301
|
Pollak TA, Beck K, Irani SR, Howes OD, David AS, McGuire PK. Autoantibodies to central nervous system neuronal surface antigens: psychiatric symptoms and psychopharmacological implications. Psychopharmacology (Berl) 2016; 233:1605-21. [PMID: 26667479 PMCID: PMC4828500 DOI: 10.1007/s00213-015-4156-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/05/2015] [Indexed: 12/30/2022]
Abstract
RATIONALE Autoantibodies to central nervous system (CNS) neuronal surface antigens have been described in association with autoimmune encephalopathies which prominently feature psychiatric symptoms in addition to neurological symptoms. The potential role of these autoantibodies in primary psychiatric diseases such as schizophrenia or bipolar affective disorder is of increasing interest. OBJECTIVES We aimed to review the nature of psychiatric symptoms associated with neuronal surface autoantibodies, in the context of autoimmune encephalopathies as well as primary psychiatric disorders, and to review the mechanisms of action of these autoantibodies from a psychopharmacological perspective. RESULTS The functional effects of the autoantibodies on their target antigens are described; their clinical expression is at least in part mediated by their effects on neuronal receptor function, primarily at the synapse, usually resulting in receptor hypofunction. The psychiatric effects of the antibodies are related to known functions of the receptor target or its complexed proteins, with reference to supportive genetic and pharmacological evidence where relevant. Evidence for a causal role of these autoantibodies in primary psychiatric disease is increasing but remains controversial; relevant methodological controversies are outlined. Non-receptor-based mechanisms of autoantibody action, including neuroinflammatory mechanisms, and therapeutic implications are discussed. CONCLUSIONS An analysis of the autoantibodies from a psychopharmacological perspective, as endogenous, bioactive, highly specific, receptor-targeting molecules, provides a valuable opportunity to understand the neurobiological basis of associated psychiatric symptoms. Potentially, new treatment strategies will emerge from the improving understanding of antibody-antigen interaction within the CNS.
Collapse
Affiliation(s)
- T A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - K Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - S R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - O D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - A S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - P K McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's Health Partners, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| |
Collapse
|
302
|
Bradl M, Lassmann H. Neurologic autoimmunity: mechanisms revealed by animal models. HANDBOOK OF CLINICAL NEUROLOGY 2016; 133:121-43. [PMID: 27112675 DOI: 10.1016/b978-0-444-63432-0.00008-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over the last decade, neurologic autoimmunity has become a major consideration in the diagnosis and management of patients with many neurologic presentations. The nature of the associated antibodies and their targets has led to appreciation of the importance of the accessibility of the target antigen to antibodies, and a partial understanding of the different mechanisms that can follow antibody binding. This chapter will first describe the basic principles of autoimmune inflammation and tissue damage in the central and peripheral nervous system, and will then demonstrate what has been learnt about neurologic autoimmunity from circumstantial clinical evidence and from passive, active, and occasionally spontaneous or genetic animal models. It will cover neurologic autoimmune diseases ranging from disorders of neuromuscular transmission, peripheral and ganglionic neuropathy, to diseases of the central nervous system, where autoantibodies are either pathogenic and cause destruction or changes in function of their targets, where they are harmless bystanders of T-cell-mediated tissue damage, or are not involved at all. Finally, this chapter will summarize the relevance of current animal models for studying the different neurologic autoimmune diseases, and it will identify aspects where future animal models need to be improved to better reflect the disease reality experienced by affected patients, e.g., the chronicity or the relapsing/remitting nature of their disease.
Collapse
Affiliation(s)
- Monika Bradl
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria.
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Vienna, Austria
| |
Collapse
|
303
|
Sasaki K, Omotuyi OI, Ueda M, Shinohara K, Ueda H. NMDA receptor agonists reverse impaired psychomotor and cognitive functions associated with hippocampal Hbegf-deficiency in mice. Mol Brain 2015; 8:83. [PMID: 26637193 PMCID: PMC4670538 DOI: 10.1186/s13041-015-0176-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Structural and functional changes of the hippocampus are correlated with psychiatric disorders and cognitive dysfunctions. Genetic deletion of heparin-binding epidermal growth factor-like growth factor (HB-EGF), which is predominantly expressed in cortex and hippocampus, also causes similar psychiatric and cognitive dysfunctions, accompanying down-regulated NMDA receptor signaling. However, little is known of such dysfunctions in hippocampus-specific Hbegf cKO mice. RESULTS We successfully developed hippocampus-specific cKO mice by crossbreeding floxed Hbegf and Gng7-Cre knock-in mice, as Gng7 promoter-driven Cre is highly expressed in hippocampal neurons as well as striatal medium spiny neurons. In mice lacking hippocampus Hbegf gene, there was a decreased neurogenesis in the subgranular zone (SGZ) of the dentate gyrus as well as down-regulation of PSD-95/NMDA-receptor-NR1/NR2B subunits and related NMDA receptor signaling. Psychiatric, social-behavioral and cognitive abnormalities were also observed in hippocampal cKO mice. Interestingly, D-cycloserine and nefiracetam, positive allosteric modulators (PAMs) of NMDA receptor reversed the apparent reduction in NMDA receptor signaling and most behavioral abnormalities. Furthermore, decreased SGZ neurogenesis in hippocampal cKO mice was reversed by nefiracetam. CONCLUSIONS The present study demonstrates that PAMs of NMDA receptor have pharmacotherapeutic potentials to reverse down-regulated NMDA receptor signaling, neuro-socio-cognitive abnormalities and decreased neurogenesis in hippocampal cKO mice.
Collapse
Affiliation(s)
- Keita Sasaki
- Department of Pharmacology and Therapeutic Innovation, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan.
| | - Olaposi Idowu Omotuyi
- Department of Pharmacology and Therapeutic Innovation, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan.
| | - Mutsumi Ueda
- Department of Pharmacology and Therapeutic Innovation, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan.
| | - Kazuyuki Shinohara
- Department of Neurobiology and Behavior, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan.
| | - Hiroshi Ueda
- Department of Pharmacology and Therapeutic Innovation, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki, 852-8521, Japan.
