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Liu S, Hong Y, Wang BR, Wei ZQ, Zhao HD, Jiang T, Zhang YD, Shi JQ. The presence and clinical significance of autoantibodies in amyotrophic lateral sclerosis: a narrative review. Neurol Sci 2024; 45:4133-4149. [PMID: 38733435 DOI: 10.1007/s10072-024-07581-x] [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: 02/01/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a debilitating and rapidly fatal neurodegenerative disease, which is characterized by the selective loss of the upper and lower motor neurons. The pathogenesis of ALS remains to be elucidated and has been connected to genetic, environmental and immune conditions. Evidence from clinical and experimental studies has suggested that the immune system played an important role in ALS pathophysiology. Autoantibodies are essential components of the immune system. Several autoantibodies directed at antigens associated with ALS pathogenesis have been identified in the serum and/or cerebrospinal fluid of ALS patients. The aim of this review is to summarize the presence and clinical significance of autoantibodies in ALS.
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Affiliation(s)
- Shen Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Ye Hong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Bian-Rong Wang
- Department of Neurology, Geriatric Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Zi-Qiao Wei
- The Second Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu Province, 211166, PR China
| | - Hong-Dong Zhao
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Teng Jiang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Ying-Dong Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China
| | - Jian-Quan Shi
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, 210006, PR China.
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Gaig C, Sabater L. New knowledge on anti-IgLON5 disease. Curr Opin Neurol 2024; 37:316-321. [PMID: 38563128 PMCID: PMC11064895 DOI: 10.1097/wco.0000000000001271] [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] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Anti-IgLON5 disease is characterized by a distinctive sleep disorder, associated with a heterogeneous spectrum of neurological symptoms. Initial autopsies showed a novel neuronal tauopathy predominantly located in the tegmentum of the brainstem. Recently, new diagnostic red flags, biomarkers predictors of response to immunotherapy, and novel insights into the autoimmune pathogenesis of the disease have been reported. RECENT FINDINGS Patients with diagnosis of neurodegenerative dementia, progressive supranuclear palsy (PSP) or with motor-neuron disease (MND)-like syndrome have been reported to have IgLON5 antibodies, which are the hallmark of anti-IgLON5 disease. Second, low levels of neurofilament light chain in serum and cerebrospinal fluid of patients at disease onset could be a predictor of immunotherapy response. Recent neuropathological studies indicate that the neuronal tau deposits occur late in the course of the disease. Moreover, IgLON5 antibodies induce cytoskeletal changes in cultured hippocampal neurons suggesting that the tauopathy could be secondary of the IgLON5 antibody effects. SUMMARY Anti-IgLON5 disease can mimic and should be considered in atypical presentations of MND, neurodegenerative dementia and PSP. Neurofilament light chain levels seem promising biomarker for disease prognosis. Finally, the neuropathological and in vitro experimental studies strengthen the autoimmune hypothesis of the disease.
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Affiliation(s)
- Carles Gaig
- Service of Neurology, Hospital Clinic de Barcelona
| | - Lidia Sabater
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Pastene D, Lehrer E, Jubes S, Santamaria J, Iranzo A, Gaig C, Vilaseca I. Upper airway manifestations of anti-IgLON5 disease: Otorhinolaryngological point of view. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00051-6. [PMID: 38729239 DOI: 10.1016/j.otoeng.2024.04.001] [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: 02/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm. METHODS In this study, we present a series of 9 patients with anti-IgLON5 disease and otolaryngological manifestations. Patients were evaluated between July 2012 and March 2022 by video-polysomnography, fiber-optic laryngoscopy, and functional endoscopic evaluation of swallowing. RESULTS The median age was 71 years, and 5 (56%) were female. Video-polysomnography showed a NREM/REM parasomnia in 6 patients (67%), obstructive sleep apnea in 8 (88%), stridor during sleep in 7 (78%) and central apneas in 1 (11%). Six out of the 9 patients (67%) presented episodes of acute respiratory failure that required mechanical ventilation, 6 had vocal fold palsy with 4 of them requiring tracheostomy (3 had to be performed on an emergency basis). Dysphagia occurred in 8 patients (89%). Prominent upper airway secretion and sialorrhea was also present in 3 cases. CONCLUSION The anti-IgLON5 disease exhibits extensive otolaryngological symptoms, mainly affecting the upper airway. These symptoms affect the quality of life and can be life-threatening. Prompt acute management is essential for stridor, dyspnea, and dysphagia. Given the potential severity of the symptoms and rarity of the disease, it is important for otolaryngologists to be familiar with anti-IgLON5 disease. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Daniela Pastene
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Head Neck Cancer Unit, Hospital Clínic, Barcelona, Spain; Department of Surgery and Medical Surgical Specialties, School of Medicine, Universitat de Barcelona, Spain.
