IgLON5 autoimmunity tested positive in patients with isolated chronic insomnia disease

In the patients with neurological autoimmune diseases such as anti-IgLON5 disease, insomnia symptoms are very common. Clinical diagnosis of the anti-IgLON5 disease is usually made when neurodegenerative processes have occurred. To find the early signs of anti-IgLON5 disease, we evaluate the presence of IgLON5 autoantibodies in the serum of patients with chronic insomnia disease. Based on video-polysomnography, twenty-two individuals with isolated chronic insomnia disease were found. A control group of twenty-two healthy people was chosen using the PSQI. An indirect immunofluorescence cell-based test of serum anti-IgLON5 antibodies was used to investigate IgLON5 autoimmunity. Anti-IgLON5 antibodies were detected in the serum of four of these patients with the titer of 1/10. The presence of IgLON5 autoantibodies in some patients with chronic insomnia disease can be considered a causing factor of insomnia which can be effective in more specific treatments of these patients. Moreover, the recognition of anti-IgLON5 disease in the early stages and before the progression of tauopathies can be useful in effective and timely treatment.

NKT and NKT-like Cells in Autoimmune Neuroinflammatory Diseases—Multiple Sclerosis, Myasthenia Gravis and Guillain-Barre Syndrome

NKT cells comprise three subsets—type I (invariant, iNKT), type II, and NKT-like cells, of which iNKT cells are the most studied subset. They are capable of rapid cytokine production after the initial stimulus, thus they may be important for polarisation of Th cells. Due to this, they may be an important cell subset in autoimmune diseases. In the current review, we are summarising results of NKT-oriented studies in major neurological autoimmune diseases—multiple sclerosis, myasthenia gravis, and Guillain-Barre syndrome and their corresponding animal models.

Detection of MOG-IgG in Clinical Samples by Live Cell-Based Assays: Performance of Immunofluorescence Microscopy and Flow Cytometry

Human antibodies against Myelin Oligodendrocyte Glycoprotein (MOG) from immunoglobulin-G subclasses (MOG-IgG) have been recently associated with a new subgroup of neurological autoimmune diseases with distinct clinical characteristics from multiple sclerosis and neuromyelitis optica spectrum disorders. The use of MOG-IgG as a biomarker is an essential tool to assist in the diagnosis and clinical prognosis. The cell-based assay (CBA) is a methodology that expresses high levels of natively folded human MOG protein in the cell membrane being the methodology most used for clinical MOG-IgG diagnosis. However, there is still no consensus about the best approach to perform CBA to improve the results. The CBA using flow cytometry (CBA-FC) is an automated technique with objective quantification, reducing the subject of human bias that occurred at CBA using immunofluorescence (CBA-IF). In this study, we compared the performance of CBA-IF and CBA-FC as an acquisition tool analysis. The sera of 104 patients diagnosed with inflammatory Central Nervous System diseases were tested in both CBA-IF and CBA-FC. We used the dilution of 1:128 for CBA-IF and three different dilutions (1:20, 1:100, and 1:640) for CBA-FC. The CBA-FC and CBA-IF results had 88.5% agreement between assays and the CBA-IF titers by endpoint-dilution correlated with the CBA-FC titers. The highest serum dilution resulted in an increased CBA-FC specificity, but there was a reduction in the CBA-FC sensitivity. Our study showed that CBA-FC can be used in clinical practice as a diagnostic technique for MOG-IgG. In addition, in some specific cases, the combination of both techniques could be used as a tool to discriminate unspecific binding and overcome single assay limitations.

Comparison of Clinical and Biochemical Parameters of Patients with Guillain Barre Syndrome and Myasthenia Gravis: Retrospective Single Center Experience

