Detection of anti-brain serum antibodies using a semi-quantitative immunohistological method

The Hypothalamic-Pituitary Axis and Autoantibody Related Disorders

This review summarized different studies reporting the presence of autoantibodies reacting against cells of the pituitary (APAs) and/or hypothalamus (AHAs). Both APAs and AHAs have been revealed through immunofluorescence using different kinds of substrates. Autoantibodies against gonadotropic cells were mainly found in patients affected by cryptorchidism and hypogonadotropic hypogonadism while those against prolactin cells were found in different kinds of patients, the majority without pituitary abnormalities. APAs to growth hormone (GH) cells have been associated with GH deficiency while those against the adrenocorticotropic cells have distinguished central Cushing's disease patients at risk of incomplete cure after surgical adenoma removal. AHAs to vasopressin cells have identified patients at risk of developing diabetes insipidus. APAs have been also found together with AHAs in patients affected by idiopathic hypopituitarism, but both were also present in different kinds of patients without abnormalities of the hypothalamic-pituitary axis. Despite some data being promising, the clinical use of pituitary and hypothalamus autoantibodies is still limited by the low diagnostic sensitivity, irreproducibility of the results, and the absence of autoantigen/s able to discriminate the autoimmune reaction involving the pituitary or the hypothalamus from the other autoimmune states.

Sexually-dimorphic expression of tyrosine hydroxylase immunoreactivity in the brain of a vocal teleost fish (Porichthys notatus)

Vocal communication has emerged as a powerful model for the study of neural mechanisms of social behavior. Modulatory neurochemicals postulated to play a central role in social behavior, related to motivation, arousal, incentive and reward, include the catecholamines, particularly dopamine and noradrenaline. Many questions remain regarding the functional mechanisms by which these modulators interact with sensory and motor systems. Here, we begin to address these questions in a model system for vocal and social behavior, the plainfin midshipman fish (Porichthys notatus). We mapped the distribution of immunoreactivity for the catecholamine-synthesizing enzyme tyrosine hydroxylase (TH) in the midshipman brain. The general pattern of TH(+) cell groups in midshipman appears to be highly conserved with other teleost fish, with a few exceptions, including the apparent absence of pretectal catecholamine cells. Many components of the midshipman vocal and auditory systems were innervated by TH(+) fibers and terminals, including portions of the subpallial area ventralis, the preoptic complex, and the anterior hypothalamus, the midbrain periaqueductal gray and torus semicircularis, several hindbrain auditory nuclei, and parts of the hindbrain vocal pattern generator. These areas thus represent potential sites for catecholamine modulation of vocal and/or auditory behavior. To begin to test functionally whether catecholamines modulate vocal social behaviors, we hypothesized that male and female midshipman, which are sexually dimorphic in both their vocal-motor repertoires and in their responses to hearing conspecific vocalizations, should exhibit sexually dimorphic expression of TH immunoreactivity in their vocal and/or auditory systems. We used quantitative immunohistochemical techniques to test this hypothesis across a number of brain areas. We found significantly higher levels of TH expression in male midshipman relative to females in the TH cell population in the paraventricular organ of the diencephalon and in the TH-innervated torus semicircularis, the main teleost midbrain auditory structure. The torus semicircularis has been implicated in sexually dimorphic behavioral responses to conspecific vocalizations. Our data thus support the general idea that catecholamines modulate vocal and auditory processing in midshipman, and the specific hypothesis that they shape sexually dimorphic auditory responses in the auditory midbrain.

Novel neuronal and endocrine autoantibody targets in Autoimmune Polyendocrine Syndrome type 1

CONTEXT

Although pituitary autoantibodies have frequently been reported in Autoimmune Polyendocrine Syndrome type 1 (APS1), the autoimmune involvement of the hypothalamic-pituitary axis remains to be elucidated.

OBJECTIVE

Our aim was to identify in APS1 patients novel autoantibodies, especially against hypothalamic-pituitary targets, and to correlate their presence with clinical features.

PATIENTS

We analyzed 14 APS1 patients from Sardinia, compared to other diseases and healthy donors. MEASURE(S): We used immunohistochemistry, on tissues substrates from various neuroendocrine organs, to detect autoantibody targets. Immunoenzymatic assays, as well as absorption with specific antigens were used to reveal autoantibodies against growth hormone (GH), luteinizing hormone (LH) and somatocrinin (GHRH). Clinical evaluations included GH secretory and cardiovascular autonomic neuropathy tests.

