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Stroke. 2019 Sep 17:STROKEAHA119026100. doi: 10.1161/STROKEAHA.119.026100. [Epub ahead of print]

Serum Anti-NMDA (N-Methyl-D-Aspartate)-Receptor Antibodies and Long-Term Clinical Outcome After Stroke (PROSCIS-B).

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From the Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany (P.S.S., B.S., S.H., J.L.R., M.E., T.G.L.).
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Germany (S.H., H.P., M.E., T.G.L.).
Institute of Public Health, Charité-Universitätsmedizin Berlin, Germany (J.L.R.).
Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Germany (S.K.P.).
Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany (S.K.P).
German Center for Neurodegenerative Disease DZNE, partner site Berlin Charité-Universitätsmedizin Berlin, Germany (H.P., M.E.).
Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (P.U.H.).
Clinical Trial Center Würzburg, University Hospital Würzburg, Germany (P.U.H.).
Excellence Cluster Neurocure, Charité-Universitätsmedizin Berlin, Germany (M.E.).
German Center for Cardiovascular Research DZHK, partner site Berlin Charité-Universitätsmedizin Berlin, Germany (M.E., T.G.L.).


Background and Purpose- NMDAR1-abs (anti-N-Methyl-D-Aspartate receptor GluN1 antibodies), predominantly known in the context of autoimmune encephalitis, have been observed in serum of healthy individuals. A previous study found smaller stroke magnetic resonance imaging lesion growth in seropositive patients, suggesting a neuroprotective effect of these antibodies. The impact of NMDAR1-abs seropositivity on long-term functional outcome and recurrent vascular events and death after first-ever stroke remains unclear. Methods- Data from the Prospective Cohort with Incident Stroke-Berlin were used. NMDAR1-abs (ie, IgM, IgA, and IgG) were measured in serum within 7 days after first stroke. Outcomes of interest included modified Rankin Scale at one year and the time-to-event of a combined end point (recurrent stroke, myocardial infarction, and all-cause mortality) within 3 years. We calculated odds ratios from adjusted partial proportional odds models and subsequently compared outcome of patients with low titers (1:10; 1:32; and 1:100), and high titers (1:320; 1:1000) to seronegative patients. Furthermore, we estimated hazard ratios for a secondary vascular event or death in NMDAR1-abs seropositive compared with patients with seronegative in models adjusted for confounders. Results- The analyses included 583 patients with antibody measurements (39% female, median National Institutes of Health Stroke Scale:2, IQR:1-4), and NMDAR1-abs were observed in 76 (13%) patients. NMDAR1-abs seroprevalence was not associated with functional outcome (odds ratio=1.27; 95% CI, 0.77-2.09); sub-group analyses, however, showed worse outcome in patients with high titers (odds ratio=3.47; 95% CI, 1.54-7.80). Seropositive patients had an increased risk for a secondary vascular event or death (hazard ratios =1.83, 95% CI, 1.10-3.05). Conclusions- In our study, NMDAR1-abs seropositivity was not associated with functional outcome at one year after stroke, however, high titers (≥1:320) were associated with poor functional outcome. Furthermore, NMDAR1-abs seropositivity was associated with increased cardiovascular risk within 3 years after first stroke, independently from other risk factors. Clinical Trial Registration- URL: Unique identifier: NCT01363856.


autoantibodies; cell death; epidemiology; ischemia; serum; stroke

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