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Shan L, Dauvilliers Y, Siegel JM. Interactions of the histamine and hypocretin systems in CNS disorders. Nat Rev Neurol 2015; 11:401-13. [PMID: 26100750 DOI: 10.1038/nrneurol.2015.99] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Histamine and hypocretin neurons are localized to the hypothalamus, a brain area critical to autonomic function and sleep. Narcolepsy type 1, also known as narcolepsy with cataplexy, is a neurological disorder characterized by excessive daytime sleepiness, impaired night-time sleep, cataplexy, sleep paralysis and short latency to rapid eye movement (REM) sleep after sleep onset. In narcolepsy, 90% of hypocretin neurons are lost; in addition, two groups reported in 2014 that the number of histamine neurons is increased by 64% or more in human patients with narcolepsy, suggesting involvement of histamine in the aetiology of this disorder. Here, we review the role of the histamine and hypocretin systems in sleep-wake modulation. Furthermore, we summarize the neuropathological changes to these two systems in narcolepsy and discuss the possibility that narcolepsy-associated histamine abnormalities could mediate or result from the same processes that cause the hypocretin cell loss. We also review the changes in the hypocretin and histamine systems, and the associated sleep disruptions, in Parkinson disease, Alzheimer disease, Huntington disease and Tourette syndrome. Finally, we discuss novel therapeutic approaches for manipulation of the histamine system.
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Affiliation(s)
- Ling Shan
- Department of Psychiatry and Brain Research Institute, UCLA School of Medicine, Veterans' Affairs Greater Los Angeles Healthcare System (VA GLAHS), 16111 Plummer Street North Hills, 151A3, CA 91343, USA
| | - Yves Dauvilliers
- Centre de Référence Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Département de Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, 80 avenue Augustin Fliche, Montpellier 34295, France
| | - Jerome M Siegel
- Department of Psychiatry and Brain Research Institute, UCLA School of Medicine, Veterans' Affairs Greater Los Angeles Healthcare System (VA GLAHS), 16111 Plummer Street North Hills, 151A3, CA 91343, USA
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Thebault S, Waters P, Snape MD, Cottrell D, Darin N, Hallböök T, Huutoniemi A, Partinen M, Pollard AJ, Vincent A. Neuronal Antibodies in Children with or without Narcolepsy following H1N1-AS03 Vaccination. PLoS One 2015; 10:e0129555. [PMID: 26090827 PMCID: PMC4474558 DOI: 10.1371/journal.pone.0129555] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/11/2015] [Indexed: 01/03/2023] Open
Abstract
Type 1 narcolepsy is caused by deficiency of hypothalamic orexin/hypocretin. An autoimmune basis is suspected, but no specific antibodies, either causative or as biomarkers, have been identified. However, the AS03 adjuvanted split virion H1N1 (H1N1-AS03) vaccine, created to protect against the 2009 Pandemic, has been implicated as a trigger of narcolepsy particularly in children. Sera and CSFs from 13 H1N1-AS03-vaccinated patients (12 children, 1 young adult) with type 1 narcolepsy were tested for autoantibodies to known neuronal antigens including the N-methyl-D-aspartate receptor (NMDAR) and contactin-associated protein 2 (CASPR2), both associated with encephalopathies that include disordered sleep, to rodent brain tissue including the lateral hypothalamus, and to live hippocampal neurons in culture. When sufficient sample was available, CSF levels of melanin-concentrating hormone (MCH) were measured. Sera from 44 H1N1-ASO3-vaccinated children without narcolepsy were also examined. None of these patients' CSFs or sera was positive for NMDAR or CASPR2 antibodies or binding to neurons; 4/13 sera bound to orexin-neurons in rat brain tissue, but also to other neurons. MCH levels were a marginally raised (n = 8; p = 0.054) in orexin-deficient narcolepsy patients compared with orexin-normal children (n = 6). In the 44 H1N1-AS03-vaccinated healthy children, there was no rise in total IgG levels or in CASPR2 or NMDAR antibodies three weeks following vaccination. In conclusion, there were no narcolepsy-specific autoantibodies identified in type 1 narcolepsy sera or CSFs, and no evidence for a general increase in immune reactivity following H1N1-AS03 vaccination in the healthy children. Antibodies to other neuronal specific membrane targets, with their potential for directing use of immunotherapies, are still an important goal for future research.