| |
Collapse
|
304
|
Castillo-Gomez E, Kästner A, Steiner J, Schneider A, Hettling B, Poggi G, Ostehr K, Uhr M, Asif AR, Matzke M, Schmidt U, Pfander V, Hammer C, Schulz TF, Binder L, Stöcker W, Weber F, Ehrenreich H. The brain as immunoprecipitator of serum autoantibodies against N-Methyl-D-aspartate receptor subunit NR1. Ann Neurol 2015; 79:144-51. [PMID: 26505629 DOI: 10.1002/ana.24545] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/26/2015] [Accepted: 10/17/2015] [Indexed: 01/23/2023]
Abstract
Autoantibodies (AB) against N-methyl-D-aspartate receptor subunit NR1 (NMDAR1) are highly seroprevalent in health and disease. Symptomatic relevance may arise upon compromised blood-brain barrier (BBB). However, it remained unknown whether circulating NMDAR1 AB appear in the cerebrospinal fluid (CSF). Of n = 271 subjects with CSF-serum pairs, 26 were NMDAR1 AB seropositive, but only 1 was CSF positive. Contrariwise, tetanus AB (non-brain-binding) were present in serum and CSF of all subjects, with CSF levels higher upon BBB dysfunction. Translational mouse experiments proved the hypothesis that the brain acts as an 'immunoprecipitator'; simultaneous injection of NMDAR1 AB and the non-brain-binding green fluorescent protein AB resulted in high detectability of the former in brain and the latter in CSF.
Collapse
Affiliation(s)
- Esther Castillo-Gomez
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | - Anne Kästner
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | - Johann Steiner
- Department of Psychiatry, University of Magdeburg, Magdeburg
| | - Anja Schneider
- German Center for Neurodegenerative Diseases, Göttingen.,Deutsche Forschungsgemeinschaft Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen
| | - Bilke Hettling
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | - Giulia Poggi
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | - Kristin Ostehr
- Department of Psychiatry, University of Magdeburg, Magdeburg
| | | | - Abdul R Asif
- Institute for Clinical Chemistry, Göttingen Medical School, Göttingen
| | - Mike Matzke
- Department of Neurology, University of Magdeburg, Magdeburg
| | | | - Viktoria Pfander
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | - Christian Hammer
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen
| | | | - Lutz Binder
- Institute for Clinical Chemistry, Göttingen Medical School, Göttingen
| | - Winfried Stöcker
- Institute for Experimental Immunology, (affiliated with Euroimmun, Lübeck), Göttingen, Germany
| | | | - Hannelore Ehrenreich
- Department of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen.,Deutsche Forschungsgemeinschaft Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Göttingen
| |
Collapse
|
305
|
Zhang G, Chen L, Yang L, Hua X, Zhou B, Miao Z, Li J, Hu H, Namaka M, Kong J, Xu X. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice. Sci Rep 2015; 5:16751. [PMID: 26572587 PMCID: PMC4648085 DOI: 10.1038/srep16751] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/19/2015] [Indexed: 12/22/2022] Open
Abstract
Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO followed by spatial restraint stress for 2 h daily for 2 to 4 weeks from the fourth day after MCAO induced PSD-like depressive phenotypes in mice. Importantly, the mice showed exacerbated deficits of neurological functions and decreased body weights, which were accompanied with reduced levels of brain derived neurotrophic factor and neurotransmitters including serotonin and dopamine. In addition, we identified increased levels of serum cortisol in our PSD mice. Finally, we found that mice with PSD were responsive to the tri-cyclic antidepressant imipramine as evidenced by their attenuated depressive behaviors, increased body weights, recovered brain serotonin levels, and decreased serum cortisol levels. This mouse model replicates multiple features of human post-stroke depression and thus provides a new model for the investigation of PSD.
Collapse
Affiliation(s)
- Gaocai Zhang
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China.,Institute of Neuroscience, Soochow University, Suzhou City, China
| | - Li Chen
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Lingli Yang
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Xiaodong Hua
- Department of Biochemistry, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA
| | - Beiqun Zhou
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China.,Institute of Neuroscience, Soochow University, Suzhou City, China
| | - Zhigang Miao
- Institute of Neuroscience, Soochow University, Suzhou City, China
| | - Jizhen Li
- Department of Neurology, Suzhou Kowloon Hospital, 118 Wansheng Street, Suzhou City, China
| | - Hua Hu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China
| | - Michael Namaka
- College of Pharmacy and Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jiming Kong
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Xingshun Xu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou City, China.,Institute of Neuroscience, Soochow University, Suzhou City, China
| |
Collapse
|
306
|
Heine J, Prüss H, Bartsch T, Ploner C, Paul F, Finke C. Imaging of autoimmune encephalitis – Relevance for clinical practice and hippocampal function. Neuroscience 2015; 309:68-83. [DOI: 10.1016/j.neuroscience.2015.05.037] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/04/2015] [Accepted: 05/15/2015] [Indexed: 12/25/2022]
|
307
|
Desestret V, Chefdeville A, Viaccoz A, Bost C, Ducray F, Picard G, Rogemond V, Chaffois MO, Blanc C, Bardel C, Treilleux I, Pascual O, Antoine JC, Delattre JY, Honnorat J. CSF IgA NMDAR antibodies are potential biomarkers for teratomas in anti-NMDAR encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e166. [PMID: 26568967 PMCID: PMC4630685 DOI: 10.1212/nxi.0000000000000166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022]
Abstract
Objective: To evaluate the presence of immunoglobulin A (IgA) subtype of anti-NMDA receptor (NMDAR) antibodies (IgA-NMDAR-Abs) in the CSF of patients with immunoglobulin G (IgG)-NMDAR-Ab encephalitis and to describe the potential association with a specific clinical pattern. Methods: The retrospective analysis for the presence of IgA-NMDAR-Abs in 94 CSF samples from patients with anti-NMDAR encephalitis diagnosed between October 2007 and February 2014 was conducted at the French Reference Centre on Paraneoplastic Neurological Syndrome. This observational study compared 39 patients with both IgA- and IgG-NMDAR-Abs to 55 patients with only IgG-NMDAR-Abs. Results: In the retrospective cohort, 41% of the patients with NMDAR-Ab encephalitis had both CSF IgG- and IgA-NMDAR-Abs. Approximately half of the IgA-NMDAR-Ab-positive patients (18/38, 49%) definitively possessed associated tumors, primarily ovarian teratomas (17/18, 94%), compared with only 5% (3/55) of the patients in the IgA-NMDAR-Ab-negative group (p < 0.001). In the adult female population at risk for ovarian teratoma, the detection of CSF IgA-NMDAR-Ab positivity showed 85% sensitivity, 70% specificity, a 57% positive predictive value, and a 90% negative predictive value for the diagnosis of ovarian teratoma. No other specific clinical features or clinical outcome were associated with CSF IgA-NMDAR-Ab positivity. Conclusion: These results suggest that in patients with IgG-NMDAR-Ab encephalitis, CSF IgA-NMDAR-Abs could be used as a biological marker for the presence of an ovarian teratoma.