| | - Sara Jubes
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Santamaria
- Emeritus consultant and researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS) Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Center, Hospital Clínic de Barcelona, Barcelona, Spain, University of Barcelona, IDIBAPS, CIBERNED, Spain
| | - Carles Gaig
- Neurology Service, Sleep Disorders Center, Hospital Clínic de Barcelona, Barcelona, Spain, University of Barcelona, IDIBAPS, CIBERNED, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Head Neck Cancer Unit, Hospital Clínic, Barcelona, Spain; Department of Surgery and Medical Surgical Specialties, School of Medicine, Universitat de Barcelona, Spain
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Lee SY, Shoji H, Shimozawa A, Aoyagi H, Sato Y, Tsumagari K, Terumitsu M, Motegi H, Okada K, Sekiguchi K, Kuromitsu J, Nakahara J, Miyakawa T, Ito D. Phenotypic Insights Into Anti-IgLON5 Disease in IgLON5-Deficient Mice. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200234. [PMID: 38657185 PMCID: PMC11087031 DOI: 10.1212/nxi.0000000000200234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Anti-IgLON5 disease is an autoimmune neurodegenerative disorder characterized by various phenotypes, notably sleep and movement disorders and tau pathology. Although the disease is known to be associated with the neuronal cell adhesion protein IgLON5, the physiologic function of IgLON5 remains elusive. There are conflicting views on whether autoantibodies cause loss of function, activation of IgLON5, or inflammation-associated neuronal damage, ultimately leading to the disease. We generated IgLON5 knockout (-/-) mice to investigate the functions of IgLON5 and elucidate the pathomechanism of anti-IgLON5 disease. METHODS IgLON5 knockout (-/-) mice underwent behavioral tests investigating motor function, psychiatric function (notably anxiety and depression), social and exploratory behaviors, spatial learning and memory, and sensory perception. Histologic analysis was conducted to investigate tau aggregation in mice with tauopathy. RESULTS IgLON5-/- mice had poorer performance in the wire hang and rotarod tests (which are tests for motor function) than wild-type mice. Moreover, IgLON5-/- mice exhibited decreased anxiety-like behavior and/or hyperactivity in behavior tests, including light/dark transition test and open field test. IgLON5-/- mice also exhibited poorer remote memory in the contextual fear conditioning test. However, neither sleeping disabilities assessed by EEG nor tau aggregation was detected in the knockout mice. DISCUSSION These results suggest that IgLON5 is associated with activity, anxiety, motor ability, and contextual fear memory. Comparing the various phenotypes of anti-IgLON5 disease, anti-IgLON5 disease might partially be associated with loss of function of IgLON5; however, other phenotypes, such as sleep disorders and tau aggregation, can be caused by gain of function of IgLON5 and/or neuronal damage due to inflammation. Further studies are needed to elucidate the role of IgLON5 in the pathogenesis of anti-IgLON5 diseases.
