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Brain-relevant antibodies in first-episode psychosis: a matched case–control study

  • Fiona Gaughran (a1) (a2) (a3), John Lally (a3) (a4) (a5), Katherine Beck (a3), Ruaidhri McCormack (a6), Poonam Gardner-Sood (a3), Ester Coutinho (a7), Leslie Jacobson (a7), Bethan Lang (a7), Ricardo Sainz-Fuertes (a8), Evangelos Papanastasiou (a9), Marta Di Forti (a10), Tim Nicholson (a11), Angela Vincent (a12) and Robin M. Murray (a1) (a3)...

Abstract

Background

There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP).

Methods

Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case–control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded.

Results

VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls.

Conclusions

This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.

Copyright

Corresponding author

Author for correspondence: Dr John Lally, E-mail: john.lally@kcl.ac.uk

Footnotes

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These authors contributed equally to the paper and are joint first authors.

These authors contributed equally to the paper and should be acknowledged as joint last authors.

Footnotes

References

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