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Manto M, Hadjivassiliou M, Baizabal-Carvallo JF, Hampe CS, Honnorat J, Joubert B, Mitoma H, Muñiz-Castrillo S, Shaikh AG, Vogrig A. Consensus Paper: Latent Autoimmune Cerebellar Ataxia (LACA). CEREBELLUM (LONDON, ENGLAND) 2024; 23:838-855. [PMID: 36991252 PMCID: PMC10060034 DOI: 10.1007/s12311-023-01550-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/01/2023]
Abstract
Immune-mediated cerebellar ataxias (IMCAs) have diverse etiologies. Patients with IMCAs develop cerebellar symptoms, characterized mainly by gait ataxia, showing an acute or subacute clinical course. We present a novel concept of latent autoimmune cerebellar ataxia (LACA), analogous to latent autoimmune diabetes in adults (LADA). LADA is a slowly progressive form of autoimmune diabetes where patients are often initially diagnosed with type 2 diabetes. The sole biomarker (serum anti-GAD antibody) is not always present or can fluctuate. However, the disease progresses to pancreatic beta-cell failure and insulin dependency within about 5 years. Due to the unclear autoimmune profile, clinicians often struggle to reach an early diagnosis during the period when insulin production is not severely compromised. LACA is also characterized by a slowly progressive course, lack of obvious autoimmune background, and difficulties in reaching a diagnosis in the absence of clear markers for IMCAs. The authors discuss two aspects of LACA: (1) the not manifestly evident autoimmunity and (2) the prodromal stage of IMCA's characterized by a period of partial neuronal dysfunction where non-specific symptoms may occur. In order to achieve an early intervention and prevent cell death in the cerebellum, identification of the time-window before irreversible neuronal loss is critical. LACA occurs during this time-window when possible preservation of neural plasticity exists. Efforts should be devoted to the early identification of biological, neurophysiological, neuropsychological, morphological (brain morphometry), and multimodal biomarkers allowing early diagnosis and therapeutic intervention and to avoid irreversible neuronal loss.
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Affiliation(s)
- Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium
- Service des Neurosciences, University of Mons, Mons, Belgium
| | | | | | | | - Jerome Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Institut NeuroMyoGene MELIS INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Institut NeuroMyoGene MELIS INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan.
| | | | - Aasef G Shaikh
- Louis Stokes Cleveland VA Medical Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alberto Vogrig
- Clinical Neurology, Udine University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
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Khatib L, Do LD, Benaiteau M, Villagrán-García M, Scharf M, Meyer P, Haidar LA, Demeret S, Honnorat J. Autoimmune Cerebellar Ataxia Associated with Anti-Glutamate Receptor δ2 Antibodies: a Rare but Treatable Entity. CEREBELLUM (LONDON, ENGLAND) 2024; 23:260-266. [PMID: 36696031 DOI: 10.1007/s12311-023-01523-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
We report two novel cases of autoimmune cerebellar ataxia (ACA) associated with anti-glutamate receptor δ2 antibodies (Gluδ2-Abs). The first case was confirmed by indirect immunofluorescence and cell-based assays: a 29-year-old woman presented after 5 days of headache and vomiting, a pancerebellar syndrome, downbeat nystagmus, decreased visual acuity linked to bilateral retrobulbar optic neuritis (RON), and lymphocytic pleocytosis in the cerebrospinal fluid (CSF) without any abnormality detected using cerebral magnetic resonance imaging (MRI). Second-line immunotherapy allowed progressive clinical improvement, with full recovery achieved after a 4-year follow-up. Thereafter, we retrospectively tested Gluδ2-Abs in 350 patients with a suspicion of autoimmune encephalitis without characterized autoantibody. We identified a second case, a 12-year-old boy who developed 10 days after a respiratory infection, a static cerebellar syndrome with lymphocytosis in the CSF, and right cerebellum hyperintensity in MRI. Five days of corticosteroid treatment allowed a quick clinical improvement. No tumor was identified in both cases, whereas laboratory analyses revealed autoimmune stigma. The present cases suggested that ACA associated with Gluδ2-Abs is an extremely rare but treatable disease. Therefore, testing for Gluδ2-Abs might be considered in the setting of suspected ACA and no initial antibody identification. The visual deficits and ocular motility abnormalities observed in the first reported case might be part of the clinical spectrum of Gluδ2-Abs ACA. Young age, infectious prodromes, lymphocytic pleocytosis, and autoimmune background usually appear together with this syndrome and should lead to discuss the initiation of immunotherapy (after ruling out differential diagnosis, especially infectious causes).