Collapse
Affiliation(s)
- Virginie Desestret
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Aude Chefdeville
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Aurélien Viaccoz
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Chloe Bost
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - François Ducray
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Géraldine Picard
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Veronique Rogemond
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Marie-Oceane Chaffois
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Charlotte Blanc
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Claire Bardel
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Isabelle Treilleux
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Olivier Pascual
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Jean-Christophe Antoine
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Jean-Yves Delattre
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| | - Jerome Honnorat
- Lyon Neuroscience Research Center (V.D., A.C., C. Bost, F.D., V.R., C. Blanc, O.P., J.-C.A., J.H.), INSERM U1028/CNRS UMR 5292; Université de Lyon-Université Claude Bernard Lyon 1 (V.D., A.C., C. Bost, F.D., V.R., C. Bardel, O.P., J.H.); the Department of Neurology D (V.D.) and French Reference Center on Paraneoplastic Neurological Syndrome (A.V., C. Bost, F.D., G.P., V.R., M.-O.C., C. Blanc, J.-C.A., J.-Y.D., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; Service de Biostatistique (C. Bardel), Hospices Civils de Lyon, CNRS UMR 5558; Laboratoire de Biométrie et Biologie Evolutive (C. Bardel), Equipe Biostatistique-Santé, Villeurbanne; the Department of Biopathology (I.T.), Centre de Recherche en Cancérologie de Lyon; Service de Neurologie (J.-C.A.), CHU de Saint-Etienne et Université de Lyon, Saint-Etienne; and Service de Neurologie Mazarin (J.-Y.D.), Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR S975, CNRS, UMR 7225, Paris, France
| |
Collapse
|
308
|
Kullmann DM. Brain. Editorial. Brain 2015; 138:3131. [PMID: 26503936 DOI: 10.1093/brain/awv314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
309
|
Armangue T, Moris G, Cantarín-Extremera V, Conde CE, Rostasy K, Erro ME, Portilla-Cuenca JC, Turón-Viñas E, Málaga I, Muñoz-Cabello B, Torres-Torres C, Llufriu S, González-Gutiérrez-Solana L, González G, Casado-Naranjo I, Rosenfeld M, Graus F, Dalmau J. Autoimmune post-herpes simplex encephalitis of adults and teenagers. Neurology 2015; 85:1736-43. [PMID: 26491084 DOI: 10.1212/wnl.0000000000002125] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/08/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To report 14 patients with immune-mediated relapsing symptoms post-herpes simplex encephalitis (HSE) and to compare the clinical and immunologic features of the teenage and adult group with those of young children. METHODS Prospective observational study of patients diagnosed between June 2013 and February 2015. Immunologic techniques have been reported previously. RESULTS Among the teenage and adult group (8 patients, median age 40 years, range 13-69; 5 male), 3 had an acute symptom presentation suggesting a viral relapse, and 5 a presentation contiguous with HSE suggesting a recrudescence of previous deficits. Seven patients developed severe psychiatric/behavioral symptoms disrupting all social interactions, and one refractory status epilepticus. Blepharospasm occurred in one patient. Five patients had CSF antibodies against NMDA receptor (NMDAR) and 3 against unknown neuronal cell surface proteins. In 5/6 patients, the brain MRI showed new areas of contrast enhancement that decreased after immunotherapy and clinical improvement. Immunotherapy was useful in 7/7 patients, sometimes with impressive recoveries, returning to their baseline HSE residual deficits. Compared with the 6 younger children (median age 13 months, range 6-20, all with NMDAR antibodies), the teenagers and adults were less likely to develop choreoathetosis (0/8 vs 6/6, p < 0.01) and decreased level of consciousness (2/8 vs 6/6, p < 0.01) and had longer delays in diagnosis and treatment (interval relapse/antibody testing 85 days, range 17-296, vs 4 days, range 0-33, p = 0.037). CONCLUSION In teenagers and adults, the immune-mediated relapsing syndrome post-HSE is different from that known in young children as choreoathetosis post-HSE and is underrecognized. Prompt diagnosis is important because immunotherapy can be highly effective.
Collapse
Affiliation(s)
- Thaís Armangue
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Germán Moris
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Verónica Cantarín-Extremera
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Carlos Enrique Conde
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Kevin Rostasy
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Maria Elena Erro
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Juan Carlos Portilla-Cuenca
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eulàlia Turón-Viñas
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Ignacio Málaga
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Beatriz Muñoz-Cabello
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Carmen Torres-Torres
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Sara Llufriu
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Luis González-Gutiérrez-Solana
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Guillermo González
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Ignacio Casado-Naranjo
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Myrna Rosenfeld
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Francesc Graus
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Neuroimmunology Program (T.A., S.L., M.R., F.G., J.D.), August Pi Sunyer Biomedical Research Institute (IDIBAPS), and the Department of Neurology (S.L., F.G), Hospital Clínic, University of Barcelona; the Department of Neurology (G.M.) and the Pediatric Neurology Unit, Pediatrics Department (I.M.), Hospital Universitario Central de Asturias, Oviedo; the Department of Pediatric Neurology (V.C.-E., L.G.-G.-S.), Hospital Universitario Niño Jesús, Madrid, Spain; the Department of Neurology (C.E.C., G.G.), Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia; the Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany; the Department of Neurology (M.E.E., I.C.-N.), Complejo Hospitalario de Navarra, Pamplona; the Department of Neurology (J.C.P.-C.), Hospital San Pedro de Alcántara, Cáceres; the Pediatric Neurology Unit (E.T.-V.), Hospital de la Santa Creu i Sant Pau, Barcelona; the Pediatric Neurology Unit (B.M.-C.), Hospital Universitario Virgen del Rocio, Sevilla; the Department of Pediatric Neurology (C.T.-T.), Hospital General La Mancha Centro, Alcázar de San Juan, Spain; the Department of Neurology (J.D.), University of Pennsylvania, Philadelphia; and the Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain.
| | | |
Collapse
|
310
|
Ransohoff RM, Schafer D, Vincent A, Blachère NE, Bar-Or A. Neuroinflammation: Ways in Which the Immune System Affects the Brain. Neurotherapeutics 2015; 12:896-909. [PMID: 26306439 PMCID: PMC4604183 DOI: 10.1007/s13311-015-0385-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Neuroinflammation is the response of the central nervous system (CNS) to disturbed homeostasis and typifies all neurological diseases. The main reactive components of the CNS include microglial cells and infiltrating myeloid cells, astrocytes, oligodendrocytes, and the blood-brain barrier, cytokines, and cytokine signaling. Neuroinflammatory responses may be helpful or harmful, as mechanisms associated with neuroinflammation are involved in normal brain development, as well as in neuropathological processes. This review examines the roles of various cell types that contribute to the immune dysregulation associated with neuroinflammation. Microglia enter the CNS very early in embryonic development and, as such, play an essential role in both the healthy and diseased brain. B-cell diversity contributes to CNS disease through both antibody-dependent and antibody-independent mechanisms. The influences of these B-cell mechanisms on other cell types, including myeloid cells and T cells, are reviewed in relationship to antibody-mediated CNS disorders, paraneoplastic neurological diseases, and multiple sclerosis. New insights into neuroinflammation offer exciting opportunities to investigate potential therapeutic targets for debilitating CNS diseases.