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Affiliation(s)
- Sin Yi Lee
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Hirotaka Shoji
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Aki Shimozawa
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Aoyagi
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Yoshiaki Sato
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Kazuya Tsumagari
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Mika Terumitsu
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Haruhiko Motegi
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Okada
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Koji Sekiguchi
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Junro Kuromitsu
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Jin Nakahara
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Miyakawa
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Ito
- From the Department of Neurology (S.Y.L., H.M., K.O., K.S., J.N.), Keio University School of Medicine, Tokyo; Division of Systems Medical Science (H.S., T.M.), Center for Medical Science, Fujita Health University, Toyoake; Eisai-Keio Innovation Laboratory for Dementia (A.S., H.A., Y.S., M.T., J.K.), Human Biology Integration, DHBL, Eisai Co., Ltd., Shinjuku-ku; Proteome Homeostasis Research Unit (K.T.), RIKEN Center for Integrative Medical Sciences, Yokohama; Department of Neurology (H.M.), The Jikei University School of Medicine; and Department of Physiology/Memory Center (D.I.), Keio University School of Medicine, Tokyo, Japan
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Bavdhankar K, Jain N, Agrawal S, Maheshkar P, Andugulapati SS, Puntambekar S, Ravat SH, Agarwal PA. Unusual Head Drops, Neck and Truncal Dystonia and Sleep Orthopnea with a Favorable Treatment Response in IgLon5 Antibody Disease. Mov Disord Clin Pract 2024; 11:575-577. [PMID: 38477436 PMCID: PMC11078475 DOI: 10.1002/mdc3.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/21/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
| | - Neeraj Jain
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Shruti Agrawal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Parag Maheshkar
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | | | | | - Sangeeta H. Ravat
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
| | - Pankaj A. Agarwal
- Department of NeurologySeth GS Medical College and KEM HospitalMumbaiIndia
- Movement Disorders Clinic, Department of NeurologyGleneagles Global HospitalsMumbaiIndia
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Landa J, Serafim AB, Alba M, Maudes E, Molina-Porcel L, Garcia-Serra A, Mannara F, Dalmau J, Graus F, Sabater L. IgLON5 deficiency produces behavioral alterations in a knockout mouse model. Front Immunol 2024; 15:1347948. [PMID: 38370417 PMCID: PMC10869603 DOI: 10.3389/fimmu.2024.1347948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024] Open
Abstract
Background Anti-IgLON5 disease is a neurological disorder characterized by autoantibodies against IgLON5 and pathological evidence of neurodegeneration. IgLON5 is a cell adhesion molecule of unknown function that is highly expressed in the brain. Our aim was to investigate the impact of IgLON5 loss-of-function in evaluating brain morphology, social behavior, and the development of symptoms observed in an IgLON5 knockout (IgLON5-KO) mouse model. Methods The IgLON5-KO mice were generated using CRISPR-Cas9 technology. Immunohistochemistry on fixed sagittal brain sections and Western blotting brain lysates were used to confirm IgLON5 silencing and to evaluate the presence of other cell surface proteins. Two- month-old IgLON5-KO and wild-type (WT) mice underwent a comprehensive battery of behavioral tests to assess 1) locomotion, 2) memory, 3) anxiety, 4) social interaction, and 5) depressive-like behavior. Brain sections were examined for the presence of anatomical abnormalities and deposits of hyperphosphorylated tau in young adult (2-month-old) and aged (22-month-old) mice. Results Mice did not develop neurological symptoms reminiscent of those seen in patients with anti-IgLON5 disease. Behavioral testing revealed that 2-month-old IgLON5-KO mice showed subtle alterations in motor coordination and balance. IgLON5-KO females exhibited hyperactivity during night and day. Males were observed to have depressive-like behavior and excessive nest-building behavior. Neuropathological studies did not reveal brain morphological alterations or hyperphosphorylated tau deposits. Conclusion IgLON5-KO mice showed subtle alterations in behavior and deficits in fine motor coordination but did not develop the clinical phenotype of anti-IgLON5 disease.
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Affiliation(s)
- Jon Landa
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Ana Beatriz Serafim
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Mercedes Alba
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Estibaliz Maudes
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Laura Molina-Porcel
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Neurological Tissue Bank, Biobanc, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anna Garcia-Serra
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Francesco Mannara
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Centro de Investigación Biomédica en Red, Enfermedades Raras (CIBERER), Madrid, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
| | - Lidia Sabater
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomédiques August Pi i Sunyer-Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Raras (CIBERER), Madrid, Spain
