Evidence map›Paper›PMID 42606839›Full record

ArticleJAMA neurology2026

Anti-CD320 Autoantibodies and Central Nervous System Vitamin B12 Deficiency in Idiopathic Myelopathy.

John V Pluvinage, David Acero-Garces, Giacomo Greco, Carson E Moseley, Sukhman Sidhu, Kelsey C Zorn, Sravani Kondapavulur, Sonam Mohan, John Neely, Stefano Masciocchi and 58 more

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In one paragraph

Article in JAMA neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

68 authors.

John V PluvinageDepartment of Neurology, University of California, San Francisco.
David Acero-GarcesDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Giacomo GrecoNeuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
Carson E MoseleyDepartment of Neurology, University of California, San Francisco.
Sukhman SidhuDepartment of Biochemistry and Biophysics, University of California, San Francisco.
Kelsey C ZornDepartment of Biochemistry and Biophysics, University of California, San Francisco.
Sravani KondapavulurDepartment of Neurosurgery, University of California, San Francisco.
Sonam MohanKaiser Neurology, San Jose, California.
John NeelyKaiser Neurology, San Jose, California.
Stefano MasciocchiNeuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
Pietro BusinaroNeuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
Alexis García SarreónGirona Biomedical Research Institute, Neurodegeneration and Neuroinflammation Group, Salt, Spain.
Ariadna Gifreu FraixinóGirona Biomedical Research Institute, Neurodegeneration and Neuroinflammation Group, Salt, Spain.
Krista McCutcheonDepartment of Neurology, University of California, San Francisco.
Colette CasparDepartment of Neurology, University of California, San Francisco.
Richard Dela RosaDepartment of Biology, Stanford University, Stanford, California.
Colin ZamecnikDepartment of Neurology, University of California, San Francisco.
Asritha TubatiDepartment of Neurology, University of California, San Francisco.
Andoni I AsencorDepartment of Neurology, University of California, San Francisco.
Madina TugizovaDepartment of Neurology, University of California, San Francisco.
Felicia ChowDepartment of Neurology, University of California, San Francisco.
Alexandra GalatiNeuroscience Institute, The Queen's Medical Center, University of Hawaii, Honolulu.
Yair MinaNational Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
Camilo ToroOffice of the Clinical Director and Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland.
Min KangDepartment of Neurology, University of California, San Francisco.
Chu-Yueh GuoDepartment of Neurology, University of California, San Francisco.
Sarah F WesleyDepartment of Neurology, Division of Neuroimmunology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Kathryn KvamDepartment of Neurology & Neurological Sciences, Stanford University, Stanford, California.
Sydney LeeDepartment of Neurology, University of Utah, Salt Lake City.
Ahmed AbdelhakDepartment of Neurology, University of California, San Francisco.
Thomas MartinHelen Diller Family Comprehensive Cancer Center, University of California, San Francisco.
Yun-Han HuangDivision of Rheumatology, Department of Medicine, University of California, San Francisco.
Sarah B BermanDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Jenny LinnoilaDepartment of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.
John EngstromDepartment of Neurology, University of California, San Francisco.
Andrew McCaddonFaculty of Social and Life Sciences, Wrexham University, Wrexham, United Kingdom.
Ari J GreenDepartment of Neurology, University of California, San Francisco.
Ralph GreenDepartment of Pathology and Laboratory Medicine, University of California, Davis.
Bruce A C CreeDepartment of Neurology, University of California, San Francisco.
Stephen L HauserDepartment of Neurology, University of California, San Francisco.
Joseph L DeRisiDepartment of Biochemistry and Biophysics, University of California, San Francisco.
Samuel J PleasureDepartment of Neurology, University of California, San Francisco.
Jeffrey M GelfandDepartment of Neurology, University of California, San Francisco.
Gary Álvarez BravoGirona Biomedical Research Institute, Neurodegeneration and Neuroinflammation Group, Salt, Spain.
Matteo GastaldiNeuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy.
Carlos A PardoDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Michael R WilsonDepartment of Neurology, University of California, San Francisco.
UCSF Neurohospitalist Division
and the
and the
Megan RichieDepartment of Neurology, University of California, San Francisco.
Vanja DouglasDepartment of Neurology, University of California, San Francisco.
Maulik ShahDepartment of Neurology, University of California, San Francisco.
Elan L GutermanDepartment of Neurology, University of California, San Francisco.
Avindra NathSection of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
Catherine G SuenDepartment of Neurology, University of California, San Francisco.
Martineau LouineDepartment of Neurology, University of California, San Francisco.
Leah ZuroffDepartment of Neurology, University of California, San Francisco.
Josiah GerdtsDepartment of Neurology, University of California, San Francisco.
Mary KaraliusDepartment of Neurology, University of California, San Francisco.
Alyssa NylanderDepartment of Neurology, University of California, San Francisco.
Carolyn BevanDepartment of Neurology, University of California, San Francisco.
Max LiuDepartment of Neurology, University of California, San Francisco.
Iyas DaghlasDepartment of Neurology, University of California, San Francisco.
Leena SuleimanDepartment of Neurology, University of California, San Francisco.
Todd NguyenDepartment of Neurology, University of California, San Francisco.
Benjamin MeyerDepartment of Neurology, University of California, San Francisco.
Karen IbarraDepartment of Neurology, University of California, San Francisco.