Background: Guillain-Barré syndrome (GBS) and Miyastenia gravis (MG) are common neurological autoimmune diseases. With this study, we aimed to compare the patients’ complaints, clinical course and laboratory parameters of both diseases. Methods: This study was carried out as a retrospective file scan. The study covers the dates between April 1, 2017, and April 20, 2020. The GBS and MG patients were compared in terms of sociodemographic characteristics, application complaints, clinical course, laboratory findings, treatments and outcomes. Results: In this study, 51 patients from both groups were included. The mean age of GBS and MG patients was 52.1 ±19.4 and 43.6 ±15.8 years, respectively. Respiratory involvement of the patients was 23.5% in GBS and 17.6% in MG. When the treatments of the patients were compared, it was observed that 78.4% of GBS patients and 98% of MG received IVIG treatments. Only two patients from GBS group were found to be ex. When the laboratory results were compared, it was found that lactate, vitamin D, transferrin and total iron binding capacity results were lower in GBS patients, whereas, vitamin B12 and ferritin results were lower in MG patients and this difference was statistically significant (p <0.05). Conclusion: The clinical presentation of GBS and MG is diverse and the prognosis can vary significantly among patients. Within the scope of the data obtained from the study, it was concluded that wide anamnesis and laboratory analyzes are necessary and useful for the differential diagnosis of these two diseases.

M87. PREVALENCE OF AUTOIMMUNE DISEASES IN INDIVIDUALS WITH PRIMARY PSYCHOTIC DISORDERS AT BOSTON MEDICAL CENTER

Background The prevalence of autoimmune diseases is higher among individuals with psychiatric illnesses than in the general population. It is unknown if the prevalence of autoimmune diseases differs among people with different primary psychotic disorders. Our objective was to assess whether the prevalence of autoimmune diseases differs among people with schizophrenia/schizoaffective disorder, affective (bipolar/depression) psychosis, and other psychotic disorders (delusional, brief psychotic, schizophreniform, or unspecified psychosis). Methods For our cross-sectional study, we used International Classification of Diseases (ICD) codes to identify individuals with primary psychotic disorders/unspecified psychoses who received treatment at Boston Medical Center between October 2003 and May 2019. Individuals with other/unspecified psychosis with an organic cause and individuals with unspecified psychosis, brief psychotic disorder with coinciding drug withdrawal, post-partum psychosis, or drug-induced mental illness, confusion, or seizure were excluded. Autoimmune diseases were categorized as systemic or as one of seven organ-specific subgroups (dermatological, endocrinological, gastroenterological, hematological, non-systemic connective tissue, and neurological). Multivariable logistic regression was used to compare differences in prevalence of autoimmune diseases among individuals with different psychoses adjusting for age, sex, and race. We also considered sex and race-stratified analyses. Results Of the 13,938 individuals (mean age = 43 years; 58% male) diagnosed with psychosis, 55% had schizophrenia, 17% had affective psychosis, and 29% had other/unspecified psychosis. Overall, nearly 9% of individuals with psychosis had at least one autoimmune disease (8% with schizophrenia, 11% with affective psychosis, and 8% with other/unspecified psychosis). The most prevalent autoimmune disease subgroups were systemic (39%), dermatological (26%), and endocrinological (23%). Compared to individuals with schizophrenia, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.38; 95% CI: 1.17, 1.63), dermatological autoimmune diseases (OR: 1.55; 95% CI: 1.15, 2.07), or endocrinological autoimmune diseases (OR: 1.56; 95% CI: 1.14, 2.12). Compared to individuals with schizoaffective as the only psychosis diagnosis, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.31; 95% CI: 1.03, 1.66) and individuals with schizophrenia had decreased odds of having neurological autoimmune diseases (OR: 0.46; 95% CI: 0.23, 0.96). Among individuals with any psychotic disorder, females were 95% more likely to have any autoimmune disease (OR: 1.95; 95% CI: 1.72, 2.20). No racial differences were observed overall; however, compared to individuals who identified as white, individuals who identified as Black, Hispanic, and Asian had decreased odds of having gastroenterological autoimmune diseases (OR: 0.52; 95% CI: 0.35, 0.76), neurological autoimmune diseases (OR: 0.32; 95% CI: 0.10, 0.83), and systemic autoimmune diseases (OR: 0.25; 95% CI: 0.04, 0.80), respectively, while Black individuals had increased odds of having systemic autoimmune diseases (OR: 1.45; 95% CI: 1.17, 1.81). Discussion The prevalence of autoimmune diseases varied among people with different primary psychotic disorders, and certain associations were modified by sex and race. Clinicians may consider additional screening for autoimmune diseases among individuals with psychosis.