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Villéga F, Fernandes A, Jézéquel J, Uyttersprot F, Benac N, Zenagui S, Bastardo L, Gréa H, Bouchet D, Villetelle L, Nicole O, Rogemond V, Honnorat J, Dupuis JP, Groc L. Ketamine alleviates NMDA receptor hypofunction through synaptic trapping. Neuron 2024; 112:3311-3328.e9. [PMID: 39047728 DOI: 10.1016/j.neuron.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
Activity-dependent modulations of N-methyl-D-aspartate glutamate receptor (NMDAR) trapping at synapses regulate excitatory neurotransmission and shape cognitive functions. Although NMDAR synaptic destabilization has been associated with severe neurological and psychiatric conditions, tuning NMDAR synaptic trapping to assess its clinical relevance for the treatment of brain conditions remains a challenge. Here, we report that ketamine (KET) and other clinically relevant NMDAR open channel blockers (OCBs) promote interactions between NMDAR and PDZ-domain-containing scaffolding proteins and enhance NMDAR trapping at synapses. We further show that KET-elicited trapping enhancement compensates for depletion in synaptic receptors triggered by autoantibodies from patients with anti-NMDAR encephalitis. Preventing synaptic depletion mitigates impairments in NMDAR-mediated CaMKII signaling and alleviates anxiety- and sensorimotor-gating-related behavioral deficits provoked by autoantibodies. Altogether, these findings reveal an unexpected dimension of OCB action and stress the potential of targeting receptor anchoring in NMDAR-related synaptopathies.
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Affiliation(s)
- Frédéric Villéga
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France; Department of Pediatric Neurology, CIC-1401, University Children's Hospital of Bordeaux, Bordeaux, France
| | - Alexandra Fernandes
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Julie Jézéquel
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Floriane Uyttersprot
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Nathan Benac
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Sarra Zenagui
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Laurine Bastardo
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Hélène Gréa
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Delphine Bouchet
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Léa Villetelle
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Olivier Nicole
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Véronique Rogemond
- Synaptopathies and Autoantibodies Team, Institut NeuroMyoGene-MeLis, INSERM U1314, CNRS UMR 5284, Université Claude Bernard Lyon1, 69373 Lyon, France; French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677 Bron, France
| | - Jérôme Honnorat
- Synaptopathies and Autoantibodies Team, Institut NeuroMyoGene-MeLis, INSERM U1314, CNRS UMR 5284, Université Claude Bernard Lyon1, 69373 Lyon, France; French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677 Bron, France
| | - Julien P Dupuis
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France.
| | - Laurent Groc
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France.
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2
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Pan Y, Jiang Y, Wang D, Guo Z, He F, Chen Z, Dai C, Yuan Z, Chen R, Xu K, Hu Y. Anti-CRMP2 antibody induces anxiety-like behavior and increases pyramidal neuron excitability in mice. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167338. [PMID: 38986818 DOI: 10.1016/j.bbadis.2024.167338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND We have previously identified auto-antibody (Ab) to collapsin response mediator protein 2 (CRMP2) in patients with encephalitis. The present study aims to evaluate the pathogenic effects of anti-CRMP2 Ab. METHODS Recombinant CRMP2 protein was injected subcutaneously into mice to establish an active immune mouse model with anti-CRMP2 Ab. Behavioral assessments, histopathological staining, and electrophysiological testing were performed to identify any pathogenic changes. RESULTS The mice exhibited signs of impaired motor coordination four weeks post-immunization of CRMP2 protein. Moreover, CRMP2 immunized mice for eight weeks showed anxiety-like behaviors indicating by tests of open field and the elevated plus maze. After incubating the CA1 region of hippocampal brain section with the sera from CRMP2 immunized mice, the whole-cell path-clamp recordings showed increased excitability of pyramidal neurons. However, no obvious inflammation and infiltration of immune cells were observed by histopathological analysis. Western blot showed that the phosphorylation levels of CRMP2-Thr514 and -Ser522 were not affected. CONCLUSION In an active immunization model with CRMP2 protein, impaired coordination and anxiety-like behaviors were observed. Also, anti-CRMP2 Abs containing sera heightened the excitability of hippocampal pyramidal neurons in vitro, which imply the pathogenic effects of anti-CRMP2 Ab.
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Affiliation(s)
- Yue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yawei Jiang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhipeng Guo
- Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, China
| | - Fenfen He
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zirui Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chaowei Dai
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhirong Yuan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rongqing Chen
- Department of Neurobiology, School of Basic Medical Sciences, Southern Medical University, China
| | - Kaibiao Xu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Yafang Hu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Institute of Brain Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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3
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Zhu X, Huang Y, Qiu J, Zhong Z, Peng Y, Liang X, Chen J, Zhou J, Liang X, Wang H, Xie W, Ding Y. Chaihu Guizhi Decoction prevents cognitive, memory impairments and sensorimotor gating deficit induced by N-methyl-d-aspartate receptor antibody in mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 337:118806. [PMID: 39278296 DOI: 10.1016/j.jep.2024.118806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/18/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Anti-NMDAR encephalitis is one of the most common types of autoimmune encephalitis, primarily presenting with prodromal symptoms, such as fever and headache, followed by a range of neurological and psychiatric symptoms. Chaihu Guizhi Decoction (CGD), a traditional Chinese medicine formulated by Zhang Zhongjing in the Eastern Han Dynasty, has been effectively used in clinical practice to treat the symptoms of Taiyang and Shaoyang disorders, including fever, headache, and psychiatric disorders. AIM OF THE STUDY To demonstrate the protective effects of CGD in an animal model of anti-NMDAR encephalitis and explore the potential mechanisms involved. MATERIALS AND METHODS UHPLC-HRMS was used to identify CGD's chemical components and serum metabolomic profiles. Network pharmacology and molecular docking were performed to predict potential targets of CGD for the treatment of anti-NMDAR encephalitis. The effect of CGD on anti-NMDAR encephalitis was evaluated using a mouse model induced by patients' antibodies. Behavioral tests were performed to assess cognitive impairment and schizophrenia-like behaviors. The effect of CGD on the cell-surface NMDAR GluN1 subunit in cultured neurons treated with patient antibodies was detected by immunofluorescence. Golgi staining was used to observe morphological changes in hippocampal dendrites. The expression of NMDAR-interacting proteins and various neuroreceptors in the hippocampus were examined to validate the targets predicted using network pharmacology and molecular docking. RESULTS CGD alleviated cognitive, memory, and sensorimotor gating deficits in mice treated with anti-NMDAR encephalitis patients' antibodies. Further experiments demonstrated the effect of CGD in preventing NMDAR reduction both in vitro and in vivo. Meanwhile, CGD regulated NMDAR-interacting proteins and dopamine receptors but did not affect hippocampal dendritic morphology and synaptic density. Additionally, CGD modifies metabolic pathways associated with anti-NMDAR encephalitis and other neurological and psychiatric disorders. CONCLUSIONS CGD exhibited protective effects against anti-NMDAR encephalitis by mitigating the antibody-induced reduction in NMDAR and NMDAR-interacting proteins.
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Affiliation(s)
- Xiaoyu Zhu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Yingyi Huang
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Jing Qiu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zheng Zhong
- Department of Chemistry and the Swire Institute of Marine Science, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Yu Peng
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Xiaoshan Liang
- Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jinyu Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jieli Zhou
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Xiaotao Liang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Honghao Wang
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China.
| | - Wei Xie
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China; Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Yuewen Ding
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China; Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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4
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Wang H, Xie C, Deng B, Ding J, Li N, Kou Z, Jin M, He J, Wang Q, Wen H, Zhang J, Zhou Q, Chen S, Chen X, Yuan TF, Zhu S. Structural basis for antibody-mediated NMDA receptor clustering and endocytosis in autoimmune encephalitis. Nat Struct Mol Biol 2024:10.1038/s41594-024-01387-3. [PMID: 39227720 DOI: 10.1038/s41594-024-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 08/07/2024] [Indexed: 09/05/2024]
Abstract
Antibodies against N-methyl-D-aspartate receptors (NMDARs) are most frequently detected in persons with autoimmune encephalitis (AE) and used as diagnostic biomarkers. Elucidating the structural basis of monoclonal antibody (mAb) binding to NMDARs would facilitate the development of targeted therapy for AE. Here, we reconstructed nanodiscs containing green fluorescent protein-fused NMDARs to label and sort individual immune B cells from persons with AE and further cloned and identified mAbs against NMDARs. This allowed cryo-electron microscopy analysis of NMDAR-Fab complexes, revealing that autoantibodies bind to the R1 lobe of the N-terminal domain of the GluN1 subunit. Small-angle X-ray scattering studies demonstrated NMDAR-mAb stoichiometry of 2:1 or 1:2, structurally suitable for mAb-induced clustering and endocytosis of NMDARs. Importantly, these mAbs reduced the surface NMDARs and NMDAR-mediated currents, without tonically affecting NMDAR channel gating. These structural and functional findings imply that the design of neutralizing antibody binding to the R1 lobe of NMDARs represents a potential therapy for AE treatment.
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Affiliation(s)
- Han Wang
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chun Xie
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Bo Deng
- Department of Neurology, Huashan Hospital and Institute of Neurology, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Jingjun Ding
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine and School of Psychology, Shanghai, China
| | - Na Li
- National Facility for Protein Science in Shanghai, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China
| | - Zengwei Kou
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Mengmeng Jin
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jie He
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | | | - Han Wen
- DP Technology, Beijing, China
| | - Jinbao Zhang
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Qinming Zhou
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sheng Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, National Center for Neurological Disorders, Fudan University, Shanghai, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine and School of Psychology, Shanghai, China.
| | - Shujia Zhu
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
- University of Chinese Academy of Sciences, Beijing, China.
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5
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Gao D, Lv X, Shen Z, Wang H, Zhao W, Wang H, Jin X, Tan L, Yin L, Wang J, Yue W, Wang H. Early Diagnosis of CNS Virus Infections from Neurological Autoimmune Diseases: A Cross-Sectional Study from China in ER Setting. Brain Sci 2024; 14:888. [PMID: 39335384 PMCID: PMC11430841 DOI: 10.3390/brainsci14090888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
It is challenging to differentiate between central nervous system (CNS) virus infections and neurological autoimmune diseases in the emergency department. Considering their different pathogenesis, we assume they differ in neuropsychiatric symptoms and laboratory results. A total of 80 patients were included in this study, 50 with CNS virus infections and 30 with CNS autoimmune diseases, confirmed by a polymerase chain reaction (PCR) of cerebrospinal fluid (CSF). A binary logistic regression model and receiver operating characteristic (ROC) curve were employed to examine the discrimination between the two types of diseases based on neuropsychiatric symptoms and laboratory results. Compared to patients with neurological autoimmune diseases, patients with CNS virus infections had a higher incidence of abnormal behavior (p = 0.026) and abnormal sensation/thought (p = 0.029); higher total (p = 0.005), direct (p = 0.004), and indirect bilirubin (p = 0.004); and increased CSF cell (p = 0.01) and CSF white cell counts (p = 0.01). Patients with disturbance of consciousness and abnormal sensation/thought were 7.79-fold and 5.07-fold more likely to be diagnosed with CNS virus infections (OR = 7.79, p = 0.008; OR = 5.07, p = 0.032). Each unit increase in blood indirect bilirubin concentration and CSF white cell counts increased the risk of developing CNS virus infections by 1.25-fold and 1.01-fold (OR = 1.25, p = 0.016; OR = 1.01, p = 0.011). ROC analysis showed that the area under the curve was 88.0% (p < 0.001). Our study found that patients with CNS viral infections tend to have higher blood indirect bilirubin concentration, CSF leukocyte count, frequency of disorders of consciousness, and abnormal sensation and thought, which may help differentiate them from those with neurological autoimmune diseases.
