Early autoimmunity and outcome in virus encephalitis: a retrospective study based on tissue-based assay.

To explore the autoimmune response and outcome in the central nervous system (CNS) at the onset of viral infection and correlation between autoantibodies and viruses. METHODS: A retrospective observational study was conducted in 121 patients (2016-2021) with a CNS viral infection confirmed via cerebrospinal fluid (CSF) next-generation sequencing (cohort A). Their clinical information was analysed and CSF samples were screened for autoantibodies against monkey cerebellum by tissue-based assay. In situ hybridisation was used to detect Epstein-Barr virus (EBV) in brain tissue of 8 patients with glial fibrillar acidic protein (GFAP)-IgG and nasopharyngeal carcinoma tissue of 2 patients with GFAP-IgG as control (cohort B). RESULTS: Among cohort A (male:female=79:42; median age: 42 (14-78) years old), 61 (50.4%) participants had detectable autoantibodies in CSF. Compared with other viruses, EBV increased the odds of having GFAP-IgG (OR 18.22, 95% CI 6.54 to 50.77, p<0.001). In cohort B, EBV was found in the brain tissue from two of eight (25.0%) patients with GFAP-IgG. Autoantibody-positive patients had a higher CSF protein level (median: 1126.00 (281.00-5352.00) vs 700.00 (76.70-2899.00), p<0.001), lower CSF chloride level (mean: 119.80±6.24 vs 122.84±5.26, p=0.005), lower ratios of CSF-glucose/serum-glucose (median: 0.50[0.13-0.94] vs 0.60[0.26-1.23], p=0.003), more meningitis (26/61 (42.6%) vs 12/60 (20.0%), p=0.007) and higher follow-up modified Rankin Scale scores (1 (0-6) vs 0 (0-3), p=0.037) compared with antibody-negative patients. A Kaplan-Meier analysis revealed that autoantibody-positive patients experienced significantly worse outcomes (p=0.031). CONCLUSIONS: Autoimmune responses are found at the onset of viral encephalitis. EBV in the CNS increases the risk for autoimmunity to GFAP.

Network pharmacologic molecular mechanism of Shenmai Injection in treatment of COVID-19 combined with coronary heart disease

Objective: To analyze the molecular interaction network pathway of Shenmai Injection in the treatment of COVID-19 with coronary heart disease by using network pharmacology. Methods: Using the TCMSP and ETCM to retrieve the chemical constituents of Ginseng Radix et Rhizoma Rubra and Ophiopogonis Radix in Shenmai Injection. The target of the compound was predicted through the SwissTargetPrediction database. The target of COVID-19 with coronary heart disease was screened through the NCBI database and the GeneCards database, and the targets of compound and disease were mapped to obtain the target of the compound for treating the disease. FunRich software and DAVID database were used to perform GO function enrichment analysis and KEGG pathway enrichment analysis, and Excel software and Tableau software to draw bar charts and bubble charts for visualization. Finally, Cytoscape 3.7.1 software was used to build compound-target-pathway network. Glide was used to dock the components of Shenmai Injection with 3CL hydrolase (Mpro). Results: The results showed that ophiopogonin D', ophiopogonin D, ginsenoside Rg 2, methyl ophiopogonanone A, ophiogenin-3-O-α-L-rhamnopyranosyl (1→2)-β-D-glucopyranoside, ginsenoside Rb 2, ginsenoside R 0, ophiopogon A, sanchinoside Rd, ophiopogonanone E, and ginsenoside Re showed higher degrees in the analysis and stronger binding with 3CL hydrolase. Those compounds were the main effective components in the treatment of COVID-19 combined with coronary heart disease, involving 77 targets such as IL6, GAPDH, ALB, TNF, MAPK1, MAPK3, TP53, EGFR, CASP3, and CXCL8. KEGG pathway enrichment analysis revealed that there were 124 (P < 0.05) signaling pathways involving HIF-1 signaling pathway, TNF signaling pathway, sphingolipid signaling pathway, Toll-like receptor signaling pathway, neurotrophin signaling pathway, VEGF signaling pathway, apoptosis, Ras signaling pathway, PI3K-Akt signaling pathway, and prolactin signaling pathway. The results of molecular docking showed that the affinity between the 17 components of Shenmai Injection and the 3CL hydrolase of SARS-CoV-2 was less than -25 kJ/mol. Conclusion: Shenmai Injection can achieve simultaneous intervention of COVID-19 and coronary heart disease by inhibiting cytokine storms, maintaining cardiac function homeostasis, regulating immunity, and antivirals. It presents the network regulation mechanism of mutual influence and complex correlation. This study can provide a scientific basis for the treatment of Shenmai Injection in critically ill patients with COVID-19.