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Gerovska D, Noer JB, Qin Y, Ain Q, Januzi D, Schwab M, Witte OW, Araúzo-Bravo MJ, Kretz A. A distinct circular DNA profile intersects with proteome changes in the genotoxic stress-related hSOD1 G93A model of ALS. Cell Biosci 2023; 13:170. [PMID: 37705092 PMCID: PMC10498603 DOI: 10.1186/s13578-023-01116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Numerous genes, including SOD1, mutated in familial and sporadic amyotrophic lateral sclerosis (f/sALS) share a role in DNA damage and repair, emphasizing genome disintegration in ALS. One possible outcome of chromosomal instability and repair processes is extrachromosomal circular DNA (eccDNA) formation. Therefore, eccDNA might accumulate in f/sALS with yet unknown function. METHODS We combined rolling circle amplification with linear DNA digestion to purify eccDNA from the cervical spinal cord of 9 co-isogenic symptomatic hSOD1G93A mutants and 10 controls, followed by deep short-read sequencing. We mapped the eccDNAs and performed differential analysis based on the split read signal of the eccDNAs, referred as DifCir, between the ALS and control specimens, to find differentially produced per gene circles (DPpGC) in the two groups. Compared were eccDNA abundances, length distributions and genic profiles. We further assessed proteome alterations in ALS by mass spectrometry, and matched the DPpGCs with differentially expressed proteins (DEPs) in ALS. Additionally, we aligned the ALS-specific DPpGCs to ALS risk gene databases. RESULTS We found a six-fold enrichment in the number of unique eccDNAs in the genotoxic ALS-model relative to controls. We uncovered a distinct genic circulome profile characterized by 225 up-DPpGCs, i.e., genes that produced more eccDNAs from distinct gene sequences in ALS than under control conditions. The inter-sample recurrence rate was at least 89% for the top 6 up-DPpGCs. ALS proteome analyses revealed 42 corresponding DEPs, of which 19 underlying genes were itemized for an ALS risk in GWAS databases. The up-DPpGCs and their DEP tandems mainly impart neuron-specific functions, and gene set enrichment analyses indicated an overrepresentation of the adenylate cyclase modulating G protein pathway. CONCLUSIONS We prove, for the first time, a significant enrichment of eccDNA in the ALS-affected spinal cord. Our triple circulome, proteome and genome approach provide indication for a potential importance of certain eccDNAs in ALS neurodegeneration and a yet unconsidered role as ALS biomarkers. The related functional pathways might open up new targets for therapeutic intervention.
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Affiliation(s)
- Daniela Gerovska
- Computational Biology and Systems Biomedicine, Biodonostia Health Research Institute, 20014, San Sebastian, Spain
| | - Julie B Noer
- Department of Biology, Section for Ecology and Evolution, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Yating Qin
- Department of Biology, Section for Ecology and Evolution, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Quratul Ain
- Department of Neurology, Jena University Hospital, 07747, Jena, Thuringia, Germany
- Department of Internal Medicine IV, Hepatology, Jena University Hospital, 07747, Jena, Thuringia, Germany
| | - Donjetë Januzi
- Department of Neurology, Jena University Hospital, 07747, Jena, Thuringia, Germany
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, 07747, Jena, Thuringia, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, 07747, Jena, Thuringia, Germany
- Jena Center for Healthy Ageing, Jena University Hospital, Jena, Thuringia, Germany
| | - Marcos J Araúzo-Bravo
- Computational Biology and Systems Biomedicine, Biodonostia Health Research Institute, 20014, San Sebastian, Spain.
- Basque Foundation for Science, IKERBASQUE, 48013, Bilbao, Spain.
- Max Planck Institute for Molecular Biomedicine, Computational Biology and Bioinformatics Group, 48149, Münster, North Rhine-Westphalia, Germany.
- Department of Cell Biology and Histology, Faculty of Medicine and Nursing, University of Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Alexandra Kretz
- Department of Neurology, Jena University Hospital, 07747, Jena, Thuringia, Germany.
- Jena Center for Healthy Ageing, Jena University Hospital, Jena, Thuringia, Germany.
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8
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Tankéré P, Le Cam P, Folliet L, Bernard E, Cluse F, Gobert F, Ricordeau F, Jaffiol A, Peronnet T, Stauffer E, Peter-Derex L, Petitjean T. Unveiled central hypoventilation after tracheotomy in anti-IgLON5 disease: a case report. J Clin Sleep Med 2023; 19:1701-1704. [PMID: 37166031 PMCID: PMC10476033 DOI: 10.5664/jcsm.10658] [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: 02/21/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023]
Abstract
Anti-IgLON5 disease is a recently described entity that has been associated with neurological symptoms and sleep disturbances including sleep breathing disorders. Sleep stridor as well as obstructive and less often central sleep apnea have been reported but rarely needing ventilation on tracheotomy. We report the case of a patient in whom obstructive sleep apnea with secondary development of dysphagia and recurrent aspiration pneumonia led to the diagnosis of anti-IgLON 5 disease. Acute respiratory failure due to laryngospasm required intubation and eventually tracheotomy. Yet hypoventilation persisted, and polysomnography demonstrated central sleep apnea alternating with sleep-related tachypnea. Nocturnal ventilation was thus reintroduced. The association of obstructive sleep apnea with dysphagia is a potential red flag for anti-IgLON5 disease, which remains an overlooked diagnosis. Breathing disorders can be complex in this context, with a mixed obstructive and central pattern whose central component can be unveiled after tracheotomy. This highlights the importance of closely monitoring sleep and respiration even after tracheotomy. CITATION Tankéré P, Le Cam P, Folliet L, et al. Unveiled central hypoventilation after tracheotomy in anti-IgLON5 disease: a case report. J Clin Sleep Med. 2023;19(9):1701-1704.