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Affiliation(s)
- Daiquan Gao
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Xue Lv
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Zuoyao Shen
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Huicong Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Wenfeng Zhao
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Huang Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Xiukun Jin
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Liuchen Tan
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Lu Yin
- Medical Research & Biometrics Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102300, China
| | - Junhui Wang
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan 727000, China
| | - Weihua Yue
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Beijing 100069, China
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6
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Jamet Z, Mergaux C, Meras M, Bouchet D, Villega F, Kreye J, Prüss H, Groc L. NMDA receptor autoantibodies primarily impair the extrasynaptic compartment. Brain 2024; 147:2745-2760. [PMID: 38758090 PMCID: PMC11292910 DOI: 10.1093/brain/awae163] [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: 11/08/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Autoantibodies directed against the N-methyl-D-aspartate receptor (NMDAR-Ab) are pathogenic immunoglobulins detected in patients suffering from NMDAR encephalitis. NMDAR-Ab alter the receptor membrane trafficking, synaptic transmission and neuronal network properties, leading to neurological and psychiatric symptoms in patients. Patients often have very little neuronal damage but rapid and massive (treatment-responsive) brain dysfunctions related to an unknown early mechanism of NMDAR-Ab. Our understanding of this early molecular cascade remains surprisingly fragmented. Here, we used a combination of single molecule-based imaging of membrane proteins to unveil the spatiotemporal action of NMDAR-Ab on live hippocampal neurons. We first demonstrate that different clones of NMDAR-Ab primarily affect extrasynaptic (and not synaptic) NMDARs. In the first minutes, NMDAR-Ab increase extrasynaptic NMDAR membrane dynamics, declustering its surface interactome. NMDAR-Ab also rapidly reshuffle all membrane proteins located in the extrasynaptic compartment. Consistent with this alteration of multiple proteins, effects of NMDAR-Ab were not mediated through the sole interaction between the NMDAR and EphB2 receptor. In the long term, NMDAR-Ab reduce the NMDAR synaptic pool by slowing down receptor membrane dynamics in a cross-linking-independent manner. Remarkably, exposing only extrasynaptic NMDARs to NMDAR-Ab was sufficient to produce their full-blown effect on synaptic receptors. Collectively, we demonstrate that NMDAR-Ab initially impair extrasynaptic proteins, then the synaptic ones. These data thus shed new and unsuspected light on the mode of action of NMDAR-Ab and, probably, our understanding of (extra)synaptopathies.
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Affiliation(s)
- Zoe Jamet
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Camille Mergaux
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Morgane Meras
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Delphine Bouchet
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Frédéric Villega
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
- Department of Pediatric Neurology, CIC-0005, University Children's Hospital of Bordeaux, F-33000 Bordeaux, France
| | - Jakob Kreye
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Laurent Groc
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
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7
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Dor A, Harrison C, Irani SR, Al-Diwani A, Grogan J, Manohar S. N-Methyl-D-Aspartate Receptor-Antibody Encephalitis Impairs Maintenance of Attention to Items in Working Memory. J Neurosci 2024; 44:e1500232024. [PMID: 38830760 PMCID: PMC11236588 DOI: 10.1523/jneurosci.1500-23.2024] [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: 08/07/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024] Open
Abstract
NMDA receptors (NMDARs) may be crucial to working memory (WM). Computational models predict that they sustain neural firing and produce associative memory, which may underpin maintaining and binding information, respectively. We test this in patients with antibodies to NMDAR (n = 10, female) and compare them with healthy control participants (n = 55, 20 male, 35 female). Patients were tested after recovery with a task that separates two aspects of WM: sustaining attention and feature binding. Participants had to remember two colored arrows. Then attention was directed to one of them. After a variable delay, they reported the direction of either the same arrow (congruent cue) or of the other arrow (incongruent cue). We asked how congruency affected recall precision and measured types of error. Patients had difficulty in both sustaining attention to an item over time and feature binding. Controls were less precise after longer delays and incongruent cues. In contrast, patients did not benefit from congruent cues at longer delays [group × congruency (long condition); p = 0.041], indicating they could not sustain attention. Additionally, patients reported the wrong item (misbinding errors) more than controls after congruent cues [group × delay (congruent condition), main effect of group; p ≤ 0.001]. Our results suggest NMDARs are critical for both maintaining attention and feature binding.
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Affiliation(s)
- Afrose Dor
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Corin Harrison
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, United Kingdom
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Adam Al-Diwani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - John Grogan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Sanjay Manohar
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, United Kingdom
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8
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Maudes E, Jamet Z, Marmolejo L, Dalmau JO, Groc L. Positive Allosteric Modulation of NMDARs Prevents the Altered Surface Dynamics Caused by Patients' Antibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200261. [PMID: 38771989 PMCID: PMC11111324 DOI: 10.1212/nxi.0000000000200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/27/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES A positive allosteric modulator of the NMDAR, SGE-301, has been shown to reverse the alterations caused by the antibodies of patients with anti-NMDAR encephalitis (NMDARe). However, the mechanisms involved beyond receptor modulation are unclear. In this study, we aimed to investigate how this modulator affects NMDAR membrane dynamics. METHODS Cultured hippocampal neurons were treated with SGE-301 or vehicle, alongside with immunoglobulins G (IgG) from patients with NMDARe or healthy controls. NMDAR surface dynamics were assessed with single-molecule imaging by photoactivated localization microscopy. RESULTS NMDAR trajectories from neurons treated with SGE-301 were less confinement, with increased diffusion coefficients. This effect mainly occurred at synapses because extrasynaptic diffusion and confinement were minimally affected by SGE-301. Treatment with patients' IgG reduced NMDAR surface dynamics and increased their confinement. Remarkably, SGE-301 incubation antagonized patients' IgG effects in both synaptic and extrasynaptic membrane compartments, restoring diffusion and confinement values similar to those from neurons exposed to control IgG. DISCUSSION We demonstrate that SGE-301 upregulates NMDAR surface diffusion and antagonizes the pathogenic effects of patients' IgG on NMDAR membrane organization. These findings suggest a potential therapeutic strategy for NMDARe.
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Affiliation(s)
- Estibaliz Maudes
- From the Neuroimmunology Program (E.M., L.M., J.O.D.), Fundació Clinic per la Recerca Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), University of Barcelona, Spain; and University of Bordeaux (Z.J., L.G.), CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, Bordeaux, France
| | - Zoë Jamet
- From the Neuroimmunology Program (E.M., L.M., J.O.D.), Fundació Clinic per la Recerca Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), University of Barcelona, Spain; and University of Bordeaux (Z.J., L.G.), CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, Bordeaux, France
| | - Laura Marmolejo
- From the Neuroimmunology Program (E.M., L.M., J.O.D.), Fundació Clinic per la Recerca Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), University of Barcelona, Spain; and University of Bordeaux (Z.J., L.G.), CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, Bordeaux, France
| | - Josep O Dalmau
- From the Neuroimmunology Program (E.M., L.M., J.O.D.), Fundació Clinic per la Recerca Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), University of Barcelona, Spain; and University of Bordeaux (Z.J., L.G.), CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, Bordeaux, France
| | - Laurent Groc
- From the Neuroimmunology Program (E.M., L.M., J.O.D.), Fundació Clinic per la Recerca Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), University of Barcelona, Spain; and University of Bordeaux (Z.J., L.G.), CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, Bordeaux, France
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9
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Pluvinage JV, Ngo T, Fouassier C, McDonagh M, Holmes BB, Bartley CM, Kondapavulur S, Hurabielle C, Bodansky A, Pai V, Hinman S, Aslanpour A, Alvarenga BD, Zorn KC, Zamecnik C, McCann A, Asencor AI, Huynh T, Browne W, Tubati A, Haney MS, Douglas VC, Louine M, Cree BAC, Hauser SL, Seeley W, Baranzini SE, Wells JA, Spudich S, Farhadian S, Ramachandran PS, Gillum L, Hales CM, Zikherman J, Anderson MS, Yazdany J, Smith B, Nath A, Suh G, Flanagan EP, Green AJ, Green R, Gelfand JM, DeRisi JL, Pleasure SJ, Wilson MR. Transcobalamin receptor antibodies in autoimmune vitamin B12 central deficiency. Sci Transl Med 2024; 16:eadl3758. [PMID: 38924428 DOI: 10.1126/scitranslmed.adl3758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Vitamin B12 is critical for hematopoiesis and myelination. Deficiency can cause neurologic deficits including loss of coordination and cognitive decline. However, diagnosis relies on measurement of vitamin B12 in the blood, which may not accurately reflect the concentration in the brain. Using programmable phage display, we identified an autoantibody targeting the transcobalamin receptor (CD320) in a patient with progressive tremor, ataxia, and scanning speech. Anti-CD320 impaired cellular uptake of cobalamin (B12) in vitro by depleting its target from the cell surface. Despite a normal serum concentration, B12 was nearly undetectable in her cerebrospinal fluid (CSF). Immunosuppressive treatment and high-dose systemic B12 supplementation were associated with increased B12 in the CSF and clinical improvement. Optofluidic screening enabled isolation of a patient-derived monoclonal antibody that impaired B12 transport across an in vitro model of the blood-brain barrier (BBB). Autoantibodies targeting the same epitope of CD320 were identified in seven other patients with neurologic deficits of unknown etiology, 6% of healthy controls, and 21.4% of a cohort of patients with neuropsychiatric lupus. In 132 paired serum and CSF samples, detection of anti-CD320 in the blood predicted B12 deficiency in the brain. However, these individuals did not display any hematologic signs of B12 deficiency despite systemic CD320 impairment. Using a genome-wide CRISPR screen, we found that the low-density lipoprotein receptor serves as an alternative B12 uptake pathway in hematopoietic cells. These findings dissect the tissue specificity of B12 transport and elucidate an autoimmune neurologic condition that may be amenable to immunomodulatory treatment and nutritional supplementation.
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Affiliation(s)
- John V Pluvinage
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Thomas Ngo
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Camille Fouassier
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Maura McDonagh
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Brandon B Holmes
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Christopher M Bartley
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
- Department of Psychiatry and Behavioral Sciences, UCSF, San Francisco, CA 94158, USA
| | - Sravani Kondapavulur
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA 94158, USA
| | - Charlotte Hurabielle
- Department of Medicine, Division of Rheumatology, UCSF, San Francisco, CA, 94158, USA
| | - Aaron Bodansky
- Department of Pediatrics, Division of Critical Care, UCSF, San Francisco, CA 94158, USA
| | - Vincent Pai
- Bruker Cellular Analysis, Emeryville, CA, 94608, USA
| | - Sam Hinman
- Bruker Cellular Analysis, Emeryville, CA, 94608, USA
| | - Ava Aslanpour
- Bruker Cellular Analysis, Emeryville, CA, 94608, USA
| | - Bonny D Alvarenga
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, UCSF, San Francisco, CA 94158, USA
| | - Colin Zamecnik
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | | | - Andoni I Asencor
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Trung Huynh
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Weston Browne
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Asritha Tubati
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Michael S Haney
- Department of Neurology, Stanford University, Stanford, CA 94304, USA
| | - Vanja C Douglas
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Martineau Louine
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Bruce A C Cree
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - William Seeley
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Sergio E Baranzini
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - James A Wells
- Department of Pharmaceutical Chemistry, UCSF, San Francisco, CA 94158, USA
| | - Serena Spudich
- Department of Neurology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Shelli Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT 06520, USA
| | - Prashanth S Ramachandran
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | | | - Chadwick M Hales
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Julie Zikherman
- Department of Medicine, Division of Rheumatology, UCSF, San Francisco, CA, 94158, USA
| | - Mark S Anderson
- Diabetes Center, UCSF, San Francisco, CA 94143, USA
- Department of Medicine, Division of Endocrinology, UCSF, San Francisco, CA 94158, USA
| | - Jinoos Yazdany
- Department of Neurological Surgery, UCSF, San Francisco, CA 94158, USA
| | - Bryan Smith
- Division of Neuroimmunology and Neurovirology, National Institute of Neurologic Disorders and Stroke, Bethesda, MD 20824, USA
| | - Avindra Nath
- Division of Neuroimmunology and Neurovirology, National Institute of Neurologic Disorders and Stroke, Bethesda, MD 20824, USA
| | - Gina Suh
- Department of Medicine, Division of Infectious Disease, Mayo Clinic, Rochester, MN 55905, USA
| | - Eoin P Flanagan
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ari J Green
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Ralph Green
- Department of Pathology and Laboratory Medicine, University of California, Davis, CA 95616, USA
| | - Jeffrey M Gelfand
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Joseph L DeRisi
- Bruker Cellular Analysis, Emeryville, CA, 94608, USA
- Chan Zuckerberg Biohub San Francisco, San Francisco, CA 94158, USA
| | - Samuel J Pleasure
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
| | - Michael R Wilson
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA 94158, USA
- Weill Institute for Neurosciences, UCSF, San Francisco, CA 94158, USA
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10
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Papi C, Milano C, Spatola M. Mechanisms of autoimmune encephalitis. Curr Opin Neurol 2024; 37:305-315. [PMID: 38667756 DOI: 10.1097/wco.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the pathogenic mechanisms involved in autoimmune encephalitides mediated by antibodies against neuronal surface antigens, with a focus on NMDAR and LGI1 encephalitis. RECENT FINDINGS In antibody-mediated encephalitides, binding of IgG antibodies to neuronal surface antigens results in different pathogenic effects depending on the type of antibody, IgG subclass and epitope specificity. NMDAR IgG1 antibodies cause crosslinking and internalization of the target, synaptic and brain circuitry alterations, as well as alterations of NMDAR expressing oligodendrocytes, suggesting a link with white matter lesions observed in MRI studies. LGI1 IgG4 antibodies, instead, induce neuronal dysfunction by disrupting the interaction with cognate proteins and altering AMPAR-mediated signaling. In-vitro findings have been corroborated by memory and behavioral changes in animal models obtained by passive transfer of patients' antibodies or active immunization. These models have been fundamental to identify targets for innovative therapeutic strategies, aimed at counteracting or preventing antibody effects, such as the use of soluble ephrin-B2, NMDAR modulators (e.g., pregnenolone, SGE-301) or chimeric autoantibody receptor T cells (CAART) in models of NMDAR encephalitis. SUMMARY A deep understanding of the pathogenic mechanisms underlying antibody-mediated encephalitides is crucial for the development of new therapeutic approaches targeting brain autoimmunity.
