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Segal Y, Rotschild O, Mina Y, Maayan Eshed G, Levinson T, Paran Y, Dekel M, Cohen-Poradosu R, Ashkenazi A, Moreno I, Aizenstein O, Halutz O, Alcalay Y, Gadoth A. Epidemiology of autoimmune encephalitis and comparison to infectious causes-Experience from a tertiary center. Ann Clin Transl Neurol 2024. [PMID: 39030965 DOI: 10.1002/acn3.52147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/29/2024] [Accepted: 06/21/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVES The incidence of autoimmune encephalitis (AIE) has risen in the last decade, yet recent studies are lacking. We compared the epidemiology of autoimmune and infectious encephalitis cases in Tel-Aviv Sourasky Medical Center (TASMC) between 2010 and 2020. METHODS All encephalitis cases, aged 18 and above, admitted to TASMC between the years 2010 and 2020 were reviewed for demographic, clinical, laboratory, and imaging data and categorized based on etiology. RESULTS Two hundred and twenty-five patients with encephalitis were identified. The most common identifiable cause was viral (42%), followed by autoimmune encephalitis (35%), bacterial (18%), and fungal/parasitic (5%). The incidence of AIE cases out of the yearly admitted cases increased substantially, from 3.8/100 K in 2010 to 18.8/100 K in 2020. The incidence of viral cases also increased while those of bacterial and fungal/parasitic infections remained stable. Patients with AIE were younger compared to infectious patients (p-value <0.001) and had lower markers of systemic and cerebrospinal fluid inflammation (p-value for all <0.001). Seizures were more common among AIE patients (p-value <0.001), yet one-year mortality rates were higher among infectious patients (p-value <0.001). INTERPRETATION AIE incidence has risen significantly in our institution during the past decade, with current rates comparable to those of all infectious causes combined. Based on this cohort, clinical clues for an autoimmune etiology include a non-inflammatory cerebrospinal fluid profile, the presence of seizures, and temporal lobe imaging abnormalities (also common in herpetic encephalitis). In light of its rising incidence and the importance of early treatment, AIE should be considered in the differential diagnosis of all encephalitis cases.
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Affiliation(s)
- Yahel Segal
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Ofer Rotschild
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Yair Mina
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - Tal Levinson
- Infectious Diseases Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Yael Paran
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Infectious Diseases Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Michal Dekel
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Infectious Diseases Unit, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | | | - Adi Ashkenazi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Moreno
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Aizenstein
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Ora Halutz
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Clinical Microbiology Laboratory, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yifat Alcalay
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Immunology Laboratory, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Avi Gadoth
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv, Israel
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
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Liu X, Zheng X, Shu Y, Qu X, Wang Q, Liu X, Hu FY, Liu J, Lian Y, He BM, Li C, Zhou D, Qiu W, Sun L, Hong Z. Genome-Wide Association Study Identifies IFIH1 and HLA-DQB1*05:02 Loci Associated With Anti-NMDAR Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200221. [PMID: 38579189 PMCID: PMC11010247 DOI: 10.1212/nxi.0000000000200221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare autoimmune neurologic disorder, the genetic etiology of which remains poorly understood. Our study aims to investigate the genetic basis of this disease in the Chinese Han population. METHODS We performed a genome-wide association study and fine-mapping study within the major histocompatibility complex (MHC) region of 413 Chinese patients with anti-NMDAR encephalitis recruited from 6 large tertiary hospitals and 7,127 healthy controls. RESULTS Our genome-wide association analysis identified a strong association at the IFIH1 locus on chromosome 2q24.2 (rs3747517, p = 1.06 × 10-8, OR = 1.55, 95% CI, 1.34-1.80), outside of the human leukocyte antigen (HLA) region. Furthermore, through a fine-mapping study of the MHC region, we discovered associations for 3 specific HLA class I and II alleles. Notably, HLA-DQB1*05:02 (p = 1.43 × 10-12; OR, 2.10; 95% CI 1.70-2.59) demonstrates the strongest association among classical HLA alleles, closely followed by HLA-A*11:01 (p = 4.36 × 10-7; OR, 1.52; 95% CI 1.29-1.79) and HLA-A*02:07 (p = 1.28 × 10-8; OR, 1.87; 95% CI 1.50-2.31). In addition, we uncovered 2 main HLA amino acid variation associated with anti-NMDAR encephalitis including HLA-DQβ1-126H (p = 1.43 × 10-12; OR, 2.10; 95% CI 1.70-2.59), exhibiting a predisposing effect, and HLA-B-97R (p = 3.40 × 10-8; OR, 0.63; 95% CI 0.53-0.74), conferring a protective effect. Computational docking analysis suggested a close relationship between the NR1 subunit of NMDAR and DQB1*05:02. DISCUSSION Our findings indicate that genetic variation in IFIH1, involved in the type I interferon signaling pathway and innate immunity, along with variations in the HLA class I and class II genes, has substantial implications for the susceptibility to anti-NMDAR encephalitis in the Chinese Han population.