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Affiliation(s)
- Pierre Tankéré
- Reference Center for Rare Pulmonary Diseases, Pulmonary Medicine and Intensive Care Unit, Dijon University Hospital, Dijon, France
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Le Cam
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Laure Folliet
- Respiratory Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emilien Bernard
- ALS Resource and Competence Centre Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- Electroneuromyography and Neuromuscular Disorders Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florent Cluse
- ALS Resource and Competence Centre Pierre Wertheimer Hospital, Hospices Civils de Lyon, Bron, France
- Electroneuromyography and Neuromuscular Disorders Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France
| | - Florent Gobert
- Intensive Care Unit, Neurological Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, IMPACT and CAP Teams, INSERM U1028, CNRS UMR 5292, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - François Ricordeau
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Antoine Jaffiol
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Théo Peronnet
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emeric Stauffer
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Lyon Neuroscience Research Center, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
- Laboratory LIBM EA7424, Team “Vascular Biology and Red Blood Cell,” University of Lyon 1, Lyon, France
| | - Thierry Petitjean
- Center for Sleep Medicine and Respiratory Disease, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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9
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Grossauer A, Hussl A, Mahlknecht P, Peball M, Heidbreder A, Deisenhammer F, Djamshidian A, Seppi K, Heim B. Anti-IgLON5 Disease with Isolated Hemichorea: A Case Report and Review of the Literature. Mov Disord Clin Pract 2022; 10:115-119. [PMID: 36698996 PMCID: PMC9847301 DOI: 10.1002/mdc3.13614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anti-IgLON5 disease is an autoimmune encephalopathy with sleep disturbances as a hallmark in the majority of reported cases. Additional clinical symptoms are heterogenous and include movement disorders, bulbar dysfunction, autonomic disorders, and neurocognitive impairment. Case Here, we report the case of an 87-year-old woman presenting with isolated progressive hemichorea. An extensive diagnostic work-up revealed antibodies against IgLON5 in the serum. Neither history nor polysomnography (PSG) unveiled signs and features of sleep dysfunction typically reported in anti-IgLON5 disease. Literature Review In an extensive literature review we identified twelve other studies reporting about patients with confirmed anti-IgLON5 disease and chorea as extrapyramidal movement disorder in their clinical phenotype. Subsequently, clinical characteristics of these patients were carefully evaluated. Conclusions Our results support the diversity of clinical phenotypes in anti-IgLON5 disease, adding isolated hemichorea to the spectrum of presenting symptoms. As sleep-related disorders are often not the leading reason for consultation and only revealed by PSG examination, we suggest that screening for antibodies against IgLON5 should be considered in patients presenting with unexplained movement disorders, including isolated hemichorea.
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Affiliation(s)
- Anna Grossauer
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Hussl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Marina Peball
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Atbin Djamshidian
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Beatrice Heim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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10
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Sista SR, Crum B, Aboseif A, Devine MF, Zekeridou A, Hammami MB, Rezk MM, Truffert A, Lalive PH, Kunchok A, McKeon A, Dubey D. Motor-neuron-disease-like phenotype associated with IgLON5 disease. J Neurol 2022; 269:6139-6144. [PMID: 35857139 PMCID: PMC9578379 DOI: 10.1007/s00415-022-11262-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
A growing spectrum of neurological manifestations are being recognized in association with IgLON5 autoimmunity, including recent reports of motor-neuron-disease-like phenotype. Here we describe four cases of IgLON5 autoimmunity with motor neuron involvement and evaluate an additional 109 probable or definite amyotrophic lateral sclerosis cases seen in our neuromuscular clinic for IgLON5-IgG seropositivity. The presence of parasomnias, vocal cord dysfunction or hyperkinetic movements in a patient with motor-neuron-disease-like phenotype should prompt evaluation for IgLON5-IgG autoantibodies. Recognition and treatment of this autoimmune disease with immunosuppressive agents may bring about significant neurological improvement in a minority of cases.