Funding

Academic Rheumatology and Clinical ImmunologyT32AR079068 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Jinoos Yazdany, JULIE ZIKHERMAN · 2021 to 2026
$2.5M
NIAMS NIH HHS T32 AR079068
6 · The paper itself

Abstract

Importance: Disorders affecting the spinal cord (myelopathies) can cause severe disability. Despite diagnostic advances, approximately 12% to 18% of myelopathy cases continue to elude an etiological diagnosis, hampering effective treatment. Objective: To describe a novel autoantibody associated with idiopathic myelopathy (IM) and report its clinical, radiographic, and metabolic characteristics. Design, Setting, and Participants: This retrospective case-control study was conducted from May 2014 to October 2025 at 4 tertiary care centers. Biofluids from 148 patients diagnosed with IM were evaluated based on clinical evidence of myelopathy without an identified etiology. Biofluids from patients with other neurological diseases (ONDs; n = 32) or known autoimmune myelitis (n = 30) were used for comparison. Proteomewide phage display was used to discover novel autoantibodies. Targeted immunoassays were used to screen for a candidate autoantibody. Downstream metabolites were measured in the cerebrospinal fluid (CSF). Exposure: Autoantibody status. Main Outcomes and Measures: Prevalence, clinical phenotype, CSF profile, and magnetic resonance imaging pattern of autoantibody-positive IM. Results: Autoantibodies targeting the transcobalamin receptor (CD320) responsible for cellular transport of vitamin B12 were identified in 18 of 32 individuals with IM (56%) in a discovery cohort (mean [SD] age, 54 [14] years; 19 male). Bioactive vitamin B12 concentration was decreased in the CSF of individuals with positive anti-CD320 test results compared with that of control individuals with ONDs (mean [SD], 15.1 [2.3] pmol/L vs 22.9 [10.7] pmol/L; P = .03), indicative of autoimmune vitamin B12 central deficiency. Compared to individuals with IM and negative anti-CD320 test results, those with IM and positive anti-CD320 test results demonstrated a higher frequency of subacute time course (n = 10 [56%] vs n = 1 [7%]; P = .008), normal CSF profile (n = 15 [83%] vs n = 7 [50%]; P = .04), and dorsolateral spinal cord abnormalities on magnetic resonance imaging (n = 11 [61%] vs n = 1 [7%]; P = .003). In 2 independent validation cohorts comprising 91 and 25 patients with IM, anti-CD320 was detected in 41 (45%) and 12 (48%) patients, respectively. Comorbid anti-CD320 antibodies were detected in a smaller proportion of patients with other known autoimmune etiologies of myelopathy. Five individuals with IM and positive anti-CD320 test results received vitamin B12 supplementation with or without concurrent immunosuppression, and 4 of 5 showed clinical improvement. Conclusions and Relevance: In this study, autoimmune vitamin B12 central deficiency was associated with IM. Screening for anti-CD320 antibodies followed by metabolic confirmation of a CNS-restricted vitamin B12 deficiency may be considered in the diagnostic evaluation of myelopathy.

Identifiers

PMID42606839
PMCPMC13482640

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