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Affiliation(s)
- Xu Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiaodong Zheng
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Yaqing Shu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiao Qu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Qun Wang
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiao Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Fa-Yun Hu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Jie Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Yajun Lian
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Bao-Ming He
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Caihua Li
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Dong Zhou
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Wei Qiu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Liangdan Sun
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Zhen Hong
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
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Jordi SBU, Misselwitz B. Refining the Concept of Microscopic Colitis: HLA Signatures Discriminating Collagenous and Lymphocytic Colitis. J Crohns Colitis 2024; 18:339-340. [PMID: 38174741 DOI: 10.1093/ecco-jcc/jjad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Sebastian Bruno Ulrich Jordi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
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Li S, Hu X, Wang M, Yu L, Zhang Q, Xiao J, Hong Z, Zhou D, Li J. Single-cell RNA sequencing reveals diverse B cell phenotypes in patients with anti-NMDAR encephalitis. Psychiatry Clin Neurosci 2024; 78:197-208. [PMID: 38063052 DOI: 10.1111/pcn.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUNDS Anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is a severe autoimmune disorder characterized by prominent psychiatric symptoms. Although the role of NMDAR antibodies in the disease has been extensively studied, the phenotype of B cell subsets is still not fully understood. METHODS We utilized single-cell RNA sequencing, single-cell B cell receptor sequencing (scBCR-seq), bulk BCR sequencing, flow cytometry, and enzyme-linked immunosorbent assay to analyze samples from both NMDAR-E patients and control individuals. RESULTS The cerebrospinal fluid (CSF) of NMDAR-E patients showed significantly increased B cell counts, predominantly memory B (Bm) cells. CSF Bm cells in NMDAR-E patients exhibited upregulated expression of differential expression genes (DEGs) associated with immune regulatory function (TNFRSF13B and ITGB1), whereas peripheral B cells upregulated DEGs related to antigen presentation. Additionally, NMDAR-E patients displayed higher levels of IgD- CD27- double negative (DN) cells and DN3 cells in peripheral blood (PB). In vitro, DN1 cell subsets from NMDAR-E patients differentiated into DN2 and DN3 cells, while CD27+ and/or IgD+ B cells (non-DN) differentiated into antibody-secreting cells (ASCs) and DN cells. NR1-IgG antibodies were found in B cell culture supernatants from patients. Differential expression of B cell IGHV genes in CSF and PB of NMDAR-E patients suggests potential antigen class switching. CONCLUSION B cell subpopulations in the CSF and PB of NMDAR-E patients exhibit distinct compositions and transcriptomic features. In vitro, non-DN cells from NMDAR-E can differentiate into DN cells and ASCs, potentially producing NR1-IgG antibodies. Further research is necessary to investigate the potential contribution of DN cell subpopulations to NR1-IgG antibody production.
