Distinct immunoreactivity pattern to Bacillus mannanilyticus in a subgroup of anti-NMDA receptor encephalitis

Yong-Won Shin; Soon-Tae Lee; Young-Sook Kim; Dohyun Han; Yuichi Nogi; Kon Chu; Sang Kun Lee

doi:10.1016/j.jneuroim.2020.577215

Distinct immunoreactivity pattern to Bacillus mannanilyticus in a subgroup of anti-NMDA receptor encephalitis

J Neuroimmunol. 2020 Mar 12:342:577215. doi: 10.1016/j.jneuroim.2020.577215. Online ahead of print.

Authors

Yong-Won Shin¹, Soon-Tae Lee², Young-Sook Kim³, Dohyun Han⁴, Yuichi Nogi⁵, Kon Chu³, Sang Kun Lee³

Affiliations

¹ Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea.
² Department of Neurology, Seoul National University Hospital, Seoul, South Korea. Electronic address: slee@snuh.org.
³ Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
⁴ Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
⁵ Extremobiosphere Research Center, Japan Agency for Marine-Earth Science and Technology, Yokosuka, Japan.

PMID: 32182453
DOI: 10.1016/j.jneuroim.2020.577215

Abstract

Over half of anti-NMDA receptor encephalitis (NMDARE) is unrelated to etiologies such as teratomas or herpes simplex encephalitis. Bacillus mannanilyticus nonribosomal peptide synthetase (NRPS) shares a protein sequence with GluN1. After confirming the anti-NRPS antibody immunoreactivity in an index patient by liquid chromatography-tandem mass spectrometry (LC-MS/MS), we identified 24/57 (42%) patients with similar immunoreactivity patterns by western blotting. These patients mostly (20/24 [83%]) did not have ovarian teratomas, had fewer medial temporal (2/24 [8%]) and any (5/24 [21%]) brain lesions and less pleocytosis (13/24 [54%]). These results identified an anti-NMDARE subgroup with a distinct immunoreactivity pattern, which needs further investigation.

Keywords: Anti-NMDA receptor encephalitis; Bacillus mannanilyticus; Nonribosomal peptide synthetase.