Collapse
Affiliation(s)
| | - Dorothy Schafer
- University of Massachusetts Medical School, Amherst, MA, USA
| | | | | | - Amit Bar-Or
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
311
|
Fauser S, Uttner I, Ariño H, Scherbaum WA, Saiz A, Lewerenz J. Long latency between GAD-antibody detection and development of limbic encephalitis--a case report. BMC Neurol 2015; 15:177. [PMID: 26420440 PMCID: PMC4589124 DOI: 10.1186/s12883-015-0435-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/21/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the pathogenesis of limbic encephalitis other promoting factors besides the pure existence of autoantibodies are increasingly discussed to play a significant role. This is to our knowledge the first described patient in whom the presence of autoantibodies precedes the manifestation of limbic encephalitis for many years. CASE PRESENTATION At the age of 38 years, in the serum of a patient with polyendocrine autoimmunity high titers of cytoplasmic islet cell antibodies and of anti-glutamate decarboxylase (GAD) 65 antibodies were observed as an incidential finding, GAD67 antibodies were negative at that time. After a latency of 18 years, she manifested with refractory temporal lobe epilepsy most likely due to autoimmune limbic encephalitis. After epilepsy onset, the patient underwent magnetic resonance imaging (MRI), electroencephalography, cerebrospinal fluid (CSF), serum and neuropsychological investigations during a follow-up period of 8 years. A pharmacoresistent epilepsy with seizure onset from the right temporal lobe and declarative memory deficits were observed affecting primarily the recall of verbal informations. MRI showed a slightly increased signal in the right amygdala without progression. GAD antibodies could be detected in serum (titre 1: 1000) and CSF (titre 1:1) by immunofluorescence. Both, GAD65 and GAD67 antibodies were observed in cell-based assays. CONCLUSIONS It can be assumed that in addition to a pre-existing systemic T-cell response associated with the longstanding polyendocrine autoimmunity, a delayed intrathecal autoimmunity developed leading to limbic encephalitis. This change might be reflected by the development of GAD67 antibodies in our patient. Besides the contribution of this case report to a better understandig of the pathomechanisms for the development of central nervous system (CNS) autoimmunity, it also has a clinical impact as early treatment of GAD antibody-associated CNS disorders has a better prognosis. Therefore, vigilance for symptoms indicating GAD antibody-associated CNS autoimmunity is mandatory in patients with GAD antibody-associated endocrine dysfunction.
Collapse
Affiliation(s)
- Susanne Fauser
- Department of Neurology, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany. .,Epilepsiezentrum Bethel, Maraweg, 2133617, Bielefeld, Germany.
| | - Ingo Uttner
- Department of Neurology, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Helena Ariño
- Service of Neurology, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic, Villarroel 170, Barcelona, 08036, Spain.
| | - Werner A Scherbaum
- Heinrich-Heine University, University Hospital, Moorenstrasse 5, 40225, Duesseldorf, Germany.
| | - Albert Saiz
- Service of Neurology, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic, Villarroel 170, Barcelona, 08036, Spain.
| | - Jan Lewerenz
- Department of Neurology, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| |
Collapse
|
312
|
Venkatesan A, Benavides DR. Autoimmune encephalitis and its relation to infection. Curr Neurol Neurosci Rep 2015; 15:3. [PMID: 25637289 DOI: 10.1007/s11910-015-0529-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Encephalitis, an inflammatory condition of the brain that results in substantial morbidity and mortality, has numerous causes. Over the past decade, it has become increasingly recognized that autoimmune conditions contribute significantly to the spectrum of encephalitis causes. Clinical suspicion and early diagnosis of autoimmune etiologies are of particular importance due to the need for early institution of immune suppressive therapies to improve outcome. Emerging clinical observations suggest that the most commonly recognized cause of antibody-mediated autoimmune encephalitis, anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, may in some cases be triggered by herpes virus infection. Other conditions such as Rasmussen's encephalitis (RE) and febrile infection-related epilepsy syndrome (FIRES) have also been posited to be autoimmune conditions triggered by infectious agents. This review focuses on emerging concepts in central nervous system autoimmunity and addresses clinical and mechanistic findings linking autoimmune encephalitis and infections. Particular consideration will be given to anti-NMDA receptor encephalitis and its relation to herpes simplex encephalitis.
Collapse
Affiliation(s)
- Arun Venkatesan
- Johns Hopkins Encephalitis Center, Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
| | | |
Collapse
|
313
|
Wright S, Hashemi K, Stasiak L, Bartram J, Lang B, Vincent A, Upton AL. Epileptogenic effects of NMDAR antibodies in a passive transfer mouse model. Brain 2015; 138:3159-67. [PMID: 26373601 DOI: 10.1093/brain/awv257] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/21/2015] [Indexed: 12/20/2022] Open
Abstract
Most patients with N-methyl D-aspartate-receptor antibody encephalitis develop seizures but the epileptogenicity of the antibodies has not been investigated in vivo. Wireless electroencephalogram transmitters were implanted into 23 C57BL/6 mice before left lateral ventricle injection of antibody-positive (test) or healthy (control) immunoglobulin G. Mice were challenged 48 h later with a subthreshold dose (40 mg/kg) of the chemo-convulsant pentylenetetrazol and events recorded over 1 h. Seizures were assessed by video observation of each animal and the electroencephalogram by an automated seizure detection programme. No spontaneous seizures were seen with the antibody injections. However, after the pro-convulsant, the test mice (n = 9) had increased numbers of observed convulsive seizures (P = 0.004), a higher total seizure score (P = 0.003), and a higher number of epileptic 'spike' events (P = 0.023) than the control mice (n = 6). At post-mortem, surprisingly, the total number of N-methyl D-aspartate receptors did not differ between test and control mice, but in test mice the levels of immunoglobulin G bound to the left hippocampus were higher (P < 0.0001) and the level of bound immunoglobulin G correlated with the seizure scores (R(2) = 0.8, P = 0.04, n = 5). Our findings demonstrate the epileptogenicity of N-methyl D-aspartate receptor antibodies in vivo, and suggest that binding of immunoglobulin G either reduced synaptic localization of N-methyl D-aspartate receptors, or had a direct effect on receptor function, which could be responsible for seizure susceptibility in this acute short-term model.