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Affiliation(s)
- Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Breast Cancer, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiang Hu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Luoting Yu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Qiao S, Sun Q, Li H, Yin J, Wang A, Zhang S. Abnormal DNA methylation analysis of leucine-rich glioma-inactivated 1 antibody encephalitis reveals novel methylation-driven genes related to prognostic and clinical features. Clin Epigenetics 2023; 15:139. [PMID: 37644514 PMCID: PMC10463459 DOI: 10.1186/s13148-023-01550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Aberrant DNA methylation occurs commonly during pathogenesis of neuroimmunological diseases and is of clinical value in various encephalitis subtypes. However, knowledge of the impact of DNA methylation changes on pathogenesis of leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis remains limited. METHODS A total of 44 cytokines and 10 immune checkpoint moleculars (ICMs) in the serum of patients with LGI1 encephalitis and healthy donors (HDs) were measured to evaluate the association of them with clinical parameters. Genome-wide DNA methylation profiles were performed in peripheral blood mononuclear cell (PBMC) from LGI1 encephalitis patients and HDs using reduced representation bisulfite sequencing (RRBS) and validated for the methylation status by pyrosequencing. MicroRNA profiles were acquired in serum exosome by small RNA sequencing. Targeted cytokines expression was assessed at the presence or absence of miR-2467-5p in PBMCs and the culture media, and the binding of miR-2467-5p and its targeted genes was validated by luciferase assay. RESULTS There existed significant difference in 22 cytokines/chemokines and 6 ICMs between LGI1 encephalitis patients and HDs. Decreased PDCD1 with increased ICAM1 could predict unfavorable prognosis in one-year follow-up for LGI1 encephalitis patients. Fifteen of cytokines/chemokines and ICMs presented DNA-methylated changes in the promoter and gene body using RRBS in which five were verified as methylation status by pyrosequencing, and the methylation level of CSF3, CCL2, and ICAM1 was conversely associated with their expression in PBMCs. By combining RRBS data with exosome-derived microRNA sequencing, we found that hypomethylated-driven hsa-miR-2467-5p presented elevated expression in serum exosomes and PBMCs in LGI1 encephalitis. Mechanically, miR-2467-5p significantly induced reduced expression of CSF3 and PDCD1 by binding with their 3`UTR while enhanced CCL15 expression, but not significantly correlated with peripheral blood CD19 + B cell proportion of LGI1 encephalitis patients. CONCLUSIONS Our results provided convincing evidence for DNA methylation changes, microRNA profiles in serum exosome for LGI1 encephalitis, and we also identified several novel cytokines related to clinical features in which some represented epigenetic modification of methylated-driven pattern and microRNA modulation. Our study contributed to develop treatment for epigenetic pathogenesis in LGI1 encephalitis.
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Affiliation(s)
- Shan Qiao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, China
- Department of Medical Genetics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Quanye Sun
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiyun Li
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Yin
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Aihua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, China
| | - Shanchao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, Jinan, China.