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Affiliation(s)
- Claudia Papi
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
| | - Chiara Milano
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Spatola
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
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11
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Yang Y, Fu S, Jiang G, Xu G, Tian J, Ma X. Functional connectivity changes of the hippocampal subregions in anti-N-methyl-D-aspartate receptor encephalitis. Brain Imaging Behav 2024; 18:686-697. [PMID: 38363500 DOI: 10.1007/s11682-024-00852-3] [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] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
The hippocampus plays an important role in the pathophysiological mechanism of Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Nevertheless, the connection between the resting-state activity of the hippocampal subregions and neuropsychiatric disorders in patients remains unclear. This study aimed to explore the changes in functional connectivity (FC) in the hippocampal subregions of patients with anti-NMDAR encephalitis and its association with clinical symptoms and cognitive performance. Twenty-three patients with anti-NMDAR encephalitis and 23 healthy controls (HC) were recruited. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans and completed clinical cognitive scales. Based on the Brainnetome Atlas, the rostral (anterior) and caudal (posterior) hippocampi of both the left and right hemispheres were selected as regions of interest (ROIs) for FC analysis. First, a one-sample t-test was used to observe the whole-brain connectivity distribution of hippocampal subregions within the patient and HC groups at a threshold of p < 0.05. The two-sample t-test was used to compare the differences in hippocampal ROIs connectivity between groups, followed by a partial correlation analysis between the FC values of brain regions with statistical differences and clinical variables. This study observed that the distribution of whole-brain functional connectivity in the rostral and caudal hippocampi aligned with the connectivity differences between the anterior and posterior hippocampi. Compared to the HC group, the patients showed significantly decreased FC between the bilateral rostral hippocampus and the left inferior orbitofrontal gyrus and between the right rostral hippocampus and the right cerebellum. However, a significant increase in FC was observed between the right rostral hippocampus and left superior temporal gyrus, the left caudal hippocampus and right superior frontal gyrus, and the right caudal hippocampus and left gyrus rectus. Partial correlation analysis showed that FC between the left inferior orbitofrontal gyrus and the right rostral hippocampus was significantly negatively correlated with the California Verbal Learning Test (CVLT) and Brief Visuospatial Memory Test (BVMT) scores. The FC between the right rostral hippocampus and the left superior temporal gyrus was negatively correlated with BVMT scores. FC abnormalities in the hippocampal subregions of patients with anti-NMDAR encephalitis were associated with cognitive impairment, emotional changes, and seizures. These results may help explain the pathophysiological mechanisms and clinical manifestations of anti-NMDAR encephalitis and NMDAR dysfunction-related diseases such as schizophrenia.
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Affiliation(s)
- Yujie Yang
- The Second School of Clinical Medicine, Southern Medial University, Guangzhou City, Guangdong province, PR China
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Shishun Fu
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Guihua Jiang
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Guang Xu
- Department of Neurology, Guangdong Second Provincial General Hospital, No.466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Junzhang Tian
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China.
| | - Xiaofen Ma
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China.
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12
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Italia M, Salvadè M, La Greca F, Zianni E, Pelucchi S, Spinola A, Ferrari E, Archetti S, Alberici A, Benussi A, Solje E, Haapasalo A, Hoffmann D, Katisko K, Krüger J, Facchinetti R, Scuderi C, Padovani A, DiLuca M, Scheggia D, Borroni B, Gardoni F. Anti-GluA3 autoantibodies define a new sub-population of frontotemporal lobar degeneration patients with distinct neuropathological features. Brain Behav Immun 2024; 118:380-397. [PMID: 38485064 DOI: 10.1016/j.bbi.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024] Open
Abstract
Autoantibodies directed against the GluA3 subunit (anti-GluA3 hIgGs) of AMPA receptors have been identified in 20%-25% of patients with frontotemporal lobar degeneration (FTLD). Data from patients and in vitro/ex vivo pre-clinical studies indicate that anti-GluA3 hIgGs negatively affect glutamatergic neurotransmission. However, whether and how the chronic presence of anti-GluA3 hIgGs triggers synaptic dysfunctions and the appearance of FTLD-related neuropathological and behavioural signature has not been clarified yet. To address this question, we developed and characterized a pre-clinical mouse model of passive immunization with anti-GluA3 hIgGs purified from patients. In parallel, we clinically compared FTLD patients who were positive for anti-GluA3 hIgGs to negative ones. Clinical data showed that the presence of anti-GluA3 hIgGs defined a subgroup of patients with distinct clinical features. In the preclinical model, anti-GluA3 hIgGs administration led to accumulation of phospho-tau in the postsynaptic fraction and dendritic spine loss in the prefrontal cortex. Remarkably, the preclinical model exhibited behavioural disturbances that mostly reflected the deficits proper of patients positive for anti-GluA3 hIgGs. Of note, anti-GluA3 hIgGs-mediated alterations were rescued in the animal model by enhancing glutamatergic neurotransmission with a positive allosteric modulator of AMPA receptors. Overall, our study clarified the contribution of anti-GluA3 autoantibodies to central nervous system symptoms and pathology and identified a specific subgroup of FTLD patients. Our findings will be instrumental in the development of a therapeutic personalised medicine strategy for patients positive for anti-GluA3 hIgGs.
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Affiliation(s)
- Maria Italia
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Michela Salvadè
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Filippo La Greca
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Elisa Zianni
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Silvia Pelucchi
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Alessio Spinola
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Elena Ferrari
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Silvana Archetti
- Department of Laboratories, Central Laboratory of Clinical Chemistry Analysis. ASST Spedali Civili, Brescia, Italy
| | - Antonella Alberici
- Neurology Unit, Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Eino Solje
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland; Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Annakaisa Haapasalo
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Dorit Hoffmann
- A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kasper Katisko
- Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland; Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Johanna Krüger
- Research Unit of Clinical Medicine, Neurology, University of Oulu, Oulu, Finland; Neurocenter, Neurology, Oulu University Hospital, Oulu, Finland; Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Roberta Facchinetti
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Caterina Scuderi
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Alessandro Padovani
- Neurology Unit, Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Diego Scheggia
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy
| | - Barbara Borroni
- Neurology Unit, Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabrizio Gardoni
- Department of Pharmacological and Biomolecular Sciences (DiSFeB), University of Milan, Milan, Italy.
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13
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Zhou L, Duan J. The role of NMDARs in the anesthetic and antidepressant effects of ketamine. CNS Neurosci Ther 2024; 30:e14464. [PMID: 37680076 PMCID: PMC11017467 DOI: 10.1111/cns.14464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As a phencyclidine (PCP) analog, ketamine can generate rapid-onset and substantial anesthetic effects. Contrary to traditional anesthetics, ketamine is a dissociative anesthetic and can induce loss of consciousness in patients. Recently, the subanaesthetic dose of ketamine was found to produce rapid-onset and lasting antidepressant effects. AIM However, how different concentrations of ketamine can induce diverse actions remains unclear. Furthermore, the molecular mechanisms underlying the NMDAR-mediated anesthetic and antidepressant effects of ketamine are not fully understood. METHOD In this review, we have introduced ketamine and its metabolism, summarized recent advances in the molecular mechanisms underlying NMDAR inhibition in the anesthetic and antidepressant effects of ketamine, explored the possible functions of NMDAR subunits in the effects of ketamine, and discussed the future directions of ketamine-based anesthetic and antidepressant drugs. RESULT Both the anesthetic and antidepressant effects of ketamine were thought to be mediated by N-methyl-D-aspartate receptor (NMDAR) inhibition. CONCLUSION The roles of NMDARs have been extensively studied in the anaesthetic effects of ketamine. However, the roles of NMDARs in antidepressant effects of ketamine are complicated and controversial.
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Affiliation(s)
- Liang Zhou
- Department of Pharmacology, College of Pharmaceutical SciencesSoochow UniversitySuzhouChina
| | - Jingjing Duan
- Department of Anatomy and Neurobiology, Zhongshan School of MedicineSunYat‐sen UniversityGuangzhouChina
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14
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Li SJ, Wu YL, Chen JH, Shen SY, Duan J, Xu HE. Autoimmune diseases: targets, biology, and drug discovery. Acta Pharmacol Sin 2024; 45:674-685. [PMID: 38097717 PMCID: PMC10943205 DOI: 10.1038/s41401-023-01207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/20/2023] [Indexed: 03/17/2024] Open
Abstract
Autoimmune diseases (AIDs) arise from a breakdown in immunological self-tolerance, wherein the adaptive immune system mistakenly attacks healthy cells, tissues and organs. AIDs impose excessive treatment costs and currently rely on non-specific and universal immunosuppression, which only offer symptomatic relief without addressing the underlying causes. AIDs are driven by autoantigens, targeting the autoantigens holds great promise in transforming the treatment of these diseases. To achieve this goal, a comprehensive understanding of the pathogenic mechanisms underlying different AIDs and the identification of specific autoantigens are critical. In this review, we categorize AIDs based on their underlying causes and compile information on autoantigens implicated in each disease, providing a roadmap for the development of novel immunotherapy regimens. We will focus on type 1 diabetes (T1D), which is an autoimmune disease characterized by irreversible destruction of insulin-producing β cells in the Langerhans islets of the pancreas. We will discuss insulin as possible autoantigen of T1D and its role in T1D pathogenesis. Finally, we will review current treatments of TID and propose a potentially effective immunotherapy targeting autoantigens.
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Affiliation(s)
- Shu-Jie Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- Department of Traditional Chinese Medicine, Fujian Medical University Union Hospital, Fuzhou, 350000, China.
| | - Yan-Li Wu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Juan-Hua Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Shi-Yi Shen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jia Duan
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, 528400, China.
| | - H Eric Xu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- School of Life Science and Technology, Shanghai Tech University, Shanghai, 201210, China.
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15
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Pavăl D, Gherghel-Pavăl N, Căpățînă OO, Stan A, Micluția IV. The relevance of anti-N-methyl-D-aspartate receptor encephalitis for psychiatrists. Int J Psychiatry Clin Pract 2024; 28:73-81. [PMID: 38702981 DOI: 10.1080/13651501.2024.2323926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/20/2024] [Indexed: 05/06/2024]
Abstract
Psychiatrists are often the first to be consulted in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. While this disease is rare, psychiatrists need to be aware of its relevant fundamental, clinical and therapeutic aspects. We begin by reviewing the connection between anti-NMDAR encephalitis and the glutamate hypothesis of schizophrenia. Next, we focus on the profile of the patient typically afflicted with this disease. Then, we tackle the limited utility of current diagnostic criteria during the early stage of the disease. After reviewing the psychiatric features, we debate the quest for finding specific psychiatric phenotypes that could facilitate early-stage diagnosis. We conclude by discussing the treatment of psychiatric symptoms and disease outcomes. As follows, this paper presents the relevance of anti-NMDAR encephalitis for psychiatrists.
