几年之内，针对神经系统的自身抗体产生了一种新的疾病分类。对于其中的几种，我们称之为“已确定的”，直接致病性已被证明，现在指导诊断途径和早期免疫治疗。对于数量快速增长的其他抗神经元自身抗体，其在疾病中的作用尚不清楚。越来越多的证据表明，它们可能通过对大脑功能发挥调节作用而导致疾病。因此，我们建议根据实验证明的致病性程度和临床关联强度对神经系统自身抗体进行三级分类：已建立的、新兴的、探索性的。这可能有助于关注以前从未假设过的自身抗体介导机制的临床症状，包括自身免疫性精神病和痴呆、癌症认知障碍和神经退行性疾病。根据此处回顾的最新数据，体液自身免疫可能代表大脑健康的另一个“超级系统”。 “脑抗体组”，即数千种抗神经元自身抗体的组成，不仅可以在疾病中，甚至在健康衰老中塑造神经元功能。为了实现这一新概念，需要进行广泛的研究来阐明从原子水平到临床水平、逐个自身抗体的致病性。此类分析可以发现新的生物标志物，增强我们对潜在机制的理解，并确定选择性疗法。© 2024 作者。约翰·威利出版的免疫学评论

Within a few years, autoantibodies targeting the nervous system resulted in a novel disease classification. For several of them, which we termed 'established', direct pathogenicity has been proven and now guides diagnostic pathways and early immunotherapy. For a rapidly growing number of further anti-neuronal autoantibodies, the role in disease is less clear. Increasing evidence suggests that they could contribute to disease, by playing a modulating role on brain function. We therefore suggest a three-level classification of neurological autoantibodies according to the degree of experimentally proven pathogenicity and strength of clinical association: established, emerging, explorative. This may facilitate focusing on clinical constellations in which autoantibody-mediated mechanisms have not been assumed previously, including autoimmune psychosis and dementia, cognitive impairment in cancer, and neurodegenerative diseases. Based on recent data reviewed here, humoral autoimmunity may represent an additional "super-system" for brain health. The "brain antibody-ome", that is, the composition of thousands of anti-neuronal autoantibodies, may shape neuronal function not only in disease, but even in healthy aging. Towards this novel concept, extensive research will have to elucidate pathogenicity from the atomic to the clinical level, autoantibody by autoantibody. Such profiling can uncover novel biomarkers, enhance our understanding of underlying mechanisms, and identify selective therapies.© 2024 The Author(s). Immunological Reviews published by John Wiley & Sons Ltd.