D Assay for Detection of NMDAR Antibodieshuman serum samples as described above with the exception of DAPI staining, which was omitted. Images were obtained with a TCS SP5 confocal laser scanning microscope (Leica).Flow cytometry based assay (FACS)HEK293A cells were grown in tissue culture test plates 6 (TPP, Art. No. 92006) at a density of 3 x 105 cells per 3 ml per well and transfected with human NMDAR as described above. Unspecific binding of serum antibodies was determined by using HEK293A cells transiently transfected with hCD2-EmGFP fusion protein using hCD2 cDNA cloned into Vivid Colors pcDNA 6.2C-EmGFP-GW/TOPO [20]. Forty-eight hours post transfection cells were detached using trypsin without EDTA (0.25 in PBS; GE Healthcare, Chalfont St Giles, UK, Art. No. L11-002). Cells were incubated with 200 l trypsin for five minutes at room temperature, resuspended in washing buffer containing 20 M (+)-MK-801 (Sigma-Aldrich), centrifuged at 500 g for five minutes, and stained as described above with the following modifications: all incubation steps were performed at room temperature with orbital shaking at 200 rpm. Washing steps were performed by repeated centrifugation (3 x) at 500 g for five minutes and resuspension of the pellets. Duplicates of serum samples at a dilution of 1:100 were used at a cell density of 2 x 105 cells per 200 l. Bound serum antibodies were detected by allophycocyanin (APC)-conjugated Quinoline-Val-Asp-Difluorophenoxymethylketone site AffiniPure goat antihuman IgG antibody (1:100; Jackson ImmunoResearch Laboratory, Art. No. 109-136-088). Cells were incubated with 100 l washing buffer containing 7-amino-actinomycin D (7-AAD; 1:30; Becton Dickinson, Art. No. 559925) to exclude dead cells for ten minutes at room temperature and analyzed on a BD Accuri C6 flow cytometer. In this manner, a maximum of 22 samples were analyzed in parallel (average 14 samples per analysis). Therefore, not all samples, neither of the discovery nor of the validation group, could be analyzed with the same batch of transfected and trypsinized cells. Consequently, considering the inter-assay variation, when interpreting data from different analysis batches, is of importance. For reanalysis of samples to compare serum dilutions of 1:100 and 1:20 it was taken care that different dilutions of the same sample were analyzed in the very same experiment. NMDAR and CD2 expressing cells were detected in the green FL-1 channel, dead cells in the red FL-3 channel and antibody binding was measured in the red FL-4 channel. Ten thousand (Em)GFPpos 7-AADneg cells were acquired for each sample. Antibody bound to cell surface resulted in a shift to the right on the x-axis in FL-4. Median fluorescence intensity (MFI) from CD2 transfected cells was subtracted from MFI of NMDAR expressing cells (MFI). Healthy controls and patients with other neurological diseases were used to calculate the cutoff MFI.Statistical analysesStatistical analyses were done using IBM SPSS software (release 21.0, IBM, Armonk, NY) or GraphPad Prism 6 (GraphPad, San Diego, CA). Between-group comparisons were performed with Kruskal-Wallis test, Dunn’s multiple comparison post-hoc test, Mann-Whitney U test, Quisinostat web Fisher’s exact test and Chi-square test. Correlation of parameters was analyzed with Spearman’s nonparametric correlation. Receiver operating characteristic (ROC) curve analysis was used to determine cut-off MFI (FACS). Kappa statistics was used to assess the concordance between the two testing methods. Statistical significance was defi.D Assay for Detection of NMDAR Antibodieshuman serum samples as described above with the exception of DAPI staining, which was omitted. Images were obtained with a TCS SP5 confocal laser scanning microscope (Leica).Flow cytometry based assay (FACS)HEK293A cells were grown in tissue culture test plates 6 (TPP, Art. No. 92006) at a density of 3 x 105 cells per 3 ml per well and transfected with human NMDAR as described above. Unspecific binding of serum antibodies was determined by using HEK293A cells transiently transfected with hCD2-EmGFP fusion protein using hCD2 cDNA cloned into Vivid Colors pcDNA 6.2C-EmGFP-GW/TOPO [20]. Forty-eight hours post transfection cells were detached using trypsin without EDTA (0.25 in PBS; GE Healthcare, Chalfont St Giles, UK, Art. No. L11-002). Cells were incubated with 200 l trypsin for five minutes at room temperature, resuspended in washing buffer containing 20 M (+)-MK-801 (Sigma-Aldrich), centrifuged at 500 g for five minutes, and stained as described above with the following modifications: all incubation steps were performed at room temperature with orbital shaking at 200 rpm. Washing steps were performed by repeated centrifugation (3 x) at 500 g for five minutes and resuspension of the pellets. Duplicates of serum samples at a dilution of 1:100 were used at a cell density of 2 x 105 cells per 200 l. Bound serum antibodies were detected by allophycocyanin (APC)-conjugated AffiniPure goat antihuman IgG antibody (1:100; Jackson ImmunoResearch Laboratory, Art. No. 109-136-088). Cells were incubated with 100 l washing buffer containing 7-amino-actinomycin D (7-AAD; 1:30; Becton Dickinson, Art. No. 559925) to exclude dead cells for ten minutes at room temperature and analyzed on a BD Accuri C6 flow cytometer. In this manner, a maximum of 22 samples were analyzed in parallel (average 14 samples per analysis). Therefore, not all samples, neither of the discovery nor of the validation group, could be analyzed with the same batch of transfected and trypsinized cells. Consequently, considering the inter-assay variation, when interpreting data from different analysis batches, is of importance. For reanalysis of samples to compare serum dilutions of 1:100 and 1:20 it was taken care that different dilutions of the same sample were analyzed in the very same experiment. NMDAR and CD2 expressing cells were detected in the green FL-1 channel, dead cells in the red FL-3 channel and antibody binding was measured in the red FL-4 channel. Ten thousand (Em)GFPpos 7-AADneg cells were acquired for each sample. Antibody bound to cell surface resulted in a shift to the right on the x-axis in FL-4. Median fluorescence intensity (MFI) from CD2 transfected cells was subtracted from MFI of NMDAR expressing cells (MFI). Healthy controls and patients with other neurological diseases were used to calculate the cutoff MFI.Statistical analysesStatistical analyses were done using IBM SPSS software (release 21.0, IBM, Armonk, NY) or GraphPad Prism 6 (GraphPad, San Diego, CA). Between-group comparisons were performed with Kruskal-Wallis test, Dunn’s multiple comparison post-hoc test, Mann-Whitney U test, Fisher’s exact test and Chi-square test. Correlation of parameters was analyzed with Spearman’s nonparametric correlation. Receiver operating characteristic (ROC) curve analysis was used to determine cut-off MFI (FACS). Kappa statistics was used to assess the concordance between the two testing methods. Statistical significance was defi.