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Affiliation(s)
- Denis Pavăl
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Romanian Association for Autoimmune Encephalitis, Cluj-Napoca, Romania
| | | | - Octavia Oana Căpățînă
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Romanian Association for Autoimmune Encephalitis, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neurology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Valentina Micluția
- Department of Psychiatry, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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16
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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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Hunter D, Petit-Pedrol M, Fernandes D, Bénac N, Rodrigues C, Kreye J, Ceanga M, Prüss H, Geis C, Groc L. Converging synaptic and network dysfunctions in distinct autoimmune encephalitis. EMBO Rep 2024; 25:1623-1649. [PMID: 38253690 PMCID: PMC10933378 DOI: 10.1038/s44319-024-00056-2] [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: 08/29/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Psychiatric and neurological symptoms, as well as cognitive deficits, represent a prominent phenotype associated with variable forms of autoimmune encephalitis, regardless of the neurotransmitter receptor targeted by autoantibodies. The mechanistic underpinnings of these shared major neuropsychiatric symptoms remain however unclear. Here, we investigate the impacts of patient-derived monoclonal autoantibodies against the glutamatergic NMDAR (NMDAR mAb) and inhibitory GABAaR (GABAaR mAb) signalling in the hippocampal network. Unexpectedly, both excitatory and inhibitory synaptic receptor membrane dynamics, content and transmissions are altered by NMDAR or GABAaR mAb, irrespective of the affinity or antagonistic effect of the autoantibodies. The effect of NMDAR mAb on inhibitory synapses and GABAaR mAb on excitatory synapses requires neuronal activity and involves protein kinase signalling. At the cell level, both autoantibodies increase the excitation/inhibition balance of principal cell inputs. Furthermore, NMDAR or GABAaR mAb leads to hyperactivation of hippocampal networks through distinct alterations of principal cell and interneuron properties. Thus, autoantibodies targeting excitatory NMDAR or inhibitory GABAaR trigger convergent network dysfunctions through a combination of shared and distinct mechanisms.
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Affiliation(s)
- Daniel Hunter
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Mar Petit-Pedrol
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Dominique Fernandes
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Nathan Bénac
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Catarina Rodrigues
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France
| | - Jakob Kreye
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
| | - Mihai Ceanga
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
| | - Christian Geis
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Laurent Groc
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, F-33000, Bordeaux, France.
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18
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Luo H, Yang J, Yang X, Han Z, Fang Z, Huang D, Gui J, Ding R, Chen H, Cheng L, Ma J, Jiang L. A peptide from the Japanese encephalitis virus failed to induce the production of anti-N-methyl-d-aspartate receptor antibodies via molecular mimicry in mice. Heliyon 2024; 10:e24700. [PMID: 38298637 PMCID: PMC10828681 DOI: 10.1016/j.heliyon.2024.e24700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/29/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
Background The development of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis following viral encephalitis, such as Japanese encephalitis, has received increasing attention in recent years. However, the mechanism of anti-NMDAR antibody production following Japanese encephalitis has not been explored. Methods A peptide from the Japanese encephalitis virus (JEV), which shares a similar amino acid sequence with GluN1, was identified by sequence comparison. We then explored whether active subcutaneous immunization with the JEV peptide could induce the production of anti-NMDAR antibodies and related pathophysiological and behavioral changes in mice. In addition, a published active immune model of anti-NMDAR encephalitis using a GluN1 peptide was used as the positive control. Results A 6-amino-acid sequence with 83 % similarity between the envelope protein of the JEV (HGTVVI) and GluN1 (NGTHVI) was identified, and the sequence included the N368/G369 region. Active immunization with the JEV peptide induced a substantial and specific immune response in mice. However, anti-NMDAR antibodies were not detected in the serum of mice immunized with the JEV peptide by ELISA, CBA, and TBA. Moreover, mice immunized with the JEV peptide presented no abnormities related to anti-NMDAR antibodies according to western blotting, patch clamp, and a series of behavioral tests. In addition, active immunization with a recently reported GluN1 peptide failed to induce anti-NMDAR antibody production in mice. Conclusions In this study, the attempt of active immunization with the JEV peptide to induce the production of anti-NMDAR antibodies via molecular mimicry failed. The pathogenesis of anti-NMDAR encephalitis following Japanese encephalitis remains to be elucidated.
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Affiliation(s)
- Hanyu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Jiaxin Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Xiaoyue Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Ziyao Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Zhixu Fang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Dishu Huang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Jianxiong Gui
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Ran Ding
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Hengsheng Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Li Cheng
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Jiannan Ma
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China
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Dalmau J. Changing landscape in the field of paraneoplastic neurology: Personal perspectives over a 35-year career. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:11-32. [PMID: 38494272 DOI: 10.1016/b978-0-12-823912-4.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes are a group of rare disorders that have fascinated neurologists for more than a century. The discovery in the 1980s that many of these disorders occurred in association with antibodies against neuronal proteins revived the interest for these diseases. This chapter first traces the history of the paraneoplastic neurologic syndromes during the era that preceded the discovery of immune mechanisms and then reviews the immunologic period during which many of these syndromes were found to be associated with antibodies against intracellular onconeuronal proteins and pathogenic cytotoxic T-cell mechanisms. Alongside these developments, investigations on the antibody-mediated disorders of the peripheral nervous system, such as the myasthenic syndromes or neuromyotonia, provided suggestions for the study of the central nervous system (CNS) syndromes. These converging areas of research culminated with the groundbreaking discovery of a new category of CNS disorders mediated by antibodies against neuronal surface proteins or receptors. These disorders are not always paraneoplastic, and the understanding of these syndromes and mechanisms has changed the landscape of neurology and neurosciences.
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Affiliation(s)
- Josep Dalmau
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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20
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Casagrande S, Zuliani L, Grisold W. Paraneoplastic encephalitis. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:131-149. [PMID: 38494274 DOI: 10.1016/b978-0-12-823912-4.00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The first reports of encephalitis associated with cancer date to the 1960s and were characterized by clinical and pathologic involvement of limbic areas. This specific association was called limbic encephalitis (LE). The subsequent discovery of several "onconeural" antibodies (Abs), i.e., Abs targeting an antigen shared by neurons and tumor cells, supported the hypothesis of an autoimmune paraneoplastic etiology of LE and other forms of rapidly progressive encephalopathy. Over the past 20 years, similar clinical pictures with different clinical courses have been described in association with novel Abs-binding neuronal membrane proteins and proved to be pathogenic. The most well-known encephalitis in this group was described in 2007 as an association of a complex neuro-psychiatric syndrome, N-methyl-d-aspartate (NMDA) receptor-Abs, and ovarian teratoma in young women. Later on, nonparaneoplastic cases of NMDA receptor encephalitis were also described. Since then, the historical concept of LE and Ab associated encephalitis has changed. Some of these occur in fact more commonly in the absence of a malignancy (e.g., anti-LG1 Abs). Lastly, seronegative cases were also described. The term paraneoplastic encephalitis nowadays encompasses different syndromes that may be triggered by occult tumors.
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Affiliation(s)
- Silvia Casagrande
- Neurology Unit, Rovereto Hospital, Trento, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Luigi Zuliani
- Department of Neurology, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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21
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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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22
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Ryding M, Mikkelsen AW, Nissen MS, Nilsson AC, Blaabjerg M. Pathophysiological Effects of Autoantibodies in Autoimmune Encephalitides. Cells 2023; 13:15. [PMID: 38201219 PMCID: PMC10778077 DOI: 10.3390/cells13010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The heterogeneity of autoantibody targets in autoimmune encephalitides presents a challenge for understanding cellular and humoral pathophysiology, and the development of new treatment strategies. Thus, current treatment aims at autoantibody removal and immunosuppression, and is primarily based on data generated from other autoimmune neurological diseases and expert consensus. There are many subtypes of autoimmune encephalitides, which now entails both diseases with autoantibodies targeting extracellular antigens and classical paraneoplastic syndromes with autoantibodies targeting intracellular antigens. Here, we review the current knowledge of molecular and cellular effects of autoantibodies associated with autoimmune encephalitis, and evaluate the evidence behind the proposed pathophysiological mechanisms of autoantibodies in autoimmune encephalitis.
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Affiliation(s)
- Matias Ryding
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne With Mikkelsen
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | | | - Anna Christine Nilsson
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark;
- Brain Research—Inter Disciplinary Guided Excellence (BRIDGE), 5000 Odense, Denmark
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23
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Gong X, Wang N, Zhu H, Tang N, Wu K, Meng Q. Anti-NMDAR antibodies, the blood-brain barrier, and anti-NMDAR encephalitis. Front Neurol 2023; 14:1283511. [PMID: 38145121 PMCID: PMC10748502 DOI: 10.3389/fneur.2023.1283511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 12/26/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an antibody-related autoimmune encephalitis. It is characterized by the existence of antibodies against NMDAR, mainly against the GluN1 subunit, in cerebrospinal fluid (CSF). Recent research suggests that anti-NMDAR antibodies may reduce NMDAR levels in this disorder, compromising synaptic activity in the hippocampus. Although anti-NMDAR antibodies are used as diagnostic indicators, the origin of antibodies in the central nervous system (CNS) is unclear. The blood-brain barrier (BBB), which separates the brain from the peripheral circulatory system, is crucial for antibodies and immune cells to enter or exit the CNS. The findings of cytokines in this disorder support the involvement of the BBB. Here, we aim to review the function of NMDARs and the relationship between anti-NMDAR antibodies and anti-NMDAR encephalitis. We summarize the present knowledge of the composition of the BBB, especially by emphasizing the role of BBB components. Finally, we further provide a discussion on the impact of BBB dysfunction in anti-NMDAR encephalitis.
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Affiliation(s)
- Xiarong Gong
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China
- Department of MR, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Niya Wang
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Hongyan Zhu
- Department of Clinical Laboratory, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Ning Tang
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Kunhua Wu
- Department of MR, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Qiang Meng
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
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24
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Olivero G, Roggeri A, Pittaluga A. Anti-NMDA and Anti-AMPA Receptor Antibodies in Central Disorders: Preclinical Approaches to Assess Their Pathological Role and Translatability to Clinic. Int J Mol Sci 2023; 24:14905. [PMID: 37834353 PMCID: PMC10573896 DOI: 10.3390/ijms241914905] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Autoantibodies against NMDA and AMPA receptors have been identified in the central nervous system of patients suffering from brain disorders characterized by neurological and psychiatric symptoms. It has been demonstrated that these autoantibodies can affect the functions and/or the expression of the targeted receptors, altering synaptic communication. The importance to clarify, in preclinical models, the molecular mechanisms involved in the autoantibody-mediated effects has emerged in order to understand their pathogenic role in central disorders, but also to propose new therapeutic approaches for preventing the deleterious central consequences. In this review, we describe some of the available preclinical literature concerning the impact of antibodies recognizing NMDA and AMPA receptors in neurons. This review discusses the cellular events that would support the detrimental roles of the autoantibodies, also illustrating some contrasting findings that in our opinion deserve attention and further investigations before translating the preclinical observations to clinic.
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Affiliation(s)
- Guendalina Olivero
- Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy; (G.O.); (A.R.)
| | - Alessandra Roggeri
- Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy; (G.O.); (A.R.)
| | - Anna Pittaluga
- Center of Excellence for Biomedical Research, 3Rs Center, Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genoa, Italy
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25
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Yu X, Wax J, Riemekasten G, Petersen F. Functional autoantibodies: Definition, mechanisms, origin and contributions to autoimmune and non-autoimmune disorders. Autoimmun Rev 2023; 22:103386. [PMID: 37352904 DOI: 10.1016/j.autrev.2023.103386] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/18/2023] [Indexed: 06/25/2023]
Abstract
A growing body of evidence underscores the relevance of functional autoantibodies in the development of various pathogenic conditions but also in the regulation of homeostasis. However, the definition of functional autoantibodies varies among studies and a comprehensive overview on this emerging topic is missing. Here, we do not only explain functional autoantibodies but also summarize the mechanisms underlying the effect of such autoantibodies including receptor activation or blockade, induction of receptor internalization, neutralization of ligands or other soluble extracellular antigens, and disruption of protein-protein interactions. In addition, in this review article we discuss potential triggers of production of functional autoantibodies, including infections, immune deficiency and tumor development. Finally, we describe the contribution of functional autoantibodies to autoimmune diseases including autoimmune thyroid diseases, myasthenia gravis, autoimmune pulmonary alveolar proteinosis, autoimmune autonomic ganglionopathy, pure red cell aplasia, autoimmune encephalitis, pemphigus, acquired thrombotic thrombocytopenic purpura, idiopathic dilated cardiomyopathy and systemic sclerosis, as well as non-autoimmune disorders such as allograft rejection, infectious diseases and asthma.
