Journal of neurology, neurosurgery, and psychiatry · 2026
Intrathecal Epstein-Barr virus reactivation in patients with autoimmune glial fibrillary acidic protein astrocytopathy.
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Handa Hideo, Uzawa Akiyuki, Kimura Akio, Mori Masahiro, Iizuka Takahiro, Yasuda Manato, Sugiyama Atsuhiko, Shimohata Takayoshi, Kuwabara Satoshi
Аннотация
BACKGROUND: The pathogenic mechanisms underlying autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy (GFAP-A), a central nervous system disorder associated with GFAP autoimmunity, remain controversial. The present study aimed to investigate the potential role of the intrathecal reactivation of Epstein-Barr virus (EBV) in patients with GFAP-A.
METHODS: EBV-DNA levels were measured in the cerebrospinal fluid (CSF) and blood samples of 14 patients with GFAP-A and 28 patients with other disorders. IgM and IgG antibodies against EBV viral capsid antigen (VCA) and IgG antibodies against early antigen (EA) were also measured in serum samples.
RESULTS: EBV-DNA was detected in the CSF samples in 10 of the 14 patients with GFAP-A and in 1 of the 28 patients in the disease control group, with a significant difference between the two groups (71.4% vs 3.6%; p<0.0001). Conversely, EBV-DNA was not detected in the blood of the 13 patients with GFAP-A. In patients with GFAP-A, the CSF-EBV-DNA level was significantly associated with the worst modified Rankin scale score during the acute phase (rs=0.6143, p=0.0194). Serum antibody profiling revealed evidence of past EBV infection, with VCA-IgG positivity and VCA-IgM and/or EA-IgG negativity observed in 92.9% of the patients with GFAP-A.
CONCLUSION: The study findings suggest that GFAP autoimmunity is associated with intrathecal EBV reactivation.
METHODS: EBV-DNA levels were measured in the cerebrospinal fluid (CSF) and blood samples of 14 patients with GFAP-A and 28 patients with other disorders. IgM and IgG antibodies against EBV viral capsid antigen (VCA) and IgG antibodies against early antigen (EA) were also measured in serum samples.
RESULTS: EBV-DNA was detected in the CSF samples in 10 of the 14 patients with GFAP-A and in 1 of the 28 patients in the disease control group, with a significant difference between the two groups (71.4% vs 3.6%; p<0.0001). Conversely, EBV-DNA was not detected in the blood of the 13 patients with GFAP-A. In patients with GFAP-A, the CSF-EBV-DNA level was significantly associated with the worst modified Rankin scale score during the acute phase (rs=0.6143, p=0.0194). Serum antibody profiling revealed evidence of past EBV infection, with VCA-IgG positivity and VCA-IgM and/or EA-IgG negativity observed in 92.9% of the patients with GFAP-A.
CONCLUSION: The study findings suggest that GFAP autoimmunity is associated with intrathecal EBV reactivation.
Предметные рубрики MeSH
HumansMaleFemaleGlial Fibrillary Acidic ProteinAdultMiddle AgedDNA, ViralHerpesvirus 4, HumanImmunoglobulin GVirus ActivationEpstein-Barr Virus InfectionsAstrocytesCapsid ProteinsImmunoglobulin MAgedAutoantibodiesYoung AdultAntigens, ViralAutoimmune Diseases of the Nervous SystemAdolescentAntibodies, Viral