Neuroglial biomarkers in autoimmune encephalitis: advances in diagnosis, prognosis, and pathophysiological insights.

IF 2.4 4区 医学 Q2 CLINICAL NEUROLOGY
Neurological Sciences Pub Date : 2025-10-01 Epub Date: 2025-08-18 DOI:10.1007/s10072-025-08406-1
Maria S Borioni, Alessandra Morano, Alessia L De Matteis, Adolfo Mazzeo, Pierludovico Moro, Carlo Di Bonaventura, Emanuele Cerulli Irelli
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Abstract

Autoimmune encephalitis (AE) presents with a diverse spectrum of neuropsychiatric symptoms, often leading to diagnostic challenges and delays in treatment. Neuroglial biomarkers may improve AE diagnosis, disease monitoring, and prognostication. This review examines the diagnostic and prognostic value of fluid biomarkers in AE, focusing on markers of neuroaxonal damage, synaptic dysfunction, astroglial activation, and amyloid metabolism. A systematic search of PubMed, Cochrane, and Scopus databases (from inception until November 26, 2024) was performed. Of the 1,270 articles screened, 31 studies met the inclusion criteria. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis was the most frequently investigated subtype (70% of studies). Neurofilament light chain (NfL) was the most widely analyzed biomarker, with elevated levels in both cerebrospinal fluid and serum, aiding in the differentiation of AE from primary psychiatric disorders and in the early identification of checkpoint inhibitor-related neurotoxicity. NfL and total tau (t-Tau) were consistently higher in paraneoplastic than non-paraneoplastic AE. Despite some variability across studies, amyloid-beta (Aβ) 42 and Aβ40, as well as phosphorylated tau (p-Tau), were altered in AE compared to controls, although generally to a lesser extent than in Alzheimer's disease. Higher baseline NfL and YKL-40 correlated with disease severity, and NfL reductions post-immunotherapy were linked to treatment response. Despite consistent heterogeneities in sampling timing, these findings highlight the potential of neuroglial biomarkers as diagnostic and prognostic tools in AE. Future studies should explore longitudinal biomarker dynamics and refine their clinical applications.

自身免疫性脑炎中的神经胶质生物标志物:诊断、预后和病理生理学方面的进展
自身免疫性脑炎(AE)表现出多种神经精神症状,常常导致诊断困难和治疗延误。神经胶质生物标志物可改善AE诊断、疾病监测和预后。本文综述了液体生物标志物在AE中的诊断和预后价值,重点关注神经轴突损伤、突触功能障碍、星形胶质细胞激活和淀粉样蛋白代谢的标志物。系统检索PubMed、Cochrane和Scopus数据库(从成立到2024年11月26日)。在筛选的1270篇文章中,31篇研究符合纳入标准。抗n -甲基- d -天冬氨酸受体(NMDAR)脑炎是最常见的亚型(70%的研究)。神经丝轻链(NfL)是分析最广泛的生物标志物,在脑脊液和血清中都有升高的水平,有助于AE与原发性精神疾病的区分,并有助于早期识别检查点抑制剂相关的神经毒性。副肿瘤性AE的NfL和总tau (t-Tau)始终高于非副肿瘤性AE。尽管研究之间存在一些差异,但与对照组相比,AE中淀粉样蛋白β (a β) 42和a β40以及磷酸化tau蛋白(p-Tau)发生了改变,尽管其程度通常低于阿尔茨海默病。较高的基线NfL和YKL-40与疾病严重程度相关,免疫治疗后NfL降低与治疗反应有关。尽管取样时间存在一致性异质性,但这些发现强调了神经胶质生物标志物作为AE诊断和预后工具的潜力。未来的研究应探索纵向生物标志物动力学并完善其临床应用。
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
Neurological Sciences
Neurological Sciences 医学-临床神经学
CiteScore
6.10
自引率
3.00%
发文量
743
审稿时长
4 months
期刊介绍: Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.
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