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Affiliation(s)
- Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel, Members of the German Center for Lung Research (DZL), 23845 Borstel, Germany.
| | - Jacqueline Wax
- Priority Area Chronic Lung Diseases, Research Center Borstel, Members of the German Center for Lung Research (DZL), 23845 Borstel, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University Clinic of Schleswig Holstein, University of Lübeck, 23538 Lübeck, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel, Members of the German Center for Lung Research (DZL), 23845 Borstel, Germany
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26
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Rada A, Bien CG. What is autoimmune encephalitis-associated epilepsy? Proposal of a practical definition. Epilepsia 2023; 64:2249-2255. [PMID: 37353891 DOI: 10.1111/epi.17699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 06/25/2023]
Abstract
Seizures resulting from cerebral autoimmunity are either acutely symptomatic in the context of autoimmune encephalitis (AIE) with neural surface antibodies, or they are indicative of an enduring predisposition to seizures, that is, epilepsy. Here, we propose a practical definition for autoimmune encephalitis-associated epilepsy (AEAE): Seizures associated with antibodies against glutamic acid decarboxylase, paraneoplastic syndromes, or Rasmussen encephalitis are classified as AEAE. AEAE secondary to AIE with antibodies against the N-methyl-D-aspartate receptor, leucine-rich glioma inactivated protein 1, contactin-associated protein-2, or γ-aminobutyric acid-B receptor can be diagnosed if the following criteria are met: seizures persist for at least 2 years after immunotherapy initiation; no signs of encephalitis on magnetic resonance imaging and no fluorodeoxyglucose positron emission tomography hypermetabolism; normal cerebrospinal fluid cell count; and a substantial decrease in antibody titers. This classification corresponds to different disease mechanisms. While AIE results from the pathogenic effects of neural antibodies, AEAE is probably the consequence of encephalitis-related tissue damage and thereby mainly structurally mediated. The distinction between AIE and AEAE also has practical consequences: In AIE, immunotherapy is usually highly beneficial, whereas anti-seizure medication has little effect. In AEAE, immunotherapy is less promising and the usual anti-seizure interventions are preferable. In addition, the diagnosis of AEAE has social consequences in terms of driving and professional limitations.
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Affiliation(s)
- Anna Rada
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
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27
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Varley JA, Strippel C, Handel A, Irani SR. Autoimmune encephalitis: recent clinical and biological advances. J Neurol 2023; 270:4118-4131. [PMID: 37115360 PMCID: PMC10345035 DOI: 10.1007/s00415-023-11685-3] [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: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
In 2015, we wrote a review in The Journal of Neurology summarizing the field of autoantibody-associated neurological diseases. Now, in 2023, we present an update of the subject which reflects the rapid expansion and refinement of associated clinical phenotypes, further autoantibody discoveries, and a more detailed understanding of immunological and neurobiological pathophysiological pathways which mediate these diseases. Increasing awareness around distinctive aspects of their clinical phenotypes has been a key driver in providing clinicians with a better understanding as to how these diseases are best recognized. In clinical practice, this recognition supports the administration of often effective immunotherapies, making these diseases 'not to miss' conditions. In parallel, there is a need to accurately assess patient responses to these drugs, another area of growing interest. Feeding into clinical care are the basic biological underpinnings of the diseases, which offer clear pathways to improved therapies toward enhanced patient outcomes. In this update, we aim to integrate the clinical diagnostic pathway with advances in patient management and biology to provide a cohesive view on how to care for these patients in 2023, and the future.
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Affiliation(s)
- James A Varley
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - Christine Strippel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK.
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK.
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28
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Shu Y, Peng F, Zhao B, Liu C, Li Q, Li H, Wang Y, Jiang Y, Lu T, Wang Q, Sun J, Feng H, Lu Z, Liu X, Wang J, Qiu W. Transfer of patient's peripheral blood mononuclear cells (PBMCs) disrupts blood-brain barrier and induces anti-NMDAR encephalitis: a study of novel humanized PBMC mouse model. J Neuroinflammation 2023; 20:164. [PMID: 37443034 DOI: 10.1186/s12974-023-02844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune neuropsychiatric disease. Brain access of anti-NMDAR autoantibody through the blood-brain barrier (BBB) is essential for pathogenesis. Most previous animal models limit the investigation of etiologies of BBB damage in patients. METHODS In this study, we established a novel humanized mouse model of anti-NMDAR encephalitis by intraperitoneal injection of patients' peripheral blood mononuclear cells (PBMCs) into BALB/c Rag2-/-Il2rg-/-SirpαNODFlk2-/- mice. RESULTS We found that engraftment of patients' PBMCs not only produced potent anti-GluN1 autoantibodies, but also disrupted BBB integrity to allow brain access of autoantibodies, resulting in a hyperactive locomotor phenotype, anxiety- and depressive-like behaviors, cognitive deficits, as well as functional changes in corresponding brain regions. Transcriptome analysis suggested an exaggerated immune response and impaired neurotransmission in the mouse model and highlighted Il-1β as a hub gene implicated in pathological changes. We further demonstrated that Il-1β was produced by endothelial cells and disrupted BBB by repressing tight junction proteins. Treatment with Anakinra, an Il-1 receptor antagonist, ameliorated BBB damage and neuropsychiatric behaviors. CONCLUSIONS Our study provided a novel and clinically more relevant humanized mouse model of anti-NMDAR encephalitis and revealed an intrinsic pathogenic property of the patient's lymphocytes.
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Affiliation(s)
- Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Bingchu Zhao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Chunxin Liu
- Department of Emergency, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qihui Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Huilu Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yanjun Jiang
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong SAR, China
- Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tingting Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Qin Wang
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Jian Sun
- Guangdong Laboratory for Lingnan Modern Agriculture, National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original BacteriaCollege of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Huiyu Feng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Xiaodong Liu
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China.
- Institute of Neuroscience and Brain Diseases; Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.
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29
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Ciano-Petersen NL, Robert M, Muñiz-Castrillo S, Wucher V, Klich A, Vogrig A, Villagrán García M, Farina A, Goncalves D, Picard G, Rogemond V, Joubert B, Oliver-Martos B, Serrano-Castro PJ, Maucort-Boulch D, Honnorat J. Prognostic Value of Persistent CSF Antibodies at 12 Months in Anti-NMDAR Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200108. [PMID: 37147137 PMCID: PMC10162705 DOI: 10.1212/nxi.0000000000200108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/07/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-NMDA receptor (NMDAR) encephalitis is defined by the presence of antibodies (Abs) targeting the NMDAR in the CSF. This study aimed to determine the prognostic value of persistent CSF NMDAR-Abs during follow-up. METHODS This retrospective observational study included patients diagnosed with anti-NMDAR encephalitis in the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis and for whom CSF samples were obtained at diagnosis and >4 months of follow-up to evaluate CSF NMDAR-Ab persistence. Because patients were tested for CSF NMDAR-Abs at different time points, samples were stratified into different periods of follow-up (i.e., 12 months was considered for the 9- to 16-month follow-up period). RESULTS Among the 501 patients diagnosed with anti-NMDAR encephalitis between January 2007 and June 2020, 89 (17%) were tested between 4 and 120 months for CSF NMDAR-Abs after clinical improvement and included in the study (75/89 women, 84%; median age 20 years, interquartile range [IQR] 16-26). During follow-up, 21 of 89 (23%) patients had a relapse after a median time of 29 months (IQR 18-47), and 20 of 89 (22%) had a poor outcome (mRS ≥3) after a median last follow-up of 36 months (IQR 19-64). Most patients (69/89, 77%) were tested at the 12-month follow-up period, and 42 of 69 (60%) of them had persistent CSF NMDAR-Abs. When comparing patients with persistent or absent CSF NMDAR-Abs at 12 months, poor outcome at the last follow-up was more frequent in the former (38% vs 8%, p = 0.01), who had relapses more often (23% vs 7%), which also appeared earlier in the course of the disease (90% during the following 4 years of follow-up vs 20%), although no significant difference was observed at long-term follow-up (p = 0.15). In addition, patients with persistent CSF NMDAR-Abs at 12 months had higher titers of CSF NMDAR-Abs at diagnosis. DISCUSSION In this study, patients with persistent CSF NMDAR-Abs at 12 months were more likely to have subsequent relapses and a poor long-term outcome. However, these findings should be interpreted with caution because of the variability in the time of sampling of this study. Future prospective studies are required to validate these results in larger cohorts.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Mélisse Robert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Sergio Muñiz-Castrillo
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Valentin Wucher
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Amna Klich
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Alberto Vogrig
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Macarena Villagrán García
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Antonio Farina
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - David Goncalves
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Geraldine Picard
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Veronique Rogemond
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Bastien Joubert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Begoña Oliver-Martos
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Pedro J Serrano-Castro
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Delphine Maucort-Boulch
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Jerome Honnorat
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain.
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Dong B, Yue Y, Dong H, Wang Y. N-methyl-D-aspartate receptor hypofunction as a potential contributor to the progression and manifestation of many neurological disorders. Front Mol Neurosci 2023; 16:1174738. [PMID: 37396784 PMCID: PMC10308130 DOI: 10.3389/fnmol.2023.1174738] [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: 02/27/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
N-methyl-D-aspartate receptors (NMDA) are glutamate-gated ion channels critical for synaptic transmission and plasticity. A slight variation of NMDAR expression and function can result in devastating consequences, and both hyperactivation and hypoactivation of NMDARs are detrimental to neural function. Compared to NMDAR hyperfunction, NMDAR hypofunction is widely implicated in many neurological disorders, such as intellectual disability, autism, schizophrenia, and age-related cognitive decline. Additionally, NMDAR hypofunction is associated with the progression and manifestation of these diseases. Here, we review the underlying mechanisms of NMDAR hypofunction in the progression of these neurological disorders and highlight that targeting NMDAR hypofunction is a promising therapeutic intervention in some neurological disorders.
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Affiliation(s)
- Bin Dong
- Department of Geriatrics, Jilin Geriatrics Clinical Research Center, The First Hospital of Jilin University, Changchun, China
| | - Yang Yue
- School of Psychology, Northeast Normal University, Changchun, China
| | - Han Dong
- Department of Geriatrics, Jilin Geriatrics Clinical Research Center, The First Hospital of Jilin University, Changchun, China
| | - Yuehui Wang
- Department of Geriatrics, Jilin Geriatrics Clinical Research Center, The First Hospital of Jilin University, Changchun, China
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González-González IM, Gray JA, Ferreira J, Conde-Dusman MJ, Bouchet D, Perez-Otaño I, Groc L. GluN3A subunit tunes NMDA receptor synaptic trafficking and content during postnatal brain development. Cell Rep 2023; 42:112477. [PMID: 37149869 PMCID: PMC11189104 DOI: 10.1016/j.celrep.2023.112477] [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: 10/18/2021] [Revised: 01/29/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Signaling via N-methyl-d-aspartate receptors (NMDARs) is critical for the maturation of glutamatergic synapses, partly through a developmental switch from immature synapses expressing primarily GluN2B- and GluN3A-containing subtypes to GluN2A-rich mature ones. This subunit switch is thought to underlie the synaptic stabilization of NMDARs necessary for neural network consolidation. However, the cellular mechanisms controlling the NMDAR exchange remain unclear. Using a combination of single-molecule and confocal imaging and biochemical and electrophysiological approaches, we show that surface GluN3A-NMDARs form a highly diffusive receptor pool that is loosely anchored to synapses. Remarkably, changes in GluN3A subunit expression selectively alter the surface diffusion and synaptic anchoring of GluN2A- but not GluN2B-NMDARs, possibly through altered interactions with cell surface receptors. The effects of GluN3A on NMDAR surface diffusion are restricted to an early time window of postnatal development in rodents, allowing GluN3A subunits to control the timing of NMDAR signaling maturation and neuronal network refinements.