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Segal Y, Nisnboym M, Regev K, Arnon K, Kolb H, Fahoum F, Aizenstein O, Paran Y, Louzoun Y, Israeli S, Loewenthal R, Svetlitzky N, Alcalay Y, Raphael I, Gadoth A. New Insights on DR and DQ Human Leukocyte Antigens in Anti-LGI1 Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200103. [PMID: 36973076 PMCID: PMC10042442 DOI: 10.1212/nxi.0000000000200103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES To explore the clinical characteristics and HLA associations of patients with anti-leucine-rich glioma-inactivated 1 encephalitis (LGI1E) from a large single center in Israel. Anti-LGI1E is the most commonly diagnosed antibody-associated encephalitic syndrome in adults. Recent studies of various populations reveal significant associations with specific HLA genes. We examined the clinical characteristics and HLA associations of a cohort of Israeli patients. METHODS Seventeen consecutive patients with anti-LGI1E diagnosed at Tel Aviv Medical Center between the years 2011 and 2018 were included. HLA typing was performed using next-generation sequencing at the tissue typing laboratory of Sheba Medical Center and compared with data from the Ezer Mizion Bone Marrow Donor Registry, containing over 1,000,000 samples. RESULTS Our cohort displayed a male predominance and median age at onset in the 7th decade, as previously reported. The most common presenting symptom was seizures. Notably, paroxysmal dizziness spells were significantly more common than previously reported (35%), whereas faciobrachial dystonic seizures were found only in 23%. HLA analysis revealed overrepresentation of DRB1*07:01 (OR: 3.18, CI: 20.9 p < 1.e-5) and DRB1*04:02 (OR: 3.8, CI: 20.1 p < 1.e-5), as well as of the DQ allele DQB1*02:02 (OR: 2.8, CI: 14.2 p < 0.0001) as previously reported. A novel overrepresentation observed among our patients was of the DQB1*03:02 allele (OR: 2.3, CI: 6.9 p < 0.008). In addition, we found DR-DQ associations, among patients with anti-LGI1E, that showed complete or near-complete linkage disequilibrium (LD). By applying LD analysis to an unprecedentedly large control cohort, we were able to show that although in the general population, DQB*03:02 is not fully associated with DRB1*04:02, in the patient population, both alleles are always coupled, suggesting the DRB1*04:02 association to be primary to disease predisposition. In silico predictions performed for the overrepresented DQ alleles reveal them to be strong binders of LGI1-derived peptides, similarly to overrepresented DR alleles. These predictions suggest a possible correlation between peptide binding sites of paired DR-DQ alleles. DISCUSSION Our cohort presents distinct immune characteristics with substantially higher overrepresentation of DRB1*04:02 and slightly lower overrepresentation of DQB1*07:01 compared with previous reports implying differences between different populations. DQ-DR interactions found in our cohort may shed additional light on the complex role of immunogenetics in the pathogenesis of anti-LGI1E, implying a possible relevance of certain DQ alleles and DR-DQ interactions.
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Affiliation(s)
- Yahel Segal
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Michal Nisnboym
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Keren Regev
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Karni Arnon
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Hadar Kolb
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Firas Fahoum
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Orna Aizenstein
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yael Paran
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yoram Louzoun
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Sapir Israeli
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Ron Loewenthal
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Nina Svetlitzky
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yifat Alcalay
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Itay Raphael
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Avi Gadoth
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA.
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Lake CM, Breen JJ. Sequence similarity between SARS-CoV-2 nucleocapsid and multiple sclerosis-associated proteins provides insight into viral neuropathogenesis following infection. Sci Rep 2023; 13:389. [PMID: 36617594 PMCID: PMC9825799 DOI: 10.1038/s41598-022-27348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 continues to cause death and disease throughout the world, underscoring the necessity of understanding the virus and host immune response. From the start of the pandemic, a prominent pattern of central nervous system (CNS) pathologies, including demyelination, has emerged, suggesting an underlying mechanism of viral mimicry to CNS proteins. We hypothesized that immunodominant epitopes of SARS-CoV-2 share homology with proteins associated with multiple sclerosis (MS). Using PEPMatch, a newly developed bioinformatics package which predicts peptide similarity within specific amino acid mismatching parameters consistent with published MHC binding capacity, we discovered that nucleocapsid protein shares significant overlap with 22 MS-associated proteins, including myelin proteolipid protein (PLP). Further computational evaluation demonstrated that this overlap may have critical implications for T cell responses in MS patients and is likely unique to SARS-CoV-2 among the major human coronaviruses. Our findings substantiate the hypothesis of viral molecular mimicry in the pathogenesis of MS and warrant further experimental exploration.