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Affiliation(s)
- Sri Raghav Sista
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Brian Crum
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Albert Aboseif
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michelle F Devine
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Anastasia Zekeridou
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - M Bakri Hammami
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mohammed M Rezk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - André Truffert
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Patrice H Lalive
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Amy Kunchok
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew McKeon
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Divyanshu Dubey
- Laboratory Medicine and Pathology, Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
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11
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Zhang YZ, Ni Y, Gao YN, Shen DD, He L, Yin D, Meng HY, Zhou QM, Hu J, Chen S. Anti-IgLON5 disease: a novel topic beyond neuroimmunology. Neural Regen Res 2022; 18:1017-1022. [PMID: 36254983 PMCID: PMC9827781 DOI: 10.4103/1673-5374.355742] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anti-IgLON5 disease is a recently defined autoimmune disorder of the nervous system associated with autoantibodies against IgLON5. Given its broad clinical spectrum and extremely complex pathogenesis, as well as difficulties in its early diagnosis and treatment, anti-IgLON5 disease has become the subject of considerable research attention in the field of neuroimmunology. Anti-IgLON5 disease has characteristics of both autoimmunity and neurodegeneration due to the unique activity of the anti-IgLON5 antibody. Neuropathologic examination revealed the presence of a tauopathy preferentially affecting the hypothalamus and brainstem tegmentum, potentially broadening our understanding of tauopathies. In contrast to that seen with other autoimmune encephalitis-related antibodies, basic studies have demonstrated that IgLON5 antibody-induced neuronal damage and degeneration are irreversible, indicative of a potential link between autoimmunity and neurodegeneration in anti-IgLON5 disease. Herein, we comprehensively review and discuss basic and clinical studies relating to anti-IgLON5 disease to better understand this complicated disorder.
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Affiliation(s)
- Yi-ZongHeng Zhang
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You Ni
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Ning Gao
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding-Ding Shen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Lu He
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dou Yin
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan-Yu Meng
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin-Ming Zhou
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
| | - Ji Hu
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China,School of Life Science and Technology, ShanghaiTech University, Shanghai, China,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
| | - Sheng Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
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12
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Madetko N, Marzec W, Kowalska A, Przewodowska D, Alster P, Koziorowski D. Anti-IgLON5 Disease - The Current State of Knowledge and Further Perspectives. Front Immunol 2022; 13:852215. [PMID: 35300333 PMCID: PMC8921982 DOI: 10.3389/fimmu.2022.852215] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
Anti-IgLON5 disease is a relatively new neurological entity with the first cases reported in 2014. So far, less than 70 articles on this topic have been published. Due to its unspecific symptomatology, diverse progression, novelty and ambiguous character, it remains a difficulty for both clinical practitioners and scientists. The aim of this review is to summarize the current knowledge concerning anti-IgLON5 disease; mechanisms underlying its cause, symptomatology, clinical progression, differential diagnosis and treatment, which could be helpful in clinical practice and future research.
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Affiliation(s)
- Natalia Madetko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Weronika Marzec
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Kowalska
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Przewodowska
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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13
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Atadzhanov M, Chishimba L. Recognition of Movement Disorders as Cardinal Features of Anti-IgLON5 Disease: Expanding the Clinical Spectrum. Neurology 2021; 97:661-662. [PMID: 34380752 DOI: 10.1212/wnl.0000000000012636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Masharip Atadzhanov
- From the Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka.
| | - Lorraine Chishimba
- From the Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka
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14
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Werner J, Jelcic I, Schwarz EI, Probst-Müller E, Nilsson J, Schwizer B, Bloch KE, Lutterotti A, Jung HH, Schreiner B. Anti-IgLON5 Disease: A New Bulbar-Onset Motor Neuron Mimic Syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/2/e962. [PMID: 33531378 PMCID: PMC8057065 DOI: 10.1212/nxi.0000000000000962] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
Objective To expand the spectrum of anti-IgLON5 disease by adding 5 novel
anti-IgLON5–seropositive cases with bulbar motor neuron disease-like
phenotype. Methods We characterized the clinical course, brain MRI and laboratory findings, and
therapy response in these 5 patients. Results Patients were severely affected by bulbar impairment and its respiratory
consequences. Sleep-related breathing disorders and parasomnias were common.