RESULTS

Sera from 12/14 APS1 patients revealed autoantibodies reacting with the hypothalamic-pituitary axis, cerebellum, substantia nigra, and/or adrenal medulla, as well as with GH, LH and/or GHRH. Of APS1 patients, 5 showed GH deficiency, in association (4/5 cases) with autoantibodies to hypothalamic and/or pituitary targets. Hypogonadotrophic hypogonadism was revealed in one APS1 patient, together with autoantibodies against gonadotropes. Autonomic neuropathy was detected in 5 of 10 patients, associated with autoantibodies to adrenal medulla in 2 cases. Of 5 patients with autoantibodies to cerebellar neurons, 2 reported emotional or memory alterations.

CONCLUSIONS

The majority of Sardinian APS1 patients developed autoantibodies to an assortment of neuroendocrine cells. Novel targets of clinical relevance may include pituitary hormones, uncharacterized pituitary targets, and adrenal medullary cells. An high prevalence of GH deficiency, and possibly of autonomic neuropathy, were also revealed.

Anti transglutaminase antibodies cause ataxia in mice

Background

Celiac disease (CD) is an autoimmune gastrointestinal disorder characterized by the presence of anti-transglutaminase 2 (TG2) and anti-gliadin antibodies. Amongst the neurological dysfunctions associated with CD, ataxia represents the most common one.

Methods

We analyzed by immunohistochemistry, the anti-neural reactivity of the serum from 20 CD patients. To determine the role of anti-TG2 antibodies in ataxia, two anti-TG2 single chain variable fragments (scFv), isolated from a phage-display IgA antibody library, were characterized by immunohistochemistry and ELISA, and injected in mice to study their effects on motor coordination. We found that 75% of the CD patient population without evidence of neurological involvement, has circulating anti-neural IgA and/or IgG antibodies. Two anti-TG2 scFvs, cloned from one CD patient, stained blood vessels but only one reacted with neurons. This anti-TG2 antibody showed cross reactivity with the transglutaminase isozymes TG3 and TG6. Intraventricular injection of the anti-TG2 or the anti-TG2/3/6 cross-reactive scFv provoked transient, equally intensive ataxia in mice.

Conclusion

The serum from CD patients contains anti-TG2, TG3 and TG6 antibodies that may potentially cause ataxia.

Cerebellar ataxia as a possible organ-specific autoimmune disease

The purpose of this study was to investigate the possibility that autoimmunity is responsible for some cases of sporadic idiopathic ataxia. We prospectively investigated 400 patients with progressive ataxia and identified a group of patients with idiopathic sporadic ataxia. A comparison of the prevalence of autoimmune diseases, the autoimmunity linked HLA DQ2, and serum anticerebellar antibodies was made between patients with idiopathic sporadic and those with genetically characterized ataxia. Ninety-one of 400 (23%) patients with progressive ataxia had idiopathic sporadic ataxia. The prevalence of autoimmune diseases in this group was 47% as compared with 6% in the group of patients with genetic ataxias (P < 0.0001). The HLA DQ2 was found in 71% of patients with sporadic ataxia, in 34% in patients with genetic ataxia, and in 36% of healthy local population (P = 0.0005 by Chi squared test). Anticerebellar antibodies were detected in 12 out of 20 patients with idiopathic sporadic as opposed to one of 20 patients with genetic ataxia. The significantly higher prevalence of autoimmune diseases, HLA DQ2 and anti-cerebellar antibodies in patients with idiopathic sporadic ataxia compared to genetic ataxia supports the notion that autoimmunity may account for some cases of idiopathic sporadic cerebellar ataxia.

Quantification of antineural antibodies in autoimmune neurological disorders

More than 50 different neurological pathologies have a confirmed or suspected autoimmune etiology affecting an estimated number of 75 million people worldwide. Autoantibodies are a useful diagnostic marker for most autoimmune diseases even though their pathological role is not evident, and several tests for their detection are commercially available. However, for autoimmune diseases involving the nervous system, lack of clear information on the identity of antineural antibody targets and the presence of many rare diseases have hampered the development of specific diagnostic assays. This review focuses on the actual knowledge on confirmed and suspected autoimmune diseases that target the CNS and the diagnostic relevance of corresponding antineural autoantibodies.