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Affiliation(s)
- Camille M. Lake
- grid.419681.30000 0001 2164 9667Office of Data Science and Emerging Technologies, National Institute of Allergy and Infectious Diseases, Rockville, MD USA
| | - Joseph J. Breen
- grid.419681.30000 0001 2164 9667Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, Rockville, MD USA
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Lancaster E. Autoantibody Encephalitis: Presentation, Diagnosis, and Management. J Clin Neurol 2022; 18:373-390. [PMID: 35796263 PMCID: PMC9262450 DOI: 10.3988/jcn.2022.18.4.373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023] Open
Abstract
Autoantibody encephalitis causes distinct clinical syndromes involving alterations in mentation, abnormal movements, seizures, psychiatric symptoms, sleep disruption, spasms, and neuromyotonia. The diagnoses can be confirmed by specific antibody tests, although some antibodies may be better detected in spinal fluid and others in serum. Each disorder conveys a risk of certain tumors which may inform diagnosis and be important for treatment. Autoantibodies to receptors and other neuronal membrane proteins are generally thought to be pathogenic and result in loss of function of the targets, so understanding the pharmacology of the receptors may inform our understanding of the syndromes. Patients may be profoundly ill but the syndromes usually respond to immune therapy, although there are differences in the types of immune therapy that are thought to be most effective for the various disorders.
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Affiliation(s)
- Eric Lancaster
- Department of Neurology, The University of Pennsylvania, Philadelphia, PA, USA.
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9
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Gill AJ, Venkatesan A. Pathogenic mechanisms in neuronal surface autoantibody-mediated encephalitis. J Neuroimmunol 2022; 368:577867. [DOI: 10.1016/j.jneuroim.2022.577867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022]
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Liu X, Guo KD, Lin JF, Gong X, Li AQ, Zhou D, Hong Z. HLA-DRB1*03:01 is associated with female sex and younger age of anti-LGI1 encephalitis. Eur J Neurol 2022; 29:2367-2375. [PMID: 35488492 DOI: 10.1111/ene.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/04/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the association between human leukocyte antigen (HLA) genotype and clinical characteristics of anti-LGI1 encephalitis. METHODS HLA genotyping was performed in 34 patients with anti-LGI1 encephalitis admitted to West China Hospital between April 2014 and May 2021, as well as in 305 healthy controls. The on-line tool NetMHCIIpan 4.0 and AutoDock Vina software were used to predict binding between LGI1 peptide and HLA Class II molecules. RESULTS Risk of anti-LGI1 encephalitis was strongly associated with the DRB1*03:01 allele (OR 4.31, 95% CI 1.96-9.25, Pc = 2.75×10-4 ) and the DRB1*03:01-DQB1*02:01 haplotype (OR 4.45, 95% CI 2.02-9.59, Pc = 2.94×10-4 ). Compared to carriers of the DRB1*07:01 allele, those with the DRB1*03:01 allele were more likely to be female (93.3% vs 33.3%; P = 0.004) and to be younger (median age, 38 vs 65 years; P < 0.001). DRB1*03:01 carriers showed stronger response to immunotherapy than carriers of the DRB1*07:01 allele, based on median score decrease on the modified Rankin scale [2 (interquartile range, 1-2) vs. 1 (interquartile range, 0-1); P = 0.03] at 4 weeks after immunotherapy. Prediction and docking algorithms suggested that the LGI1 peptide can bind to the DRB1*03:01 molecule strongly. CONCLUSIONS The strong association between anti-LGI1 encephalitis and certain HLA class II alleles supports a primary autoimmune origin for the disease. Carriers of the DRB1*03:01 allele in Chinese patients with anti-LGI1 encephalitis are more likely to be female, to suffer earlier disease onset and to respond better to immunotherapy.