Collapse
Affiliation(s)
- Sukhvir Wright
- 1 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Kevan Hashemi
- 2 Open Source Instruments Inc, 130 Mount Auburn Street, Watertown, MA 02472, USA
| | - Lukasz Stasiak
- 3 Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| | - Julian Bartram
- 3 Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| | - Bethan Lang
- 1 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - Angela Vincent
- 1 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, OX3 9DU, UK
| | - A Louise Upton
- 3 Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, OX1 3PT, UK
| |
Collapse
|
314
|
Prüss H, Leubner J, Wenke NK, Czirják GÁ, Szentiks CA, Greenwood AD. Anti-NMDA Receptor Encephalitis in the Polar Bear (Ursus maritimus) Knut. Sci Rep 2015; 5:12805. [PMID: 26313569 PMCID: PMC4551079 DOI: 10.1038/srep12805] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 07/06/2015] [Indexed: 12/31/2022] Open
Abstract
Knut the polar bear of the Berlin Zoological Garden drowned in 2011 following seizures and was diagnosed as having suffered encephalitis of unknown etiology after exhaustive pathogen screening. Using the diagnostic criteria applied to human patients, we demonstrate that Knut’s encephalitis is almost identical to anti-NMDA receptor encephalitis which is a severe autoimmune disease representing the most common non-infectious encephalitis in humans. High concentrations of antibodies specific against the NR1 subunit of the NMDA receptor were detected in Knut’s cerebrospinal fluid. Histological examination demonstrated very similar patterns of plasma cell infiltration and minimal neuronal loss in affected brain areas. We conclude that Knut suffered anti-NMDA receptor encephalitis making his the first reported non-human case of this treatable disease. The results suggest that anti-NMDA receptor encephalitis may be a disease of broad relevance to mammals that until now has remained undiagnosed.
Collapse
Affiliation(s)
- H Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Leubner
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Germany
| | - N K Wenke
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Germany
| | - G Á Czirják
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - C A Szentiks
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - A D Greenwood
- Department of Wildlife Diseases, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| |
Collapse
|
315
|
|
316
|
Abstract
The hippocampus has a pivotal role in learning and in the formation and consolidation of memory and is critically involved in the regulation of emotion, fear, anxiety, and stress. Studies of the hippocampus have been central to the study of memory in humans and in recent years, the regional specialization and organization of hippocampal functions have been elucidated in experimental models and in human neurological and psychiatric diseases. The hippocampus has long been considered a classic model for the study of neuroplasticity as many examples of synaptic plasticity such as long-term potentiation and -depression have been identified and demonstrated in hippocampal circuits. Neuroplasticity is the ability to adapt and reorganize the structure or function to internal or external stimuli and occurs at the cellular, population, network or behavioral level and is reflected in the cytological and network architecture as well as in intrinsic properties of hippocampal neurons and circuits. The high degree of hippocampal neuroplasticity might, however, be also negatively reflected in the pronounced vulnerability of the hippocampus to deleterious conditions such as ischemia, epilepsy, chronic stress, neurodegeneration and aging targeting hippocampal structure and function and leading to cognitive deficits. Considering this framework of plasticity and vulnerability, we here review basic principles of hippocampal anatomy and neuroplasticity on various levels as well as recent findings regarding the functional organization of the hippocampus in light of the regional vulnerability in Alzheimer's disease, ischemia, epilepsy, neuroinflammation and aging.
Collapse
Affiliation(s)
- T Bartsch
- Department of Neurology, Memory Disorders and Plasticity Group, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - P Wulff
- Institute of Physiology, Neurophysiology, University of Kiel, Olshausenstrasse 40, 24098 Kiel, Germany.
| |
Collapse
|
317
|
Ehling P, Melzer N, Budde T, Meuth SG. CD8(+) T Cell-Mediated Neuronal Dysfunction and Degeneration in Limbic Encephalitis. Front Neurol 2015; 6:163. [PMID: 26236280 PMCID: PMC4502349 DOI: 10.3389/fneur.2015.00163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/02/2015] [Indexed: 12/31/2022] Open
Abstract
Autoimmune inflammation of the limbic gray matter structures of the human brain has recently been identified as major cause of mesial temporal lobe epilepsy with interictal temporal epileptiform activity and slowing of the electroencephalogram, progressive memory disturbances, as well as a variety of other behavioral, emotional, and cognitive changes. Magnetic resonance imaging exhibits volume and signal changes of the amygdala and hippocampus, and specific anti-neuronal antibodies binding to either intracellular or plasma membrane neuronal antigens can be detected in serum and cerebrospinal fluid. While effects of plasma cell-derived antibodies on neuronal function and integrity are increasingly becoming characterized, potentially contributing effects of T cell-mediated immune mechanisms remain poorly understood. CD8+ T cells are known to directly interact with major histocompatibility complex class I-expressing neurons in an antigen-specific manner. Here, we summarize current knowledge on how such direct CD8+ T cell–neuron interactions may impact neuronal excitability, plasticity, and integrity on a single cell and network level and provide an overview on methods to further corroborate the in vivo relevance of these mechanisms mainly obtained from in vitro studies.
