Immunotherapy in autoimmune encephalitis

Abstract

Purpose of reviewAutoimmune encephalitis (AE) refers to immune-mediated neurological syndromes often characterised by the detection of pathogenic autoantibodies in serum and/or cerebrospinal fluid which target extracellular epitopes of neuroglial antigens. There is increasing evidence these autoantibodies directly modulate function of their antigens in vivo. Early treatment with immunotherapy improves outcomes. Yet, these patients commonly exhibit chronic disability. Importantly, optimal therapeutic strategies at onset and during escalation remain poorly understood. In this review of a rapidly emerging field, we evaluate recent studies on larger cohorts, registries, and meta-analyses to highlight existing evidence for contemporary therapeutic approaches in AE.Recent findingsWe highlight acute and long-term treatments used in specific AE syndromes, exemplify how understanding disease pathogenesis can inform precision therapy and outline challenges of defining disability outcomes in AE.SummaryEarly first-line immunotherapies, including corticosteroids and plasma exchange, improve outcomes, with emerging evidence showing second-line immunotherapies (especially rituximab) reduce relapse rates. Optimal timing of immunotherapy escalation remains unclear. Routine reporting of outcome measures which incorporate cognitive impairment, fatigue, pain, and mental health will permit more accurate quantification of residual disability and comprehensive comparisons between international multicentre cohorts, and enable future meta-analyses with the aim of developing evidence-based therapeutic guidelines.

Risk Factors and Prognosis in Anti-NMDA Receptor Encephalitis Patients with Disturbance of Consciousness

“… 23 Previous studies have also shown that the prognosis of AE patients receiving immunotherapy is good, and the shorter the time from onset to immunotherapy, the better the prognosis. 34 Delayed immunotherapy will aggravate the irreversible damage caused by disturbance of consciousness, which has a significant effect on the prognosis. Therefore, for patients with anti-NMDAR encephalitis with disturbance of consciousness, immunotherapy should be given as soon as possible on the basis of symptomatic treatment, so as to shorten the time from onset to immunotherapy as far as possible, so as to strengthen the curative effect and improve the prognosis.…”

S100A6 participates in initiation of autoimmune encephalitis and is under epigenetic control

“…The dosages of Immunoglobin‐G(IgG) control, S100A6 antibody, and IVIG were all 11 pg/ml, which is almost equal to 20% of the mean concentration of S100A6 serum protein (54.99*0.2 = 11.00) in the 10 AE patients. Human immunoglobulin (IVIG) is an effective first‐line immunotherapy for patients with AE (Trewin et al., 2022). Then, 1*10 5 Toledo cells were placed in the inserts for 2 h to penetrate the BBB endothelial layer.…”

Gut microbiome-based therapies for alleviating cognitive impairment: state of the field, limitations, and future perspectives

“…(1) Abnormal immune regulation. Autoimmune-mediated inflammation 50 or neuroinflammation caused by traumatic brain injury, 51 chronic diseases or infections, 52 and toxic metabolites 53 can alter the brain's health status, leading to neuronal damage, abnormal neurotransmitter release, and impaired cognition. (2) Abnormal endocrine function.…”