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Affiliation(s)
- Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Kun Dian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Jing Fang Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Xue Gong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Ai Qing Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University.,Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, 611730, China
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Ding C, Sun Q, Li R, Li H, Wang Y. The First Case of Familiar Anti-leucine-rich Glioma-Inactivated1 Autoimmune Encephalitis: A Case Report and Literature Review. Front Neurol 2022; 13:855383. [PMID: 35493840 PMCID: PMC9047818 DOI: 10.3389/fneur.2022.855383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Anti-leucine-rich glioma-inactivated1 (Anti-LGI1) autoimmune encephalitis is a rare autoimmune disease discovered in recent years. It is generally not defined as an inherited disease, though its etiology is still unclear. Herein, we report the first case of adult patients with familial anti-LGI1 encephalitis. Two biological siblings who worked in different regions were successively diagnosed with anti-LGI1 encephalitis in their middle age. The two patients had similar clinical manifestations including imaging results. Their clinical symptoms improved after immunotherapy and antiepileptic therapy. Given that some unique human leukocyte antigen (HLA) subtypes appear at a high frequency, multiple recent studies have revealed that anti-LGI1 encephalitis is associated with genetic susceptibility. One of the patients underwent HLA genotyping and whole-exome sequencing (WES), revealing the same HLA typing as in previous studies and two rare HLA variants. Therefore, further studies involving larger samples and more populations should be conducted to explore the possibility of other influencing factors such as environmental impacts.
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Liu X, Guo K, Lin J, Gong X, Li A, Zhou D, Hong Z. Long-term seizure outcomes in patients with autoimmune encephalitis: A prospective observational registry study update. Epilepsia 2022; 63:1812-1821. [PMID: 35357695 DOI: 10.1111/epi.17245] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To update and evaluate long-term seizure outcomes in patients with autoimmune encephalitis (AE) based on a large cohort study with long follow-up. METHODS In this prospective observational registry study, we analyzed data from patients with AE mediated by common types of neuronal surface antibodies (anti-NMDAR, anti-LGI1/Caspr2, anti-GABAB R). All patients were recruited from the Department of Neurology at the West China Hospital between October 2011 and June 2019, and data were collected prospectively on their demographic and clinical characteristics, treatment strategy, and seizure outcomes with a median follow-up of 42 months (range 6-93 months). Potential risk factors associated with seizure recurrence were also assessed. RESULTS Of 320 AE patients, 75.9% had acute seizures, among whom more than 90% of patients had their last seizure within 12 months of disease onset. During our follow-up, 21 (9.3%) patients experienced seizure recurrence. Patients with anti-GABAB R encephalitis had a higher cumulative incidence of seizure recurrence than those with anti-NMDAR (log-rank P = 0.03) or anti-LGI1/Caspr2 encephalitis (log-rank P = 0.04). Among patients with anti-NMDAR encephalitis, women had a significantly higher cumulative incidence of seizure recurrence than men (log-rank P = 0.01). Interictal epileptiform discharges (IEDs) or seizures captured on continuous EEG in the acute phase were identified as potential risk factors for seizure recurrence (P=0.04; P=0.007). Among 163 patients with ≥ 24 months of follow-up, five (3.1%) showed persistent seizures and required ongoing anti-seizure medications (ASMs) despite aggressive immunotherapy. SIGNIFICANCE Seizure recurrence occurred in a small number of patients and chronic epilepsy occurred in 3.1% of patients during prolonged follow-up. Across all types of AE, risk factors for seizure recurrence were IEDs or seizures captured on EEG in the acute phase; for anti-NMDAR encephalitis, female sex was also a risk factor.
