Indications:
NMDAR (N-methyl-D-aspartate receptor) testing is primarily utilized in clinical medicine to diagnose autoimmune diseases associated with this receptor or to evaluate specific neuropsychiatric symptoms (1).
Clinical Information:
Autoimmune encephalitis is a central nervous system inflammatory disease that has been newly identified and has gained increasing attention over the past decade. Its etiology is associated with autoimmune antibodies attacking antigens located on the neuronal cell membrane or within the neuronal nucleus (2).
The progression of this type of encephalitis is rapid and severe, potentially leading to psychiatric symptoms, rapidly progressive dementia, seizures, impaired consciousness, movement disorders, involuntary movements, respiratory failure, and even death. Currently, autoimmune antibody testing serves as a crucial indicator for the diagnosis of autoimmune encephalitis.
Although current clinical practices often rely on detecting NMDA receptor antibodies in cerebrospinal fluid (CSF) or blood for diagnosis, conventional testing methods—such as immunohistochemical staining, indirect immunofluorescence assays, and enzyme immunoassays (6)(7)—still present inherent limitations in sensitivity and specificity (8). Furthermore, most of these conventional tests are purely qualitative (reporting merely as antibody negative or positive) and cannot reflect the exact concentration of the antibodies, thereby limiting their utility in continuous disease monitoring and treatment decision-making.
Test Method:
Flow Cytometry
Testing Technique:
This platform utilizes a cutting-edge, live-cell quantitative antibody testing technique based on Flow Cytometry. By transfecting 293T cells with NMDA receptor antigens, the assay significantly enhances the sensitivity and specificity of anti-NMDA receptor antibody detection. The antibody levels in patient samples are accurately quantified using a standard curve of known concentrations, providing valuable quantitative data for clinical diagnosis and therapeutic monitoring.
Specimen Requirements:
| Specimen Type | Volume | Collection Tube | Storage & Stability | Note |
| serum | 1-2 mL | SST (Gold-top tube) / Plain Serum Tube (Red-top tube) | Refrigerated (4°C) for 7 days; Frozen for 28 days | Hemolysis and lipemia in the specimen may interfere with the test results. |
| cerebrospinal fluid (CSF) | PP Tube |
Interpretation Criteria:
| Test Parameter | Interpretation Criteria | Reference Range |
| Negative | ΔgeoMFI ≦ 0 | Cerebrospinal Fluid (CSF), Serum ≦0.00 μg/mL |
| Positive | ΔgeoMFI > 0 |
If you have any inquiries regarding autoimmune disease antibody testing, please feel free to contact us:
E-mail: [email protected]
Phone: +886-2-2658-2577
Fax: +886-2-2658-3977
References:
(1) Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016 Apr;15(4):391-404. doi: 10.1016/S1474-4422(15)00401-9. Epub 2016 Feb 20. PMID: 26906964; PMCID: PMC5066574.
(2) Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008 Dec;7(12):1091-8. doi: 10.1016/S1474-4422(08)70224-2. Epub 2008 Oct 11. PMID: 18851928; PMCID: PMC2607118.
(3) Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, Gleichman AJ, Balice-Gordon R, Rosenfeld MR, Lynch D, Graus F, Dalmau J. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014 Feb;13(2):167-77. doi: 10.1016/S1474-4422(13)70282-5. Epub 2013 Dec 18. Erratum in: Lancet Neurol. 2014 Feb;13(2):135. PMID: 24360484; PMCID: PMC4006368.
(4) Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, Baehring JM, Shimazaki H, Koide R, King D, Mason W, Sansing LH, Dichter MA, RosenfeldMR, Lynch DR. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007 Jan;61(1):25-36. doi: 10.1002/ana.21050. PMID: 17262855; PMCID: PMC2430743.
(5) Gelfand JM. Autoimmune encephalitis after herpes simplex encephalitis: insights into pathogenesis. Lancet Neurol. 2018 Sep;17(9):733-735. doi: 10.1016/S1474-4422(18)30279-5. Epub 2018 Jul 23. PMID: 30049613.
(6) Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC, Gelfand JM, Geschwind M, Glaser CA, Honnorat J, Höftberger R, Iizuka T, Irani SR, Lancaster E, Leypoldt F, Prüss H, Rae-Grant A, Reindl M, Rosenfeld MR, Rostásy K, Saiz A, Venkatesan A, Vincent A, Wandinger KP, Waters P, Dalmau J. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016 Apr;15(4):391-404. doi: 10.1016/S1474-4422(15)00401-9. Epub 2016 Feb 20. PMID: 26906964; PMCID: PMC5066574.
(7) Ding JB, Dongas J, Hu K, Ding M. Autoimmune Limbic Encephalitis: A Review of Clinicoradiological Features and the Challenges of Diagnosis. Cureus. 2021 Aug 28;13(8):e17529. doi: 10.7759/cureus.17529. PMID: 34603897; PMCID: PMC8476324.
(8) Budhram A, Leung A, Nicolle MW, Burneo JG. Diagnosing autoimmune limbic encephalitis. CMAJ. 2019 May 13;191(19):E529-E534. doi: 10.1503/cmaj.181548. PMID: 31085562; PMCID: PMC6520067.
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