Collapse
Affiliation(s)
- Petra Ehling
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany ; Institute of Physiology I - Neuropathophysiology, Westfälische Wilhelms-University , Münster , Germany
| | - Nico Melzer
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany
| | - Thomas Budde
- Institute of Physiology I, Westfälische Wilhelms-University , Münster , Germany
| | - Sven G Meuth
- Department of Neurology, Westfälische Wilhelms-University of Münster , Münster , Germany ; Institute of Physiology I - Neuropathophysiology, Westfälische Wilhelms-University , Münster , Germany
| |
Collapse
|
318
|
Seebohm G, Piccini I, Strutz-Seebohm N. Paving the Way to Understand Autoantibody-Mediated Epilepsy on the Molecular Level. Front Neurol 2015. [PMID: 26217297 PMCID: PMC4491625 DOI: 10.3389/fneur.2015.00149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Correct function of neuronal networks is enabled by a delicate interplay among neurons communicating with each other. One of the keys is the communication at chemical synapses where neurotransmitters like glutamate, GABA, and glycine enable signal transfer over the synaptic cleft. Thereby, the neurotransmitters are released from the presynapse and bind as ligands to specific receptors at the postsynaptic side to allow for modulation of the postsynaptic membrane potentials. The postsynaptic electrical signal, which is highly modulated by voltage-gated ion channels, spreads over the dendritic tree and is thus integrated to allow for generation of action potentials at the axon hillock. This concert of receptors and voltage-gated ion channels depends on correct function of all its components. Misfunction of receptors and/or voltage-gated potassium channels (VGKC) leads to diverse adverse effects in patients. Such malfunctions can be the result of inherited genetic alterations or pharmacological side effects by drugs. Recently, autoantibodies targeting receptor or channel complexes like NMDAR, AMPAR, GABA-receptors, glycine receptors, LGI1 or CASPR2 (previously termed as VGKC-complex antibodies) have been discovered. The presence of specific autoantibodies against these targets associates with severe forms of antibody-mediated encephalitis. Understanding the molecular details of autoantibody actions on receptor and VGKC complexes is highly desirable and may open the path to develop specific therapies to treat humoral autoimmune encephalitis. Here, we summarize the current knowledge and discuss technical approaches to fill the gap of knowledge. These techniques include electrophysiology, biochemical approaches for epitope mapping, and in silico modeling to simulate molecular interactions between autoantibody and its molecular target.
Collapse
Affiliation(s)
- Guiscard Seebohm
- Receptor Structure and Function Group, Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster , Münster , Germany
| | - Ilaria Piccini
- Receptor Structure and Function Group, Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster , Münster , Germany
| | - Nathalie Strutz-Seebohm
- Receptor Structure and Function Group, Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases (IfGH), University Hospital Münster , Münster , Germany
| |
Collapse
|
319
|
Spatola M, Novy J, Du Pasquier R, Dalmau J, Rossetti AO. Status epilepticus of inflammatory etiology: a cohort study. Neurology 2015; 85:464-70. [PMID: 26092915 DOI: 10.1212/wnl.0000000000001717] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/01/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Inflammation-related epilepsy is increasingly recognized; however, studies on status epilepticus (SE) are very infrequent. We therefore aimed to determine the frequency of inflammatory etiologies in adult SE, and to assess related demographic features and outcomes. METHODS This was a retrospective analysis of a prospective registry of adult patients with SE treated in our center, from January 2008 to June 2014, excluding postanoxic causes. We classified SE episodes into 3 etiologic categories: infectious, autoimmune, and noninflammatory. Demographic and clinical variables were analyzed regarding their relationship to etiologies and functional outcome. RESULTS Among the 570 SE consecutive episodes, 33 (6%) were inflammatory (2.5% autoimmune; 3.3% infectious), without any change in frequency over the study period. Inflammatory SE episodes involved younger patients (mean age 53 vs 61 years, p = 0.015) and were more often refractory to initial antiepileptic treatment (58% vs 38%, odds ratio = 2.19, 95% confidence interval = 1.07-4.47, p = 0.041), despite similar clinical outcome. Subgroup analysis showed that, compared with infectious SE episodes, autoimmune SE involved younger adults (mean age 44 vs 60 years, p = 0.017) and was associated with lower morbidity (return to baseline conditions in 71% vs 32%, odds ratio = 5.41, 95% confidence interval = 1.19-24.52, p = 0.043) without any difference in mortality. CONCLUSIONS Despite increasing awareness, inflammatory SE etiologies were relatively rare; their occurrence in younger individuals and higher refractoriness to treatment did not have any effect on outcome. Autoimmune SE episodes also occurred in younger patients, but tended to have better outcomes in survivors than infectious SE.
Collapse
Affiliation(s)
- Marianna Spatola
- From the Service of Neurology (M.S., J.N., R.D.P., A.O.R.), Department of Clinical Neurosciences, CHUV and University of Lausanne, Switzerland; IDIBAPS and Service of Neurology (J.D.), Hospital Clinic, University of Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia
| | - Jan Novy
- From the Service of Neurology (M.S., J.N., R.D.P., A.O.R.), Department of Clinical Neurosciences, CHUV and University of Lausanne, Switzerland; IDIBAPS and Service of Neurology (J.D.), Hospital Clinic, University of Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia
| | - Renaud Du Pasquier
- From the Service of Neurology (M.S., J.N., R.D.P., A.O.R.), Department of Clinical Neurosciences, CHUV and University of Lausanne, Switzerland; IDIBAPS and Service of Neurology (J.D.), Hospital Clinic, University of Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia
| | - Josep Dalmau
- From the Service of Neurology (M.S., J.N., R.D.P., A.O.R.), Department of Clinical Neurosciences, CHUV and University of Lausanne, Switzerland; IDIBAPS and Service of Neurology (J.D.), Hospital Clinic, University of Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia
| | - Andrea O Rossetti
- From the Service of Neurology (M.S., J.N., R.D.P., A.O.R.), Department of Clinical Neurosciences, CHUV and University of Lausanne, Switzerland; IDIBAPS and Service of Neurology (J.D.), Hospital Clinic, University of Barcelona, Spain; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia.