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Affiliation(s)
- Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Kundian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jingfang Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xue Gong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Aiqing Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, 611730, China
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Peris Sempere V, Muñiz-Castrillo S, Ambati A, Binks S, Pinto AL, Rogemond V, Pittock SJ, Dubey D, Geschwind MD, Gelfand JM, Dilwali S, Lee ST, Knight J, Elliott KS, Irani S, Honnorat J, Mignot E. Human Leukocyte Antigen Association Study Reveals DRB1*04:02 Effects Additional to DRB1*07:01 in Anti-LGI1 Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e1140. [PMID: 35115410 PMCID: PMC8815287 DOI: 10.1212/nxi.0000000000001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To study human leukocyte antigen (HLA) allele associations in anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. METHODS A multiethnic cohort of 269 patients with anti-LGI1 encephalitis and 1,359 controls was included. Four-digit HLA sequencing and genome wide association single-nucleotide polymorphism typing imputation (0.99 concordance) were used for HLA typing. Significance of primary and secondary associations was tested using χ2, Fisher exact tests, or logistic regression with the control of population stratification covariates when applicable. RESULTS DRB1*07:01 and DQA1*02:01, 2 alleles in strong linkage disequilibrium, were associated with the disease (90% vs 24%, OR = 27.8, p < 10e-50) across ethnicity independent of variation at DRB3 and DQB1, 2 flanking HLA loci. DRB1*07:01 homozygosity was associated with a doubling of risk (OR = 2.1, p = 0.010), suggesting causality. DRB1*07:01 negative subjects were younger (p = 0.003) and more frequently female (p = 0.015). Three patients with malignant thymomas did not carry DRB1*07:01, whereas patients with other tumors had high DRB1*07:01 frequency, suggesting that the presence of tumors other than thymomas may be coincidental and not causal. In both DRB1*07:01 heterozygous individuals and DRB1*07:01 negative subjects, DRB1*04:02 was associated with anti-LGI1 encephalitis, indicating an independent effect of this allele (OR = 6.85, p = 4.57 × 10-6 and OR = 8.93, p = 2.50 × 10-3, respectively). DRB1*04:02 was also independently associated with younger age at onset (β = -6.68, p = 9.78 × 10-3). Major histocompatibility complex peptide-binding predictions using LGI1-derived peptides revealed divergent binding propensities for DRB1*04:02 and DRB1*07:01 alleles, suggesting independent pathogenic mechanisms. DISCUSSION In addition to the established primary DRB1*07:01 association in anti-LGI1 encephalitis, we observe a secondary effect of DRB1*04:02 with lower age at onset. Our study provides evidence for secondary effects within HLA locus that correlate with clinical phenotypes in anti-LGI1 encephalitis.
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Affiliation(s)
| | | | - Aditya Ambati
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sophie Binks
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Anne-Laurie Pinto
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Veronique Rogemond
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sean J. Pittock
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Divyanshu Dubey
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Michael D. Geschwind
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Jeffrey Marc Gelfand
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sonam Dilwali
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Soon-Tae Lee
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Julian Knight
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Katherine S. Elliott
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sarosh Irani
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
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Zografou C, Vakrakou AG, Stathopoulos P. Short- and Long-Lived Autoantibody-Secreting Cells in Autoimmune Neurological Disorders. Front Immunol 2021; 12:686466. [PMID: 34220839 PMCID: PMC8248361 DOI: 10.3389/fimmu.2021.686466] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
As B cells differentiate into antibody-secreting cells (ASCs), short-lived plasmablasts (SLPBs) are produced by a primary extrafollicular response, followed by the generation of memory B cells and long-lived plasma cells (LLPCs) in germinal centers (GCs). Generation of IgG4 antibodies is T helper type 2 (Th2) and IL-4, -13, and -10-driven and can occur parallel to IgE, in response to chronic stimulation by allergens and helminths. Although IgG4 antibodies are non-crosslinking and have limited ability to mobilize complement and cellular cytotoxicity, when self-tolerance is lost, they can disrupt ligand-receptor binding and cause a wide range of autoimmune disorders including neurological autoimmunity. In myasthenia gravis with predominantly IgG4 autoantibodies against muscle-specific kinase (MuSK), it has been observed that one-time CD20+ B cell depletion with rituximab commonly leads to long-term remission and a marked reduction in autoantibody titer, pointing to a short-lived nature of autoantibody-secreting cells. This is also observed in other predominantly IgG4 autoantibody-mediated neurological disorders, such as chronic inflammatory demyelinating polyneuropathy and autoimmune encephalitis with autoantibodies against the Ranvier paranode and juxtaparanode, respectively, and extends beyond neurological autoimmunity as well. Although IgG1 autoantibody-mediated neurological disorders can also respond well to rituximab induction therapy in combination with an autoantibody titer drop, remission tends to be less long-lasting and cases where titers are refractory tend to occur more often than in IgG4 autoimmunity. Moreover, presence of GC-like structures in the thymus of myasthenic patients with predominantly IgG1 autoantibodies against the acetylcholine receptor and in ovarian teratomas of autoimmune encephalitis patients with predominantly IgG1 autoantibodies against the N‐methyl‐d‐aspartate receptor (NMDAR) confers increased the ability to generate LLPCs. Here, we review available information on the short-and long-lived nature of ASCs in IgG1 and IgG4 autoantibody-mediated neurological disorders and highlight common mechanisms as well as differences, all of which can inform therapeutic strategies and personalized medical approaches.