All patients showed clinical or electrophysiologic signs of motor neuron
disease without fulfilling the diagnostic criteria for amyotrophic lateral
sclerosis. One patient regained autonomy in swallowing and eating, possibly
related to immunotherapy. Conclusion IgLON5 disease is an important differential diagnosis to evaluate in patients
with bulbar motor neuron disease-like phenotype and sleep disorders. There
is need for a deeper understanding of the underlying pathobiology to
determine whether IgLON5 disease is an immunotherapy-responsive
condition.
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Affiliation(s)
- Jana Werner
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Ilijas Jelcic
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Esther Irene Schwarz
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Elisabeth Probst-Müller
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Jakob Nilsson
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Bernhard Schwizer
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Konrad Ernst Bloch
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Andreas Lutterotti
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Hans-Heinrich Jung
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland
| | - Bettina Schreiner
- From the Department of Neurology (J.W., I.J., A.L., H.-H.J.), Department of Respiratory Medicine and Sleep Disorders Center (E.I.S., K.E.B.), Department of Immunology (E.P.-M., J.N.), University Hospital Zurich; Lindenhofspital (B. Schwizer), Bern; and Department of Neurology and University Zurich Institute of Experimental Immunology (B. Schreiner), University Hospital Zurich, Switzerland.
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15
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Devine MF, St Louis EK. Sleep Disturbances Associated with Neurological Autoimmunity. Neurotherapeutics 2021; 18:181-201. [PMID: 33786802 PMCID: PMC8116412 DOI: 10.1007/s13311-021-01020-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Associations between sleep disorders and neurological autoimmunity have been notably expanding recently. Potential immune-mediated etiopathogenesis has been proposed for various sleep disorders including narcolepsy, Kleine-Levin syndrome, and Morvan syndrome. Sleep manifestations are also common in various autoimmune neurological syndromes, but may be underestimated as overriding presenting (and potentially dangerous) neurological symptoms often require more urgent attention. Even so, sleep dysfunction has been described with various neural-specific antibody biomarkers, including IgLON5; leucine-rich, glioma-inactivated protein 1 (LGI1); contactin-associated protein 2 (CASPR2); N-methyl-D-aspartate (NMDA)-receptor; Ma2; dipeptidyl-peptidase-like protein-6 (DPPX); alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA-R); anti-neuronal nuclear antibody type-1 (ANNA-1, i.e., Hu); anti-neuronal nuclear antibody type-2 (ANNA-2, i.e., Ri); gamma-aminobutyric acid (GABA)-B-receptor (GABA-B-R); metabotropic glutamate receptor 5 (mGluR5); and aquaporin-4 (AQP-4). Given potentially distinctive findings, it is possible that sleep testing could potentially provide objective biomarkers (polysomnography, quantitative muscle activity during REM sleep, cerebrospinal fluid hypocretin-1) to support an autoimmune diagnosis, monitor therapeutic response, or disease progression/relapse. However, more comprehensive characterization of sleep manifestations is needed to better understand the underlying sleep disruption with neurological autoimmunity.
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Affiliation(s)
- Michelle F Devine
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Medicine (Division of Pulmonary, Critical Care, and Sleep Medicine), Rochester, MN, USA.
- Department of Neurology, Mayo Clinic Health System Southwest Wisconsin-La Crosse, Mayo Clinic and Foundation, Rochester, MN, USA.
- Olmsted Medical Center, MN, Rochester, USA.