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Affiliation(s)
- Simon Thebault
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Patrick Waters
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
| | - Matthew D. Snape
- Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- The NIHR Oxford Biomedical Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Dominic Cottrell
- Imperial College of Medicine, University of London, London, United Kingdom
| | - Niklas Darin
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne Huutoniemi
- Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Helsinki, Finland
| | - Markku Partinen
- Helsinki Sleep Clinic, Finnish Narcolepsy Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Andrew J. Pollard
- Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
- The NIHR Oxford Biomedical Centre, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Angela Vincent
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, United Kingdom
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Abstract
Type 1 narcolepsy is a sleep disorder characterized by excessive daytime sleepiness with unintentional sleep attacks and cataplexy. The disorder is caused by a loss of hypocretinergic neurons in the brain. The specific loss of these neurons in narcolepsy is thought to result from an autoimmune attack, and this is supported by evidence of both environmental and genetic factors pointing toward an involvement of the immune system. However, definitive proof of an autoimmune etiology is still missing. Several different immune-mediated disorders targeting neurons are known, and many of these are believed to be caused by autoreactive CD8(+) T cells. In this paper, we review the current knowledge on CD8(+) T cell-mediated neuronal damage on the basis of our understanding of other autoimmune disorders and experimental studies. We identify major histocompatibility complex class I presentation of autoantigens on neurons as a possible mechanism in the development of the disease, and propose T cell-mediated pathogenesis, with cytotoxic CD8(+) T cells targeting the hypocretinergic neurons, as a central element.
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Affiliation(s)
- Matilda Degn
- Department of Diagnostics, Molecular Sleep Laboratory, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birgitte Rahbek Kornum
- Department of Diagnostics, Molecular Sleep Laboratory, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark
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van der Heide A, Hegeman-Kleinn IM, Peeters E, Lammers GJ, Fronczek R. Immunohistochemical screening for antibodies in recent onset type 1 narcolepsy and after H1N1 vaccination. J Neuroimmunol 2015; 283:58-62. [PMID: 26004157 DOI: 10.1016/j.jneuroim.2015.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/05/2015] [Accepted: 04/13/2015] [Indexed: 01/12/2023]
Abstract
Narcolepsy type 1 patients typically have undetectable hypocretin-1 levels in the cerebrospinal fluid (CSF), as a result of a selective loss of the hypocretin containing neurons in the hypothalamus. An autoimmune attack targeting hypothalamic hypocretin (orexin) neurons is hypothesised. So far, no direct evidence for an autoimmune attack was found. One of the major limitations of previous studies was that none included patients close to disease onset. We screened serum of 21 narcolepsy type 1 patients close to disease onset (median 11 months), including 8 H1N1 vaccinated patients, for antibodies against hypocretin neurons using immunohistochemistry. No autoantibodies against hypocretin neurons could be detected.
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Affiliation(s)
- Astrid van der Heide
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - Ingrid M Hegeman-Kleinn
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; Department of Pathology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Els Peeters
- Medisch Centrum Haaglanden, Lijnbaan 32, 2512 VA den Haag, The Netherlands
| | - Gert J Lammers
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; SleepWake Centre SEIN, Achterweg 5, 2103 SW Heemstede, The Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
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Lecendreux M, Libri V, Jaussent I, Mottez E, Lopez R, Lavault S, Regnault A, Arnulf I, Dauvilliers Y. Impact of cytokine in type 1 narcolepsy: Role of pandemic H1N1 vaccination ? J Autoimmun 2015; 60:20-31. [PMID: 25892508 DOI: 10.1016/j.jaut.2015.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/23/2015] [Accepted: 03/18/2015] [Indexed: 12/21/2022]
Abstract