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Affiliation(s)
- Inmaculada M González-González
- Cellular Neurobiology Laboratory, Centro de Investigación Médica Aplicada (CIMA) and Universidad de Navarra, Pamplona, Spain; Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience (IINS), UMR 5297, 33000 Bordeaux, France
| | - John A Gray
- Department of Neurology, Center for Neuroscience, University of California, Davis, Davis, CA 95618, USA
| | - Joana Ferreira
- Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience (IINS), UMR 5297, 33000 Bordeaux, France
| | - María Jose Conde-Dusman
- Cellular Neurobiology Laboratory, Centro de Investigación Médica Aplicada (CIMA) and Universidad de Navarra, Pamplona, Spain; Cellular and Systems Biology, Instituto de Neurociencias, CSIC-UMH, 03550 San Juan de Alicante, Spain
| | - Delphine Bouchet
- Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience (IINS), UMR 5297, 33000 Bordeaux, France
| | - Isabel Perez-Otaño
- Cellular Neurobiology Laboratory, Centro de Investigación Médica Aplicada (CIMA) and Universidad de Navarra, Pamplona, Spain; Cellular and Systems Biology, Instituto de Neurociencias, CSIC-UMH, 03550 San Juan de Alicante, Spain.
| | - Laurent Groc
- Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience (IINS), UMR 5297, 33000 Bordeaux, France.
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Dupuis JP, Nicole O, Groc L. NMDA receptor functions in health and disease: Old actor, new dimensions. Neuron 2023:S0896-6273(23)00344-6. [PMID: 37236178 DOI: 10.1016/j.neuron.2023.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/06/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
N-Methyl-D-aspartate ionotropic glutamate receptors (NMDARs) play key roles in synaptogenesis, synaptic maturation, long-term plasticity, neuronal network activity, and cognition. Mirroring this wide range of instrumental functions, abnormalities in NMDAR-mediated signaling have been associated with numerous neurological and psychiatric disorders. Thus, identifying the molecular mechanisms underpinning the physiological and pathological contributions of NMDAR has been a major area of investigation. Over the past decades, a large body of literature has flourished, revealing that the physiology of ionotropic glutamate receptors cannot be restricted to fluxing ions, and involves additional facets controlling synaptic transmissions in health and disease. Here, we review newly discovered dimensions of postsynaptic NMDAR signaling supporting neural plasticity and cognition, such as the nanoscale organization of NMDAR complexes, their activity-dependent redistributions, and non-ionotropic signaling capacities. We also discuss how dysregulations of these processes may directly contribute to NMDAR-dysfunction-related brain diseases.
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Affiliation(s)
- Julien P Dupuis
- University of Bordeaux, CNRS, IINS, UMR 5297, 33000 Bordeaux, France
| | - Olivier Nicole
- University of Bordeaux, CNRS, IINS, UMR 5297, 33000 Bordeaux, France
| | - Laurent Groc
- University of Bordeaux, CNRS, IINS, UMR 5297, 33000 Bordeaux, France.
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Nikolaus M, Rausch P, Rostásy K, Bertolini A, Wickström R, Johannsen J, Denecke J, Breu M, Schimmel M, Diepold K, Haeusler M, Quade A, Berger A, Rosewich H, Steen C, von Au K, Dreesmann M, Finke C, Bartels F, Kaindl AM, Schuelke M, Knierim E. Retrospective Pediatric Cohort Study Validates NEOS Score and Demonstrates Applicability in Children With Anti-NMDAR Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200102. [PMID: 36948591 PMCID: PMC10032577 DOI: 10.1212/nxi.0000000000200102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is the most common form of autoimmune encephalitis in children and adults. Although our understanding of the disease mechanisms has progressed, little is known about estimating patient outcomes. Therefore, the NEOS (anti-NMDAR Encephalitis One-Year Functional Status) score was introduced as a tool to predict disease progression in NMDARE. Developed in a mixed-age cohort, it currently remains unclear whether NEOS can be optimized for pediatric NMDARE. METHODS This retrospective observational study aimed to validate NEOS in a large pediatric-only cohort of 59 patients (median age of 8 years). We reconstructed the original score, adapted it, evaluated additional variables, and assessed its predictive power (median follow-up of 20 months). Generalized linear regression models were used to examine predictability of binary outcomes based on the modified Rankin Scale (mRS). In addition, neuropsychological test results were investigated as alternative cognitive outcome. RESULTS The NEOS score reliably predicted poor clinical outcome (mRS ≥3) in children in the first year after diagnosis (p = 0.0014) and beyond (p = 0.036, 16 months after diagnosis). A score adapted to the pediatric cohort by adjusting the cutoffs of the 5 NEOS components did not improve predictive power. In addition to these 5 variables, further patient characteristics such as the "Herpes simplex virus encephalitis (HSE) status" and "age at disease onset" influenced predictability and could potentially be useful to define risk groups. NEOS also predicted cognitive outcome with higher scores associated with deficits of executive function (p = 0.048) and memory (p = 0.043). DISCUSSION Our data support the applicability of the NEOS score in children with NMDARE. Although not yet validated in prospective studies, NEOS also predicted cognitive impairment in our cohort. Consequently, the score could help identify patients at risk of poor overall clinical outcome and poor cognitive outcome and thus aid in selecting not only optimized initial therapies for these patients but also cognitive rehabilitation to improve long-term outcomes.
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Affiliation(s)
- Marc Nikolaus
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Philipp Rausch
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Kevin Rostásy
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Annikki Bertolini
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Ronny Wickström
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Jessika Johannsen
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Jonas Denecke
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Markus Breu
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Mareike Schimmel
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Katharina Diepold
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Martin Haeusler
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Annegret Quade
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Andrea Berger
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Hendrik Rosewich
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Claudia Steen
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Katja von Au
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Mona Dreesmann
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Carsten Finke
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Frederik Bartels
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Angela M Kaindl
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Markus Schuelke
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
| | - Ellen Knierim
- From the Department of Pediatric Neurology (M.N., A.M.K., M.S., E.K.) and Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH); Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig Holstein, Campus Kiel; Department of Genetics and Bioinformatics (P.R.), Kiel; Department of Pediatric Neurology (K.R., A.B.), Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany; Neuropediatric Unit (R.W.), Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Pediatrics (J.J., J.D.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine (M.B.), Medical University of Vienna, Austria; Department of Pediatric Neurology (M.S.), University Children's Hospital Augsburg; Division of Pediatric Neurology, Department of Pediatrics (K.D.), Hospital Kassel; Department of Pediatrics (M.H., A.Q.), Division of Neuropediatrics and Social Pediatrics, Medical University Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen; Division of Pediatric Neurology, Department of Pediatrics (A.B.), München Klinik Harlaching, Munich; Department of Pediatrics and Pediatric Neurology (H.R.), Georg August University, Göttingen; Department of Paediatric and Adolescent Medicine (C.S.), St Joseph Hospital, Berlin; Department of Pediatrics (K.v.), Vivantes Hospital Friedrichshain, Berlin; Department of Pediatrics (M.D.), Ernst von Bergmann Hospital, Potsdam; Department of Neurology (C.F., F.B.), Charité-Universitätsmedizin Berlin and Berlin School of Mind and Brain, Humboldt-Universität zu Berlin; Charité-Universitätsmedizin Berlin (A.M.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Cell Biology and Neurobiology; Charité-Universitätsmedizin Berlin (M.S., E.K.), Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), NeuroCure Clinical Research Center Berlin, Germany
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Sun N, Jia Y, Bai S, Li Q, Dai L, Li J. The power of super-resolution microscopy in modern biomedical science. Adv Colloid Interface Sci 2023; 314:102880. [PMID: 36965225 DOI: 10.1016/j.cis.2023.102880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Super-resolution microscopy (SRM) technology that breaks the diffraction limit has revolutionized the field of cell biology since its appearance, which enables researchers to visualize cellular structures with nanometric resolution, multiple colors and single-molecule sensitivity. With the flourishing development of hardware and the availability of novel fluorescent probes, the impact of SRM has already gone beyond cell biology and extended to nanomedicine, material science and nanotechnology, and remarkably boosted important breakthroughs in these fields. In this review, we will mainly highlight the power of SRM in modern biomedical science, discussing how these SRM techniques revolutionize the way we understand cell structures, biomaterials assembly and how assembled biomaterials interact with cellular organelles, and finally their promotion to the clinical pre-diagnosis. Moreover, we also provide an outlook on the current technical challenges and future improvement direction of SRM. We hope this review can provide useful information, inspire new ideas and propel the development both from the perspective of SRM techniques and from the perspective of SRM's applications.
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Affiliation(s)
- Nan Sun
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Lab of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049
| | - Yi Jia
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Lab of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Shiwei Bai
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Lab of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049
| | - Qi Li
- State Key Laboratory of Biochemical Engineering Institute of Process Engineering Chinese Academy of Sciences, Beijing 100190, China
| | - Luru Dai
- Wenzhou Institute and Wenzhou Key Laboratory of Biophysics, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325001, China
| | - Junbai Li
- Beijing National Laboratory for Molecular Sciences (BNLMS), CAS Key Lab of Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049.
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Blackman G, Kumar K, Hanrahan JG, Dalrymple A, Mullatti N, Moran N, Valentin A, Gibson L, Pollak TA, David AS. Quantitative EEG as a Prognostic Tool in Suspected Anti-N-Methyl- d -Aspartate Receptor Antibody Encephalitis. J Clin Neurophysiol 2023; 40:160-164. [PMID: 34238869 PMCID: PMC9886530 DOI: 10.1097/wnp.0000000000000877] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Anti-N-methyl- d -aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis associated with EEG abnormalities. In view of the potentially severe outcomes, there is a need to develop prognostic tools to inform clinical management. The authors explored whether quantitative EEG was able to predict outcomes in patients with suspected anti-NMDAR encephalitis. METHODS A retrospective, observational study was conducted of patients admitted to a tertiary clinical neuroscience center with suspected anti-NMDAR encephalitis. Peak power and peak frequency within delta (<4 Hz), theta (4-8 Hz), alpha (8 - 13 Hz), and beta (13-30 Hz) frequency bands were calculated for the first clinical EEG recording. Outcome was based on the modified Rankin Scale (mRS) score at 1 year after hospital discharge. Binomial logistic regression using backward elimination was performed with peak frequency and power, anti-NMDAR Encephalitis One-Year Functional Status score, age, and interval from symptom onset to EEG entered as predictors. RESULTS Twenty patients were included (mean age 48.6 years, 70% female), of which 7 (35%) had a poor clinical outcome (mRS 2-6) at 1 year. There was no association between reported EEG abnormalities and outcome. The final logistic regression model was significant (χ 2 (1) = 6.35, P < 0.012) with peak frequency in the delta range (<4 Hz) the only retained predictor. The model explained 38% of the variance (Nagelkerke R2 ) and correctly classified 85% of cases. Higher peak frequency in the delta range was significantly associated ( P = 0.04) with an increased likelihood of poor outcome. CONCLUSIONS In this exploratory study, it was found that quantitative EEG on routinely collected EEG recordings in patients with suspected anti-NMDAR encephalitis was feasible. A higher peak frequency within the delta range was associated with poorer clinical outcome and may indicate anti-NMDAR-mediated synaptic dysfunction. Quantitative EEG may have clinical utility in predicting outcomes in patients with suspected NMDAR antibody encephalitis, thereby serving as a useful adjunct to qualitative EEG assessment; however, given the small sample size, replication in a larger scale is indicated.
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Affiliation(s)
- Graham Blackman
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kieron Kumar
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - John G. Hanrahan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Anthony Dalrymple
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nandini Mullatti
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nick Moran
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
- East Kent Hospitals University Foundation Trust, Canterbury, United Kingdom
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Lucy Gibson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Division of Psychiatry, University College London, London, United Kingdom; and
- UCL Institute of Mental Health, University College London, London, United Kingdom
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Li Y, Zhang M, Liu D, Wei M, Sheng J, Wang Z, Xue S, Yu T, Xue W, Zhu B, He J. Case report: Autoimmune encephalitis with multiple auto-antibodies with reversible splenial lesion syndrome and bilateral ovarian teratoma. Front Immunol 2023; 13:1029294. [PMID: 36713425 PMCID: PMC9878315 DOI: 10.3389/fimmu.2022.1029294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background Reversible splenial lesion syndrome (RESLES) is a spectrum of disease radiologically characterized by reversible lesions caused by multiple factors, primarily involving the splenium of the corpus callosum (SCC). The most common causes of RESLES include infection, antiepileptic drug use and withdrawal, and severe metabolic disorders. Nevertheless, cases of autoimmune encephalitis (AE) are uncommon. Case presentation A 26-year-old female computer programming engineer with no previous medical or psychiatric history reported to the psychiatric hospital due to a 3-day episode of irritability, babbling, limb stiffness, sleepwalking, hallucinations, and paroxysmal mania. Brain MRI revealed abnormal signals of the SCC. Lumbar puncture was performed and further testing for auto-antibodies was conducted in both the CSF and serum. CSF of the patient was positive for anti-NMDAR (titer of 1:3.2) antibodies, and serum was also positive for anti-NMDAR (titer of 1:32) as well as mGluR5 (titer of 1:10) antibodies. Enhanced CT of the pelvis showed an enlarged pelvic mass; bilateral ovarian teratomas (mature teratoma and immature teratoma) were evaluated, which were pathologically confirmed after transabdominal left adnexal resection, right ovarian biopsy, and ovarian cystectomy. The patient considerably improved after intravenous administration of steroids, immunoglobulin, oral prednisone, surgical treatment, and chemotherapy. A follow-up MRI revealed completely resolved lesions. During a 3-month follow-up, the patient experienced complete resolution of symptoms without any sign of recurrence and tumors. The titer of the anti-NMDAR antibody decreased to 1:10 in serum. Conclusion Herein, we report a rare case of AE with overlapping auto-antibodies, along with RESLES and bilateral ovarian teratomas. The current case provides the possibility of the concurrence of mGluR5 antibodies in anti-NMDAR encephalitis. However, the underlying mechanism remains elusive. Furthermore, we provide additional evidence that overlapping antibodies-related pathology may be one of the many causes of RESLES. Nonetheless, caution should be observed in interpreting the observation, considering that this is a single-case study.