| |
Collapse
|
320
|
Sinmaz N, Amatoury M, Merheb V, Ramanathan S, Dale RC, Brilot F. Autoantibodies in movement and psychiatric disorders: updated concepts in detection methods, pathogenicity, and CNS entry. Ann N Y Acad Sci 2015; 1351:22-38. [DOI: 10.1111/nyas.12764] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Nese Sinmaz
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
| | - Mazen Amatoury
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
| | - Vera Merheb
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
| | - Russell C. Dale
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
- Discipline of Paediatrics and Child Health; Sydney Medical School, University of Sydney; Sydney Australia
| | - Fabienne Brilot
- Neuroimmunology Group, Institute for Neuroscience and Muscle Research; Kids Research Institute at The Children's Hospital at Westmead, University of Sydney; Sydney Australia
- Discipline of Paediatrics and Child Health; Sydney Medical School, University of Sydney; Sydney Australia
| |
Collapse
|
321
|
Haselmann H, Röpke L, Werner C, Kunze A, Geis C. Interactions of Human Autoantibodies with Hippocampal GABAergic Synaptic Transmission - Analyzing Antibody-Induced Effects ex vivo. Front Neurol 2015; 6:136. [PMID: 26124746 PMCID: PMC4463933 DOI: 10.3389/fneur.2015.00136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/28/2015] [Indexed: 02/04/2023] Open
Abstract
Autoantibodies (aAB) to the presynaptic located enzyme glutamate decarboxylase 65 (GAD65) are a characteristic attribute for a variety of autoimmune diseases of the central nervous system including subtypes of limbic encephalitis, stiff person-syndrome, cerebellar ataxia, and Batten’s disease. Clinical signs of hyperexcitability and improvement of disease symptoms upon immunotherapy in some of these disorders suggest a possible pathogenic role of associated aAB. Recent experimental studies report inconsistent results regarding a direct pathogenic influence of anti-GAD65 aAB affecting inhibitory synaptic transmission in central GABAergic pathways. We here provide a method for direct evaluation of aAB-induced pathomechanisms in the intact hippocampal network. Purified patient IgG fractions containing aAB to GAD65 together with fixable lipophilic styryl dyes (FMdyes) are stereotactically injected into the hilus and the dentate gyrus in anesthetized mice. Twenty-four hours after intrahippocampal injection, acute hippocampal slices are prepared and transferred to a patch-clamp recording setup equipped with a fluorescence light source. Intraneural incorporated FMdyes show correct injection site for patch-clamp recording. Whole-cell patch-clamp recordings are performed from granule cells in the dentate gyrus and extracellular stimulation is applied in the border area of the dentate gyrus-hilus region to stimulate GABAergic afferents arising from parvalbumin positive basket cells. GABA-A receptor mediated inhibitory postsynaptic currents (IPSC) and miniature IPSC are recorded after blocking glutamatergic transmission. This approach allows investigation of potential aAB-induced effects on GABA-A receptor signaling ex vivo in an intact neuronal network. This offers several advantages compared to experimental procedures used in previous studies by in vitro AB preincubation of primary neurons or slice preparations. Furthermore, this method requires only small amounts of patient material that are often limited in rare diseases.
Collapse
Affiliation(s)
- Holger Haselmann
- Hans Berger Department of Neurology, Jena University Hospital , Jena , Germany ; The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital , Jena , Germany
| | - Luise Röpke
- Hans Berger Department of Neurology, Jena University Hospital , Jena , Germany
| | - Christian Werner
- Hans Berger Department of Neurology, Jena University Hospital , Jena , Germany
| | - Albrecht Kunze
- Hans Berger Department of Neurology, Jena University Hospital , Jena , Germany
| | - Christian Geis
- Hans Berger Department of Neurology, Jena University Hospital , Jena , Germany ; The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital , Jena , Germany
| |
Collapse
|
322
|
León-Caballero J, Pacchiarotti I, Murru A, Valentí M, Colom F, Benach B, Pérez V, Dalmau J, Vieta E. Bipolar disorder and antibodies against the N-methyl-d-aspartate receptor: A gate to the involvement of autoimmunity in the pathophysiology of bipolar illness. Neurosci Biobehav Rev 2015; 55:403-12. [PMID: 26014349 DOI: 10.1016/j.neubiorev.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 05/04/2015] [Accepted: 05/11/2015] [Indexed: 01/15/2023]
Abstract
The high prevalence of comorbidity between bipolar disorder (BD) and other medical conditions, including autoimmune diseases, supports the hypothesis of the nature of BD as a biological illness category. Hence, an immune dysregulation process may play an important role in the development of at least certain subtypes of BD. Increasing evidence also suggests that the N-methyl-d-aspartate receptor (NMDAR) may be relevant in the pathophysiology of BD. A possible key mechanism underlying the physiopathology of certain autoimmune diseases that may present with affective symptoms might be the production of anti-NMDAR auto-antibodies (auto-Abs). The best characterized autoimmune anti-NMDAR disease is the anti-NMDAR encephalitis. It has been found that 4% of these patients present isolated, mostly affective, psychiatric manifestations during their illness. An interesting suggestion emerged from this overview is that the same mechanisms that trigger affective symptoms in patients with increased anti-NMDAR auto-Abs levels could be involved in the physiopathology of at least a subgroup of BD. Future studies are needed to characterize the relationship between anti-NMDAR auto-Abs and BD.
Collapse
Affiliation(s)
- J León-Caballero
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Universidad Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - I Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - M Valentí
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - F Colom
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - B Benach
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - V Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Universidad Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - J Dalmau
- Catalan Institution for Research and Advanced Studies (ICREA), IDIBAPS, University of Barcelona; Department of Neurology, University of Pennsylvania
| | - E Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| |
Collapse
|
323
|
Joubert B, Honnorat J. Autoimmune channelopathies in paraneoplastic neurological syndromes. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2015; 1848:2665-76. [PMID: 25883091 DOI: 10.1016/j.bbamem.2015.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/10/2015] [Accepted: 04/03/2015] [Indexed: 01/17/2023]
Abstract
Paraneoplastic neurological syndromes and autoimmune encephalitides are immune neurological disorders occurring or not in association with a cancer. They are thought to be due to an autoimmune reaction against neuronal antigens ectopically expressed by the underlying tumour or by cross-reaction with an unknown infectious agent. In some instances, paraneoplastic neurological syndromes and autoimmune encephalitides are related to an antibody-induced dysfunction of ion channels, a situation that can be labelled as autoimmune channelopathies. Such functional alterations of ion channels are caused by the specific fixation of an autoantibody upon its target, implying that autoimmune channelopathies are usually highly responsive to immuno-modulatory treatments. Over the recent years, numerous autoantibodies corresponding to various neurological syndromes have been discovered and their mechanisms of action partially deciphered. Autoantibodies in neurological autoimmune channelopathies may target either directly ion channels or proteins associated to ion channels and induce channel dysfunction by various mechanisms generally leading to the reduction of synaptic expression of the considered channel. The discovery of those mechanisms of action has provided insights on the regulation of the synaptic expression of the altered channels as well as the putative roles of some of their functional subdomains. Interestingly, patients' autoantibodies themselves can be used as specific tools in order to study the functions of ion channels. This article is part of a Special Issue entitled: Membrane channels and transporters in cancers.