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Affiliation(s)
- C Zografou
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - A G Vakrakou
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - P Stathopoulos
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
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15
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Xie Y, Meng H, Maimaiti B, Yu M, Zhao Y. Autoimmune encephalitis associated with anti-LGI1 antibody and Sjögren's syndrome: a case report. Neurol Sci 2021; 42:3915-3918. [PMID: 34110513 DOI: 10.1007/s10072-021-05370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yinyin Xie
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
| | - Buajieerguli Maimaiti
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Miaomiao Yu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
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16
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Muñiz-Castrillo S, Haesebaert J, Thomas L, Vogrig A, Pinto AL, Picard G, Blanc C, Do LD, Joubert B, Berzero G, Psimaras D, Alentorn A, Rogemond V, Dubois V, Ambati A, Tamouza R, Mignot E, Honnorat J. Clinical and Prognostic Value of Immunogenetic Characteristics in Anti-LGI1 Encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e974. [PMID: 33848259 PMCID: PMC7938443 DOI: 10.1212/nxi.0000000000000974] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
Objective Antibodies against leucine-rich glioma-inactivated 1 (LGI1-Abs) characterize a limbic encephalitis (LE) strongly associated with HLA-DRB1*07:01, although some patients lack LGI1-Abs in CSF or do not carry this allele. Whether they represent a different subtype of disease or have different prognoses is unclear. Methods Retrospective analysis of clinical features, IgG isotypes, and outcome according to LGI1-Ab CSF positivity and DRB1*07:01 in a cohort of anti-LGI1 LE patients. Results Patients with LGI1-Abs detected in both CSF and serum (105/134, 78%) were compared with those who were CSF negative (29/134, 22%). Both groups had similar clinical features and serum levels, but CSF-positive patients had shorter diagnostic delay, more frequently hyponatremia, inflammatory CSF, and abnormal MRI (p < 0.05). Human leukocyte antigen (HLA) genotyping was performed in 72/134 (54%) patients and 63/72 (88%) carried DRB1*07:01. Noncarriers (9/72, 12%) were younger, more commonly women, and had less frequently psychiatric and frontal symptoms (p < 0.05). No difference in IgG isotypes according to CSF positivity or HLA was found (p > 0.05). HLA and IgG isotypes were not associated with poor outcome (mRS >2 at last follow-up) in univariate analyses; CSF positivity was only identified as a poor outcome predictor in the multivariate analysis including the complete follow-up, whereas age and female sex also remained when just the first year was considered. Conclusions LE without CSF LGI1-Abs is clinically indistinguishable and likely reflects just a lesser LGI1-Ab production. HLA association is sex and age biased and presents clinical particularities, suggesting subtle differences in the immune response. Long-term outcome depends mostly on demographic characteristics and the intensity of the intrathecal synthesis.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Julie Haesebaert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Laure Thomas
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Alberto Vogrig
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Anne-Laurie Pinto
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Géraldine Picard
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Charlotte Blanc
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Le-Duy Do
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Bastien Joubert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Giulia Berzero
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Dimitri Psimaras
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Agusti Alentorn
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Véronique Rogemond
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Valérie Dubois
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Aditya Ambati
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Ryad Tamouza
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Emmanuel Mignot
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Jérôme Honnorat
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France.
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