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Affiliation(s)
- Yaqiang Li
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China,Department of Neurology, People’s Hospital of Lixin County, Bozhou, China
| | - Mei Zhang
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China,*Correspondence: Mei Zhang,
| | - Deshun Liu
- Department of Radiology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Ming Wei
- Department of Radiology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Jun Sheng
- Department of Radiology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Zhixin Wang
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Song Xue
- Department of Pathology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Tingting Yu
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Weimin Xue
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Beibei Zhu
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
| | - Jiale He
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology (First People’s Hospital of Huainan), Huainan, China
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Chen H, Dong Y, Wu Y, Yi F. Targeting NMDA receptor signaling for therapeutic intervention in brain disorders. Rev Neurosci 2023:revneuro-2022-0096. [PMID: 36586105 DOI: 10.1515/revneuro-2022-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/03/2022] [Indexed: 01/01/2023]
Abstract
N-Methyl-d-aspartate (NMDA) receptor hyperfunction plays a key role in the pathological processes of depression and neurodegenerative diseases, whereas NMDA receptor hypofunction is implicated in schizophrenia. Considerable efforts have been made to target NMDA receptor function for the therapeutic intervention in those brain disorders. In this mini-review, we first discuss ion flux-dependent NMDA receptor signaling and ion flux-independent NMDA receptor signaling that result from structural rearrangement upon binding of endogenous agonists. Then, we review current strategies for exploring druggable targets of the NMDA receptor signaling and promising future directions, which are poised to result in new therapeutic agents for several brain disorders.
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Affiliation(s)
- He Chen
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou 510515, P. R. China
| | - Yuanping Dong
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou 510515, P. R. China
| | - Yun Wu
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou 510515, P. R. China
| | - Feng Yi
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou 510515, P. R. China
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Washburn HR, Chander P, Srikanth KD, Dalva MB. Transsynaptic Signaling of Ephs in Synaptic Development, Plasticity, and Disease. Neuroscience 2023; 508:137-152. [PMID: 36460219 DOI: 10.1016/j.neuroscience.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
Synapse formation between neurons is critical for proper circuit and brain function. Prior to activity-dependent refinement of connections between neurons, activity-independent cues regulate the contact and recognition of potential synaptic partners. Formation of a synapse results in molecular recognition events that initiate the process of synaptogenesis. Synaptogenesis requires contact between axon and dendrite, selection of correct and rejection of incorrect partners, and recruitment of appropriate pre- and postsynaptic proteins needed for the establishment of functional synaptic contact. Key regulators of these events are families of transsynaptic proteins, where one protein is found on the presynaptic neuron and the other is found on the postsynaptic neuron. Of these families, the EphBs and ephrin-Bs are required during each phase of synaptic development from target selection, recruitment of synaptic proteins, and formation of spines to regulation of synaptic plasticity at glutamatergic spine synapses in the mature brain. These roles also place EphBs and ephrin-Bs as important regulators of human neurological diseases. This review will focus on the role of EphBs and ephrin-Bs at synapses.
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Affiliation(s)
- Halley R Washburn
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA; Department of Neuroscience, Jefferson Synaptic Biology Center, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, Bluemle Life Sciences Building, Room 324, Philadelphia, PA 19107, USA
| | - Praveen Chander
- Department of Neuroscience, Jefferson Synaptic Biology Center, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, Bluemle Life Sciences Building, Room 324, Philadelphia, PA 19107, USA
| | - Kolluru D Srikanth
- Department of Neuroscience, Jefferson Synaptic Biology Center, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, Bluemle Life Sciences Building, Room 324, Philadelphia, PA 19107, USA
| | - Matthew B Dalva
- Department of Neuroscience, Jefferson Synaptic Biology Center, Sidney Kimmel Medical College at Thomas Jefferson University, 233 South 10th Street, Bluemle Life Sciences Building, Room 324, Philadelphia, PA 19107, USA.
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Sabet MF, Barman S, Beller M, Meuth SG, Melzer N, Aktas O, Goebels N, Prozorovski T. Myelinating Co-Culture as a Model to Study Anti-NMDAR Neurotoxicity. Int J Mol Sci 2022; 24:ijms24010248. [PMID: 36613687 PMCID: PMC9820503 DOI: 10.3390/ijms24010248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Anti-NMDA receptor (NMDAR) encephalitis is frequently associated with demyelinating disorders (e.g., multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein-associated disease (MOGAD)) with regard to clinical presentation, neuropathological and cerebrospinal fluid findings. Indeed, autoantibodies (AABs) against the GluN1 (NR1) subunit of the NMDAR diminish glutamatergic transmission in both neurons and oligodendrocytes, leading to a state of NMDAR hypofunction. Considering the vital role of oligodendroglial NMDAR signaling in neuron-glia communication and, in particular, in tightly regulated trophic support to neurons, the influence of GluN1 targeting on the physiology of myelinated axon may be of importance. We applied a myelinating spinal cord cell culture model that contains all major CNS cell types, to evaluate the effects of a patient-derived GluN1-specific monoclonal antibody (SSM5) on neuronal and myelin integrity. A non-brain reactive (12D7) antibody was used as the corresponding isotype control. We show that in cultures at the late stage of myelination, prolonged treatment with SSM5, but not 12D7, leads to neuronal damage. This is characterized by neurite blebbing and fragmentation, and a reduction in the number of myelinated axons. However, this significant toxic effect of SSM5 was not observed in earlier cultures at the beginning of myelination. Anti-GluN1 AABs induce neurodegenerative changes and associated myelin loss in myelinated spinal cord cultures. These findings may point to the higher vulnerability of myelinated neurons towards interference in glutamatergic communication, and may refer to the disturbance of the NMDAR-mediated oligodendrocyte metabolic supply. Our work contributes to the understanding of the emerging association of NMDAR encephalitis with demyelinating disorders.
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Affiliation(s)
- Mercedeh Farhat Sabet
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Sumanta Barman
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Mathias Beller
- Institut für Mathematische Modellierung Biologischer Systeme, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Sven G. Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
| | - Norbert Goebels
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
- Correspondence: (N.G.); (T.P.); Tel.: +49-211-81-04594 (N.G.); +49-211-81-05146 (T.P.)
| | - Tim Prozorovski
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, 40225 Düsseldorf, Germany
- Correspondence: (N.G.); (T.P.); Tel.: +49-211-81-04594 (N.G.); +49-211-81-05146 (T.P.)
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Luo Y, Yu Y, Zhang M, Fan N. GluN1 antibody causes behavioral deficits in prepulse inhibition and memory through CaMKIIβ signaling. J Neuroimmunol 2022; 373:577998. [PMID: 36417808 DOI: 10.1016/j.jneuroim.2022.577998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/17/2022] [Accepted: 10/30/2022] [Indexed: 11/18/2022]
Abstract
Accumulating evidence suggests that some patients with schizophrenia have high production of autoantibodies against the N-methyl-d-aspartate receptor (NMDAR) subunit GluN1 and that these antibodies lead to cognitive impairment. However, the molecular mechanisms of the deficits seen in these patients are largely unknown. In the present study, we found that passive infusion of GluN1 antibody into the hippocampus of mice for 7 days led to decreased expression of GluN1, phosphor-Ser897-GluN1, and EphrinB2 receptor (EphB2R); deficits in long-term potentiation (LTP) and synaptic transmission in the hippocampal CA1 area; impairment in prepulse inhibition (PPI); and deterioration of recognition memory in novel object recognition test. We also found decreased expression of CaMKIIβ, ERK1/2, CREB, and NF-κB after 7 days of GluN1 antibody exposure, as was the phosphorylation of these signaling molecules. The decrease in GluN1 and phosphor-Ser897-GluN1 expression and the deficits in LTP, PPI, and recognition memory were ameliorated by CaMKIIβ overexpression. These results suggest that downregulation of CaMKIIβ-ERK1/2-CREB-NF-κB signaling is responsiable for GluN1 antibody-associated impairment in PPI and memory and that GluN1 antibody-induced NMDAR hypofunction is the underlying mechanism of this impairment. Our findings indicate possible strategies to ameliorate NMDAR antibody-associated cognitive impairment in neuropsychiatric disease. They also provide evidence that NMDAR hypofunction is an underlying mechanism for cognitive impairment in schizophrenia.
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Affiliation(s)
- Yayan Luo
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province 510370, China
| | - Yang Yu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province 510370, China
| | - Minling Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province 510370, China
| | - Ni Fan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province 510370, China.
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Jiang Y, Dai S, Jia L, Qin L, Zhang M, Liu H, Wang X, Pang R, Zhang J, Peng G, Li W. Single-cell transcriptomics reveals cell type-specific immune regulation associated with anti-NMDA receptor encephalitis in humans. Front Immunol 2022; 13:1075675. [PMID: 36544777 PMCID: PMC9762154 DOI: 10.3389/fimmu.2022.1075675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) is a rare autoimmune disease, and the peripheral immune characteristics associated with anti-NMDARE antibodies remain unclear. Methods Herein, we characterized peripheral blood mononuclear cells from patients with anti-NMDARE and healthy individuals by single-cell RNA sequencing (scRNA-seq). Results The transcriptional profiles of 129,217 cells were assessed, and 21 major cell clusters were identified. B-cell activation and differentiation, plasma cell expansion, and excessive inflammatory responses in innate immunity were all identified. Patients with anti-NMDARE showed higher expression levels of CXCL8, IL1B, IL6, TNF, TNFSF13, TNFSF13B, and NLRP3. We observed that anti-NMDARE patients in the acute phase expressed high levels of DC_CCR7 in human myeloid cells. Moreover, we observed that anti-NMDARE effects include oligoclonal expansions in response to immunizing agents. Strong humoral immunity and positive regulation of lymphocyte activation were observed in acute stage anti-NMDARE patients. Discussion This high-dimensional single-cell profiling of the peripheral immune microenvironment suggests that potential mechanisms are involved in the pathogenesis and recovery of anti-NMDAREs.
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Affiliation(s)
- Yushu Jiang
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Wei Li, ; Yushu Jiang,
| | - Shuhua Dai
- Department of Neurology, Henan Provincial People’s Hospital, Xinxiang Medical University, Zhengzhou, Henan, China
| | - Linlin Jia
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lingzhi Qin
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Milan Zhang
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huiqin Liu
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaojuan Wang
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Pang
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jiewen Zhang
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Gongxin Peng
- China Center for Bioinformatics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
| | - Wei Li
- Department of Neurology, Henan Joint International Research Laboratory of Accurate Diagnosis, Treatment, Research and Development, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Wei Li, ; Yushu Jiang,
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Binks S, Lamquet S, Crawford AH, Meurs A, Irani SR, Pakozdy A. Parallel roles of neuroinflammation in feline and human epilepsies. Vet J 2022; 290:105912. [PMID: 36209994 PMCID: PMC10912827 DOI: 10.1016/j.tvjl.2022.105912] [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: 01/22/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Autoimmune encephalitis refers to a group of disorders characterised by a non-infectious encephalitis, often with prominent seizures and surface neuronal autoantibodies. AE is an important cause of new-onset refractory status epilepticus in humans and is frequently responsive to immunotherapies including corticosteroids, plasma exchange, intravenous immunoglobulin G and rituximab. Recent research suggests that parallel autoantibodies can be detected in non-human mammalian species. The best documented example is leucine-rich glioma-inactivated 1 (LGI1)-antibodies in domestic cats with limbic encephalitis (LE). In this review, we discuss the role of neuroinflammation and autoantibodies in human and feline epilepsy and LE.