Collapse
Affiliation(s)
- Bastien Joubert
- University Lyon 1, University Lyon, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France; INSERM, UMR-S1028, CNRS, UMR-5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team, 7, Rue Guillaume Paradin, Lyon Cedex 08F-69372, France
| | - Jérôme Honnorat
- University Lyon 1, University Lyon, Rue Guillaume Paradin, 69372 Lyon Cedex 08, France; INSERM, UMR-S1028, CNRS, UMR-5292, Lyon Neuroscience Research Center, Neuro-Oncology and Neuro-Inflammation Team, 7, Rue Guillaume Paradin, Lyon Cedex 08F-69372, France; National Reference Centre for Paraneoplastic Neurological Diseases, hospices civils de Lyon, hôpital neurologique, 69677 Bron, France; Hospices Civils de Lyon, Neuro-oncology, Hôpital Neurologique, F-69677 Bron, France.
| |
Collapse
|
324
|
Ramberger M, Peschl P, Schanda K, Irschick R, Höftberger R, Deisenhammer F, Rostásy K, Berger T, Dalmau J, Reindl M. Comparison of diagnostic accuracy of microscopy and flow cytometry in evaluating N-methyl-D-aspartate receptor antibodies in serum using a live cell-based assay. PLoS One 2015; 10:e0122037. [PMID: 25815887 PMCID: PMC4376531 DOI: 10.1371/journal.pone.0122037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 02/06/2015] [Indexed: 01/17/2023] Open
Abstract
N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune neurological disease, diagnosed by a specific autoantibody against NMDAR. Antibody testing using commercially available cell-based assays (CBA) or immunohistochemistry on rat brain tissue has proven high specificity and sensitivity. Here we compare an immunofluorescence live CBA to a flow cytometry (FACS) based assay to detect NMDAR antibodies by their binding to the surface of HEK293A cells functionally expressing NMDAR. Both assays were first established using a discovery group of 76 individuals and then validated in a group of 32 patients in a blinded manner. In the CBA, 23 of 23 patients with NMDAR encephalitis were positive for NMDAR antibodies and 0 of 85 controls (32 healthy controls and 53 patients with other neurological diseases), resulting in a sensitivity and specificity of 100% (95% confidence intervals (CI) 85.1-100.0 and 95.7-100.0, respectively). The FACS based assay detected NMDAR antibodies in 20 of 23 patients and in 0 of 85 controls. Therefore, with an equally high specificity (95% CI 95.7-100.0) the sensitivity of the FACS based assay was 87% (95% CI 66.4-97.2). Comparing antibody titers from CBA with delta median fluorescence intensities from FACS showed a high concordance (kappa = 0.943, p<0.0001) and correlation (r = 0.697, p<0.0001). In conclusion, evaluation of the FACS based assay revealed a lower sensitivity and high inter-assay variation, making the CBA a more reliable detection method.
Collapse
Affiliation(s)
- Melanie Ramberger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrick Peschl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Regina Irschick
- Division of Neuroanatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Institució Catalana de Recerca i Estudis Avançats (ICREA), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Florian Deisenhammer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kevin Rostásy
- Pediatric Neurology, Witten/Herdecke University, Children’s Hospital Datteln, Datteln, Germany
| | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Josep Dalmau
- Institució Catalana de Recerca i Estudis Avançats (ICREA), IDIBAPS, Hospital Clínic, Barcelona, Spain
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| |
Collapse
|
325
|
Gresa-Arribas N, Ariño H, Martínez-Hernández E, Petit-Pedrol M, Sabater L, Saiz A, Dalmau J, Graus F. Antibodies to inhibitory synaptic proteins in neurological syndromes associated with glutamic acid decarboxylase autoimmunity. PLoS One 2015; 10:e0121364. [PMID: 25774787 PMCID: PMC4361655 DOI: 10.1371/journal.pone.0121364] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/31/2015] [Indexed: 12/12/2022] Open
Abstract
Antibodies to glutamic acid decarboxylase (GAD-ab) associate to different neurological syndromes. It is unknown if the diversity in syndrome association represents epitopes in different immunodominant domains or co-existence of antibodies to other proteins of the inhibitory synapsis. We examined the serum and CSF of 106 patients with anti-GAD related syndromes (39 cerebellar ataxia, 32 stiff-person syndrome [SPS], 18 epilepsy, and 17 limbic encephalitis [LE]). GAD65-ab titres were quantified by ELISA. Immunoblot was used to determine if the antibody-targeted epitopes of GAD65 and GAD67 were linear. A cell-based assay (CBA) with HEK293 cells expressing the GAD65 N-terminal, central catalytic domain, or C-terminal was used to investigate the immunodominant domains. Antibodies to GAD67, gamma-aminobutyric acid A receptor (GABAaR), glycine receptor (GlyR), GABAaR-associated protein (GABARAP), and gephyrin were determined with CBA. GAD-ab internalization was investigated using cultured rat hippocampal neurons. CSF GAD65-ab titres were higher in patients with cerebellar ataxia and LE compared to those with SPS (p = 0.02). GAD67-ab were identified in 81% of sera and 100% of CSF. GAD65-ab recognized linear epitopes in 98% of the patients and GAD67-ab in 42% (p<0.001). The GAD65 catalytic domain was recognized by 93% of sera, and the three domains by 22% of sera and 74% of CSF (p<0.001). Six patients had GABAaR-ab and another 6 had GlyR-ab without association to distinctive symptoms. None of the patients had gephyrin- or GABARAP-ab. GAD65-ab were not internalized by live neurons. Overall, these findings show that regardless of the neurological syndrome, the CSF immune response against GAD is more widespread than that of the serum and that there is no specific association between clinical phenotype and the presence of antibodies against other proteins of the inhibitory synapsis.
Collapse
Affiliation(s)
- Nuria Gresa-Arribas
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Helena Ariño
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Service of Neurology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Eugenia Martínez-Hernández
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Service of Neurology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Mar Petit-Pedrol
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lidia Sabater
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Albert Saiz
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Service of Neurology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Francesc Graus
- Neuroimmunology Program, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Service of Neurology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
326
|
Desestret V, Pascual O, Honnorat J. A mouse model of autoimmune encephalitis. ACTA ACUST UNITED AC 2015; 138:5-8. [PMID: 25564489 DOI: 10.1093/brain/awu342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Virginie Desestret
- 1 French Reference Centre on Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, F-69677 Bron, France 2 Lyon Neuroscience Research Centre INSERM U1028/CNRS UMR 5292, F-69372 Lyon, France 3 Université de Lyon - Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Olivier Pascual
- 2 Lyon Neuroscience Research Centre INSERM U1028/CNRS UMR 5292, F-69372 Lyon, France 3 Université de Lyon - Université Claude Bernard Lyon 1, F-69372 Lyon, France
| | - Jérôme Honnorat
- 1 French Reference Centre on Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, F-69677 Bron, France 2 Lyon Neuroscience Research Centre INSERM U1028/CNRS UMR 5292, F-69372 Lyon, France 3 Université de Lyon - Université Claude Bernard Lyon 1, F-69372 Lyon, France
| |
Collapse
|