical factors associated with seropositivity.

Our prospective, single-center cohort study included adult patients with a confirmed SARS-CoV-2 infection at least three months prior and a diagnosis of PCC. Serum and cerebrospinal fluid (CSF) samples were analyzed for the presence of antineuronal antibodies. A control group with confirmed SARS-CoV-2 infection but without PCC symptoms was included, age-, sex- and time from acute infection to sampling −matched to seropositive cases of PCC.

Among 314 consecutive patients with PCC, 38 (12.1 %) tested positive for serum antineuronal antibodies. CSF analysis was performed for a subset; however, no intrathecal autoantibodies were detected. The most prevalent serum autoantibodies targeted CASPR-2 (n = 7, 18.9 %), neurofascin-186 (n = 5, 13.2 %), and glycine receptor (n = 4, 10.8 %). Multinomial logistic regression identified intensive care unit (ICU) admission during acute COVID-19 as the only significant predictor of autoantibody positivity (OR 3.4; 95 % CI: 1.0–10.4). Of the 35 control subjects, two (5.7 %) tested seropositive: one with low titer myelin oligodendrocyte glycoprotein antibodies and another with borderline myelin antibody levels. None of the patients met criteria for autoimmune encephalitis, and neurological assessments and brain magnetic resonance imaging were unremarkable. Neuropsychological testing showed a trend toward impairments in attention and executive functions among seropositive individuals.

Thus, there was no significant difference in the prevalence of serum antineuronal antibodies in PCC compared to post-infection controls, and the association between seropositivity and ICU admission suggested systemic immune activation rather than a specific autoantibody-mediated mechanism. It remains unclear whether observed neuropsychological deficits are attributable to autoantibodies or the effects of critical illness.

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covid -19后重症监护患者血清抗神经元抗体

covid -19后疾病（PCC）是一项全球性的卫生挑战，其特征是SARS-CoV-2感染后持续出现症状。神经系统症状在PCC中很常见，免疫介导的机制被认为是潜在的因素。我们开始系统地探索PCC患者的血清抗神经元抗体和与血清阳性相关的临床因素。我们的前瞻性单中心队列研究纳入了至少三个月前确诊为SARS-CoV-2感染并诊断为PCC的成年患者。分析血清和脑脊液（CSF）样本是否存在抗神经元抗体。纳入了确诊的SARS-CoV-2感染但没有PCC症状的对照组，年龄、性别和从急性感染到采样的时间与PCC血清阳性病例相匹配。在连续314例PCC患者中，38例（12.1%）血清抗神经元抗体检测阳性。对一个子集进行CSF分析；但未检测到鞘内自身抗体。最常见的血清自身抗体针对CASPR-2 （n = 7, 18.9%）、神经束蛋白-186 （n = 5, 13.2%）和甘氨酸受体（n = 4, 10.8%）。多项logistic回归发现重症监护病房（ICU）入住是COVID-19急性期自身抗体阳性的唯一显著预测因子(OR 3.4；95% ci: 1.0-10.4)。在35名对照受试者中，2人（5.7%）血清检测呈阳性：1人具有低滴度髓磷脂少突胶质细胞糖蛋白抗体，另一人具有临界髓磷脂抗体水平。所有患者均不符合自身免疫性脑炎的标准，神经学评估和脑磁共振成像无显著差异。神经心理测试显示血清阳性个体的注意力和执行功能有受损的趋势。因此，与感染后对照组相比，PCC患者血清抗神经元抗体的流行率没有显著差异，血清阳性与ICU入院之间的关联提示系统性免疫激活，而不是特异性自身抗体介导的机制。目前尚不清楚观察到的神经心理缺陷是由于自身抗体还是危重疾病的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain, Behavior, and Immunity 医学-免疫学

CiteScore

29.60

自引率

2.00%

发文量

290

审稿时长

28 days

期刊介绍： Established in 1987, Brain, Behavior, and Immunity proudly serves as the official journal of the Psychoneuroimmunology Research Society (PNIRS). This pioneering journal is dedicated to publishing peer-reviewed basic, experimental, and clinical studies that explore the intricate interactions among behavioral, neural, endocrine, and immune systems in both humans and animals. As an international and interdisciplinary platform, Brain, Behavior, and Immunity focuses on original research spanning neuroscience, immunology, integrative physiology, behavioral biology, psychiatry, psychology, and clinical medicine. The journal is inclusive of research conducted at various levels, including molecular, cellular, social, and whole organism perspectives. With a commitment to efficiency, the journal facilitates online submission and review, ensuring timely publication of experimental results. Manuscripts typically undergo peer review and are returned to authors within 30 days of submission. It's worth noting that Brain, Behavior, and Immunity, published eight times a year, does not impose submission fees or page charges, fostering an open and accessible platform for scientific discourse.