A narrative review of identifying the culprit antibody in neuroimmune diseases: concept and clinical significance

BACKGROUND AND OBJECTIVE: Neuroimmune disease is a group of autoimmune diseases that are directed against antigens of the nervous system. Autoantibody testing is of great significance in early diagnosis, clinical severity assessment, prognosis, and efficacy evaluation. With the discovery of new antibodies and the development of antibody detection techniques, multiple antibodies have been found to coexist in patients with neuroimmune diseases. In this narrative review, we aim to define the culprit antibody and discuss the correlation between culprit antibodies and the clinical phenotype of neuroimmune diseases. METHODS: We searched Medline, Embase, Web of Science, and CNKI from inception to February 2021 to acquire references on the relationship between neuroimmune diseases and antibodies. Eligible articles were reviewed regarding the relationship between antibodies and phenotypes. KEY CONTENT AND FINDINGS: By reviewing relevant references and discussion, we propose the concept of “culprit antibody”, namely, the pathogenic antibody which has a corresponding causal relationship with one or more phenotypes during the course of a patient's neuroimmune disease. The proposal, significance, and relevant clinical research of culprit antibodies related to neuroimmune diseases are elaborated as the proposal of concept and determination points of casual relationship, association with clinical phenotypes and core phenotypes, the role in antibody overlapping syndrome in the same patient, and different stages. CONCLUSIONS: In the era of precision medicine, proposing the concept of culprit antibodies and clarifying relevant evidence chains are helpful for precise and effective immune intervention.