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Affiliation(s)
- Laura Khatib
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
| | - Le-Duy Do
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Benaiteau
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
| | - Macarena Villagrán-García
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Madeleine Scharf
- Institute of Experimental Immunology, affiliated to EURIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Pierre Meyer
- Pediatric Neurology Department, CHU de Montpellier, Montpellier, France
- Phymedexp, CNRS, INSERM, Université de Montpellier, Montpellier, France
| | - Lydia Abou Haidar
- Pediatric Neurology Department, CHU de Montpellier, Montpellier, France
| | - Sophie Demeret
- Neurology departement, CHU Pitie Salpetrière, Paris, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France.
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
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Miske R, Hahn S, Rosenkranz T, Müller M, Dettmann IM, Mindorf S, Denno Y, Brakopp S, Scharf M, Teegen B, Probst C, Melzer N, Meinck HM, Terborg C, Stöcker W, Komorowski L. Autoantibodies against glutamate receptor δ2 after allogenic stem cell transplantation. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e255. [PMID: 27458598 PMCID: PMC4946772 DOI: 10.1212/nxi.0000000000000255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/11/2016] [Indexed: 12/03/2022]
Abstract
Objective: To report on a Caucasian patient who developed steroid-responsive transverse myelitis, graft vs host disease of the gut, and anti-GluRδ2 after allogenic stem cell transplantation. Methods: Histoimmunoprecipitation (HIP) with the patient's serum and cryosections of rat and porcine cerebellum followed by mass spectrometry was used to identify the autoantigen. Correct identification was verified by indirect immunofluorescence using recombinant GluRδ2 expressed in HEK293 cells. Results: The patient's serum produced a granular staining of the cerebellar molecular layer (immunoglobulin G1 and immunoglobulin G3; endpoint titer: 1:1,000) but did not react with other CNS tissues or 28 established recombinant neural autoantigens. HIP revealed a unique protein band at ∼110 kDa that was identified as GluRδ2. The patient's serum also stained GluRδ2 transfected but not mock-transfected HEK293 cells. Control sera from 38 patients with multiple sclerosis, 85 patients with other neural autoantibodies, and 205 healthy blood donors were negative for anti-GluRδ2. Preadsorption with lysate from HEK293-GluRδ2 neutralized the patient's tissue reaction whereas control lysate had no effect. In addition to anti-GluRδ2, the patient's serum contained immunoglobulin G autoantibodies against the pancreatic glycoprotein CUZD1, which are known to be markers of Crohn disease. Conclusions: In the present case, the development of anti-GluRδ2 was associated with transverse myelitis, which was supposedly triggered by the stem cell transplantation. Similar to encephalitis in conjunction with anti-GluRδ2 reported in a few Japanese patients, the patient's neurologic symptoms ameliorated after steroid therapy.
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Affiliation(s)
- Ramona Miske
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Stefanie Hahn
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Thorsten Rosenkranz
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Matthias Müller
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Inga M Dettmann
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Swantje Mindorf
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Yvonne Denno
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Stefanie Brakopp
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Madeleine Scharf
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Bianca Teegen
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Christian Probst
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Nico Melzer
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Hans-Michael Meinck
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Christoph Terborg
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Winfried Stöcker
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology (R.M., S.H., I.M.D., S.M., Y.D., S.B., B.T., C.P., W.S., L.K.), Euroimmun AG, Lübeck; Department of Neurology (T.R., M.M., C.T.), Asklepios Klinik St. Georg, Hamburg; Department of Neurology (N.M.), University of Münster; and Department of Neurology (H.-M.M.), University of Heidelberg, Germany
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