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Affiliation(s)
- Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK.
| | - Simon Lamquet
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Abbe H Crawford
- Clinical Science and Services, The Royal Veterinary College, Hertfordshire AL9 7TA, UK
| | - Alfred Meurs
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK
| | - Akos Pakozdy
- University Clinic for Small Animals, University of Veterinary Medicine Vienna, Austria
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Zhou D, Xie C, Li X, Song N, Kou Z, Zhang T, Yuan TF. Rare presence of autoantibodies targeting to NMDA and GABA A receptors in schizophrenia patients. Schizophr Res 2022; 249:93-97. [PMID: 34916095 DOI: 10.1016/j.schres.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Accumulating evidence suggests that the pathology of some psychiatric symptoms may relate to autoantibodies against various neuronal surface antigens, such as NMDA receptors (NMDARs) or inhibitory GABAA receptors (GABAARs). However, it is unclear whether the plasma of patients with schizophrenia contains autoantibodies targeting to NMDARs or GABAARs. METHODS Serum samples of 293 patients with schizophrenia were analyzed using a combination of live-cell-based assay (CBA) and immunostaining on primary neurons to quantify the positive rate of autoantibodies targeting NMDARs or GABAARs. RESULTS Only one sample was found positive for anti-NMDAR autoantibodies, and no surface autoantibodies against GABAARs were found. No obvious difference in clinical manifestations was observed between the patients with positive and negative anti-NMDAR autoantibodies. CONCLUSIONS Our results suggest that autoantibodies against NMDARs or GABAARs may affect only a small group of patients with schizophrenia, and the rates of these autoantibodies are lower than reported in prior work. It would be interesting to perform studies with psychotic disorder instead of schizophrenia to determine whether NMDAR or GABAAR autoantibody can be used as a biomarker to provide a new avenue for immunomodulatory therapy.
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Affiliation(s)
- Dongsheng Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China.
| | - Chun Xie
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Xingxing Li
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Nan Song
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Zengwei Kou
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Tongtong Zhang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China; Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
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Dean CA, Metzbower SR, Dessain SK, Blanpied TA, Benavides DR. Regulation of NMDA Receptor Signaling at Single Synapses by Human Anti-NMDA Receptor Antibodies. Front Mol Neurosci 2022; 15:940005. [PMID: 35966009 PMCID: PMC9371948 DOI: 10.3389/fnmol.2022.940005] [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: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The NMDA receptor (NMDAR) subunit GluN1 is critical for receptor function and plays a pivotal role in synaptic plasticity. Mounting evidence has shown that pathogenic autoantibody targeting of the GluN1 subunit of NMDARs, as in anti-NMDAR encephalitis, leads to altered NMDAR trafficking and synaptic localization. However, the underlying signaling pathways affected by antibodies targeting the NMDAR remain to be fully delineated. It remains unclear whether patient antibodies influence synaptic transmission via direct effects on NMDAR channel function. Here, we show using short-term incubation that GluN1 antibodies derived from patients with anti-NMDAR encephalitis label synapses in mature hippocampal primary neuron culture. Miniature spontaneous calcium transients (mSCaTs) mediated via NMDARs at synaptic spines are not altered in pathogenic GluN1 antibody exposed conditions. Unexpectedly, spine-based and cell-based analyses yielded distinct results. In addition, we show that calcium does not accumulate in neuronal spines following brief exposure to pathogenic GluN1 antibodies. Together, these findings show that pathogenic antibodies targeting NMDARs, under these specific conditions, do not alter synaptic calcium influx following neurotransmitter release. This represents a novel investigation of the molecular effects of anti-NMDAR antibodies associated with autoimmune encephalitis.
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Affiliation(s)
- Charles A. Dean
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sarah R. Metzbower
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Scott K. Dessain
- Lankenau Institute for Medical Research, Wynnewood, PA, United States
| | - Thomas A. Blanpied
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David R. Benavides
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
- *Correspondence: David R. Benavides,
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Ciano-Petersen NL, Muñiz-Castrillo S, Birzu C, Vogrig A, Farina A, Villagrán-García M, Joubert B, Psimaras D, Honnorat J. Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis. Brain Commun 2022; 4:fcac196. [PMID: 35999839 PMCID: PMC9392471 DOI: 10.1093/braincomms/fcac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis. Cytokines are biologically active, soluble, low-molecular-weight proteins or glycoproteins involved in a wide variety of physiological functions, including central nervous system development and homeostasis, immune surveillance, as well as proliferation and maturation of immune cells. Since unbalanced cytokine expression is considered a hallmark of many autoimmune central nervous system disorders, their identification and quantification has become an essential element in personalized medicine applied to the field of neuroimmunology. Several studies have explored the cytokine profile of autoimmune encephalitis, but their interpretation and comparison is challenging due to their small sample sizes and extremely high heterogeneity, especially regarding the cytokines analysed, type of sample used, and associated neural antibody. Only the cytokine profile of anti-N-methyl-D-aspartate receptor encephalitis has extensively been investigated, with findings suggesting that, although humoral immunity is the main effector, T cells may also be relevant for the development of this disorder. A better understanding of cytokine dynamics governing neuroinflammation might offer the opportunity of developing new therapeutic strategies against specific immune cells, cytokines, antibodies, or intracellular signalling cascades, therefore leading to better outcomes and preventing undesired side effects of the presently used strategies. In this review, we first summarize the current knowledge about the role of cytokines in the pathogenesis of autoimmune encephalitis, combining theoretical analysis with experimental validations, to assess their suitability as clinical biomarkers. Second, we discuss the potential applicability of the novel targeted immunotherapies in autoimmune encephalitis depending on the immunobiology of the associated antibody, their limitations, as well as the main limitations that should be addressed in future studies.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
- Neuroimmunology and Neuroinflammation group. Biomedical Research Institute of Málaga (IBIMA) , Málaga , Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA). Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Cristina Birzu
- Service de Neurologie 2-Mazarin, Centre de Recherche de l’Institut du Cerveau et de la Moelle Epinière, Groupe Hospitalier Pitie-Salpetrière et Université Pierre et Marie Curie-Paris 6, AP-HP , Paris , France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Antonio Farina
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Macarena Villagrán-García
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Dimitri Psimaras
- Service de Neurologie 2-Mazarin, Centre de Recherche de l’Institut du Cerveau et de la Moelle Epinière, Groupe Hospitalier Pitie-Salpetrière et Université Pierre et Marie Curie-Paris 6, AP-HP , Paris , France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
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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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Co DO, Kwon JM. Autoimmune Encephalitis: Distinguishing Features and Specific Therapies. Crit Care Clin 2022; 38:393-412. [DOI: 10.1016/j.ccc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Butler C, Saraceno GE, Kechkar A, Bénac N, Studer V, Dupuis JP, Groc L, Galland R, Sibarita JB. Multi-Dimensional Spectral Single Molecule Localization Microscopy. FRONTIERS IN BIOINFORMATICS 2022; 2:813494. [PMID: 36304321 PMCID: PMC9580959 DOI: 10.3389/fbinf.2022.813494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Single molecule localization (SML) and tracking (SPT) techniques, such as (spt)PALM, (u/DNA)PAINT and quantum dot tracking, have given unprecedented insight into the nanoscale molecular organization and dynamics in living cells. They allow monitoring individual proteins with millisecond temporal resolution and high spatial resolution (<30 nm) by precisely localizing the point spread function (PSF) of individual emitters and tracking their position over time. While SPT methods have been extended to study the temporal dynamics and co-organization of multiple proteins, conventional experimental setups are restricted in the number of proteins they can probe simultaneously and usually have to tradeoff between the number of colors, the spatio-temporal resolution, and the field of view. Yet, localizing and tracking several proteins simultaneously at high spatial and temporal resolution within large field of views can provide important biological insights. By employing a dual-objective spectral imaging configuration compatible with live cell imaging combined with dedicated computation tools, we demonstrate simultaneous 3D single particle localization and tracking of multiple distinct species over large field of views to be feasible without compromising spatio-temporal resolution. The dispersive element introduced into the second optical path induces a spectrally dependent displacement, which we used to analytically separate up to five different fluorescent species of single emitters based on their emission spectra. We used commercially available microscope bodies aligned one on top of the other, offering biologists with a very ergonomic and flexible instrument covering a broad range of SMLM applications. Finally, we developed a powerful freely available software, called PALMTracer, which allows to quantitatively assess 3D + t + λ SMLM data. We illustrate the capacity of our approach by performing multi-color 3D DNA-PAINT of fixed samples, and demonstrate simultaneous tracking of multiple receptors in live fibroblast and neuron cultures.
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Affiliation(s)
- Corey Butler
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
- Imagine Optic, Orsay, France
| | - G Ezequiel Saraceno
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Adel Kechkar
- Ecole Nationale Supérieure de Biotechnologie, Laboratoire de Bioengineering, Constantine, El Khroub, Algeria
| | - Nathan Bénac
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Vincent Studer
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Julien P. Dupuis
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Laurent Groc
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Rémi Galland
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
| | - Jean-Baptiste Sibarita
- Univ. Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS, UMR 5297F-33000, F-33000, Bordeaux, France
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Impairment of early neuronal maturation in anti-NMDA-receptor encephalitis. Psychopharmacology (Berl) 2022; 239:525-531. [PMID: 34854935 DOI: 10.1007/s00213-021-06036-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
RATIONALE Adequate immunotherapies for anti-NMDAR encephalitis during pregnancy produce a relatively good clinical outcome for pregnant mothers and their infants, but there are no reports about the future growth of their babies. The damage of anti-NMDAR antibodies to early neuronal development is still unknown. OBJECTIVES Serum or cerebrospinal fluid from one patient with anti-NMDAR encephalitis (the index patient) and one patient with schizophrenia (the control patient) was administered to primary cultures of dissociated rat cortical neurons, and dendritic outgrowth, centrosome elimination, and branching of dendrites were investigated. For rescue experiments, serum of the index patient was replaced with normal culture media after 3 days' administration of the index patient. RESULTS Serum and cerebrospinal fluid of the index patient statistically significantly impaired dendritic outgrowth of cultured rat cortical primary neurons. Serum of the index patient also statistically significantly delayed centrosome elimination. Impaired dendritic outgrowth and delayed centrosome elimination were not perfectly rescued by changing to normal culture media. Serum of the index patient also statistically significantly reduced the branching of dendrites. CONCLUSIONS This is the first demonstration of the damage by anti-NMDAR antibodies on early dendritic development in vitro. As a strategy to protect embryonic neurons, our findings may support the efficacy of early immunotherapy for anti-NMDAR encephalitis in pregnancy.
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Seery N, Butzkueven H, O'Brien TJ, Monif M. Contemporary advances in anti-NMDAR antibody (Ab)-mediated encephalitis. Autoimmun Rev 2022; 21:103057. [PMID: 35092831 DOI: 10.1016/j.autrev.2022.103057] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 12/18/2022]
Abstract
The study of antibody (Ab)-mediated encephalitis has advanced dramatically since the discovery of antibodies directed against the N-methyl-D-aspartate receptor (NMDAR) in association with a unique neuro-psychiatric syndrome, over a decade-and-a-half ago. Anti-NMDAR Ab-mediated encephalitis now represents the most well characterised form of autoimmune encephalitis. The disease most commonly manifests in young women, but all ages and both sexes can be affected. Autoantibodies may arise in the context of two well-recognised disease triggers in a proportion of patients, and ultimately facilitate NMDAR displacement from synapses. Various CSF cytokines, chemokines, and other molecules have been explored as candidate biomarkers but are limited in sensitivity and specificity. The clinical spectrum is diverse, with evolution and a combination of neuro-psychiatric abnormalities at disease nadir common. Anti-NMDAR Ab-mediated encephalitis is immunotherapy responsive, and a near-majority ultimately acquire a broadly favourable clinical outcome. The diagnosis, and more particularly, the management of the disease can still hold considerable challenges. Moreover, well-defined biomarkers remain elusive. The present review will therefore delineate pathogenic and clinical advances to date in anti-NMDAR antibody-mediated encephalitis.
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Affiliation(s)
- Nabil Seery
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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