Recent advances in the identification of susceptibility genes and environmental exposures (pandemic influenza 2009 vaccination) provide strong support that narcolepsy type 1 is an immune-mediated disease. Considering the limited knowledge regarding the immune mechanisms involved in narcolepsy whether related to flu vaccination or not and the recent progresses in cytokine measurement technology, we assessed 30 cytokines, chemokines and growth factors using the Luminex technology in either peripheral (serum) or central (CSF) compartments in a large population of 90 children and adult patients with narcolepsy type 1 in comparison to 58 non-hypocretin deficient hypersomniacs and 41 healthy controls. Furthermore, we compared their levels in patients with narcolepsy whether exposed to pandemic flu vaccine or not, and analyzed the effect of age, duration of disease and symptom severity. Comparison for sera biomarkers between narcolepsy (n = 84, 54 males, median age: 15.5 years old) and healthy controls (n = 41, 13 males, median age: 20 years old) revealed an increased stimulation of the immune system with high release of several pro- and anti-inflammatory serum cytokines and growth factors with interferon-γ, CCL11, epidermal growth factor, and interleukin-2 receptor being independently associated with narcolepsy. Increased levels of interferon-γ, CCL11, and interleukin-12 were found when close to narcolepsy onset. After several adjustments, only one CSF biomarker differed between narcolepsy (n = 44, 26 males, median age: 15 years old) and non-hypocretin deficient hypersomnias (n = 57, 24 males, median age: 36 years old) with higher CCL 3 levels found in narcolepsy. Comparison for sera biomarkers between patients with narcolepsy who developed the disease post-pandemic flu vaccination (n = 36) to those without vaccination (n = 48) revealed an increased stimulation of the immune system with high release of three cytokines, regulated upon activation normal T-cell expressed and secreted, CXCL10, and CXCL9, being independently and significantly increased in the group exposed to the vaccine. No significant differences were found between narcoleptics whether exposed to flu vaccination or not for CSF biomarkers except for a lower CXCL10 level found in the exposed group. To conclude, we highlighted the role of sera cytokine with pro-inflammatory properties and especially interferon-γ being independently associated with narcolepsy close to disease onset. The activity of the interferon-γ network was also increased in the context of narcolepsy after the pandemic flu vaccination being a potential key player in the immune mechanism that triggers narcolepsy and that coordinates the immune response necessary for resolving vaccination assaults.
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Affiliation(s)
- Michel Lecendreux
- AP-HP, Pediatric Sleep Center, CHU Robert-Debré, Paris, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France
| | - Valentina Libri
- Inserm UMS20, Centre d'Immunologie Humaine (CIH) Institut Pasteur, France
| | - Isabelle Jaussent
- Inserm U1061, Montpellier, France; Université Montpellier 1, Montpellier, France
| | - Estelle Mottez
- Inserm UMS20, Centre d'Immunologie Humaine (CIH) Institut Pasteur, France
| | - Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Inserm U1061, Montpellier, France; Université Montpellier 1, Montpellier, France; Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Sophie Lavault
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, AP-HP, France; Brain Research Institute (CRICM-UPMC-Paris6; Inserm UMR_S 975; CNRS UMR 7225), Sorbonne Universities, UPMC Univ Paris 06, Paris, F-75005, France
| | - Armelle Regnault
- Aviesan/Institut Multi-Organismes Immunologie, Hématologie et Pneumologie (ITMO IHP), France
| | - Isabelle Arnulf
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, AP-HP, France; Brain Research Institute (CRICM-UPMC-Paris6; Inserm UMR_S 975; CNRS UMR 7225), Sorbonne Universities, UPMC Univ Paris 06, Paris, F-75005, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), France; Inserm U1061, Montpellier, France; Université Montpellier 1, Montpellier, France; Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.
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Arango MT, Kivity S, Shoenfeld Y. Is narcolepsy a classical autoimmune disease? Pharmacol Res 2015; 92:6-12. [PMID: 25447795 DOI: 10.1016/j.phrs.2014.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 12/19/2022]
Affiliation(s)
- María-Teresa Arango
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Center for Autoimmune Diseases Research - CREA, Universidad del Rosario, Bogota, Colombia; Doctoral Program in Biomedical Sciences, Universidad del Rosario, Bogota, Colombia
| | - Shaye Kivity
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Rheumatic Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Incumbent of the Laura Schwarz-Kip Chair for Research of Autoimmune Diseases, Tel Aviv University, Israel.
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Jacob L, Dauvilliers Y. La narcolepsie avec cataplexie : une maladie auto-immune ? Med Sci (Paris) 2014; 30:1136-43. [DOI: 10.1051/medsci/20143012017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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59
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Julkunen I, Partinen M. Neuroimmunology: Disease mechanisms in narcolepsy remain elusive. Nat Rev Neurol 2014; 10:616-7. [PMID: 25311588 DOI: 10.1038/nrneurol.2014.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ilkka Julkunen
- Department of Virology, University of Turku, Kiinamyllynkatu 13, 20520 Turku, Finland
| | - Markku Partinen
- Helsinki Sleep Clinic, VitalMed Research Centre, Sitratori 3, 00420 Helsinki, Finland
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