CASE REPORT article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1589360
This article is part of the Research TopicAdvances in Autoimmune Encephalitis: From Molecular Insights to Therapeutic ApproachesView all 5 articles
Case Report: Anti-ADAM23 antibody: An Overlooked Autoantibody against VGKC-Complex in Autoimmune Encephalitis
Provisionally accepted
- Peking Union Medical College Hospital (CAMS), Beijing, China
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Antibodies against voltage-gated potassium channel (VGKC) complex mainly include anti-LGI1 and anti-CASPR2. Anti-ADAM23 antibody has not been reported in autoimmune encephalitis (AE) previously.We report a 71-year-old female patient who presented with rapidly progressive shortterm memory loss, psychobehavioural abnormalities, and impaired consciousness. She had recovered from herpes simplex encephalitis (HSE) six months earlier. The cerebrospinal fluid (CSF) analysis suggests lymphocytic inflammation. AE was considered after exclusion of HSV reactivation and other infectious etiologies.Comprehensive screening for commercially available autoimmune and paraneoplastic antibodies was negative. The tissue-based assay (TBA) of CSF revealed a pattern of neuropil reactivity ("neuropil pattern") suggesting the presence of neuronal surface antibodies (NS-Ab). A laboratory-developed antibody panel screening by cell-based assay (CBA) identified anti-ADAM23 antibody. Immunofluorescence staining showed ADAM23 colocalized with Tuj1, expressing on the surface of neurons. Subclass analysis revealed that anti-ADAM23 antibody was predominantly of the IgG4 subclass.Finally, she was diagnosed with anti-ADAM23 antibody associated AE. During the early stage of the disease, the patient underwent several courses of intravenous immunoglobulin (IVIg) with limited efficacy. Following the addition of high-dose methylprednisolone pulse therapy, the patient's consciousness improved from coma to stupor and the seizures relieved.We propose that anti-ADAM23 antibody, a previously overlooked autoantibody targeting VGKC-complex, may have diagnostic significance for autoimmune encephalitis.
Keywords: autoimmune encephalitis, Voltage-gated potassium channel complex, anti-ADAM23 antibody, tissue-based assay, Cell-based assay
Received: 07 Mar 2025; Accepted: 08 May 2025.
Copyright: © 2025 Ni, Bai, Jiang, Fan, YAO, Ren and Guan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Haitao Ren, Peking Union Medical College Hospital (CAMS), Beijing, China
Hongzhi Guan, Peking Union Medical College Hospital (CAMS), Beijing, China
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