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Erik K St Louis
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Department of Medicine (Division of Pulmonary, Critical Care, and Sleep Medicine), Rochester, MN, USA
- Department of Neurology, Mayo Clinic Health System Southwest Wisconsin-La Crosse, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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16
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Ganguly J, Jog M. Tauopathy and Movement Disorders-Unveiling the Chameleons and Mimics. Front Neurol 2020; 11:599384. [PMID: 33250855 PMCID: PMC7674803 DOI: 10.3389/fneur.2020.599384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
The spectrum of tauopathy encompasses heterogenous group of neurodegenerative disorders characterized by neural or glial deposition of pathological protein tau. Clinically they can present as cognitive syndromes, movement disorders, motor neuron disease, or mixed. The heterogeneity in clinical presentation, genetic background, and underlying pathology make it difficult to classify and clinically approach tauopathy. In the literature, tauopathies are thus mostly highlighted from pathological perspective. From clinical standpoint, cognitive syndromes are often been focussed while reviewing tauopathies. However, the spectrum of tauopathy has also evolved significantly in the domain of movement disorders and has transgressed beyond the domain of primary tauopathies. Secondary tauopathies from neuroinflammation or autoimmune insults and some other "novel" tauopathies are increasingly being reported in the current literature, while some of them are geographically isolated. Because of the overlapping clinical phenotypes, it often becomes difficult for the clinician to diagnose them clinically and have to wait for the pathological confirmation by autopsy. However, each of these tauopathies has some clinical and radiological signatures those can help in clinical diagnosis and targeted genetic testing. In this review, we have exposed the heterogeneity of tauopathy from a movement disorder perspective and have provided a clinical approach to diagnose them ante mortem before confirmatory autopsy. Additionally, phenotypic variability of these disorders (chameleons) and the look-alikes (mimics) have been discussed with potential clinical pointers for each of them. The review provides a framework within which new and as yet undiscovered entities can be classified in the future.
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Affiliation(s)
| | - Mandar Jog
- Movement Disorder Centre, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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Cabezudo‐García P, Mena‐Vázquez N, Estivill Torrús G, Serrano‐Castro P. Response to immunotherapy in anti-IgLON5 disease: A systematic review. Acta Neurol Scand 2020; 141:263-270. [PMID: 31853949 DOI: 10.1111/ane.13207] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 12/14/2019] [Indexed: 02/05/2023]
Abstract
The aim of this study was to evaluate the frequency of response to immunotherapy in patients with anti-IgLON5 disease through a systematic review of the literature. MEDLINE and Embase databases were searched for studies that included patients with anti-IgLON5 disease who received immunotherapy (IT). Review inclusion criteria were met by 18 studies. The main study variable was response to IT, defined as the frequency of patients with an improvement greater than mild in at least one of the main symptoms defined by the clinical phenotype. Data were also gathered on the rate of response to last follow-up, the line(s) of IT received, the administration of monotherapy or combination therapy, and clinical and analytical characteristics. Selected studies included a total of 46 patients. A response to IT was observed in 20 (43.4%) and the presence of response to last follow-up in 15 (32.6%). Response was achieved more frequently with combination therapy vs monotherapy (14/21 [66.6%] vs 7/22 [31.8%]) and second-line therapy vs first-line therapy (7/13 [53.8%] vs 15/46 [32.6%]). The response rate by drug was 34.2% (12/35) for steroids, 42.8% (9/21) for IVIg, 46% (7/15) for PLEX, 100% (5/5) for AZA and 75% (3/4) for MMF. Factors associated with a response to IT included the cognitive impairment and non-classical phenotypes, presence of HLA-DQB1*05:01 without HLA-DRB1*10:01 and cerebral spinal fluid inflammation. Patients with anti-IgLON5 disease respond to IT, and this response is associated with certain clinical and analytical characteristics of the patients. Also rate of response seems higher with second-line and combination treatment. However, the quality of available studies is inadequate to allow definitive conclusions to be drawn.
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Affiliation(s)
- Pablo Cabezudo‐García
- Servicio de Neurología UGC de NeurocienciasHospital Regional Universitario de Málaga Málaga Spain
- Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
| | - Natalia Mena‐Vázquez
- Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- Servicio de Reumatología UGC de ReumatologíaHospital Regional Universitario de Málaga Málaga Spain
| | - Guillermo Estivill Torrús
- Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
- UGC de NeurocienciasHospital Regional Universitario de Málaga Málaga Spain
| | - Pedro Serrano‐Castro
- Servicio de Neurología UGC de NeurocienciasHospital Regional Universitario de Málaga Málaga Spain
- Instituto de Investigación Biomédica de Málaga‐IBIMA Málaga Spain
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Sleep and neurological autoimmune diseases. Neuropsychopharmacology 2020; 45:129-140. [PMID: 31302665 PMCID: PMC6879573 DOI: 10.1038/s41386-019-0463-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/17/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
Neurological autoimmune diseases are characterized by an inappropriate immune response that by mistake targets the nervous system. As a result, patients experiment a number of neurological manifestations that may include insomnia, excessive daytime sleepiness, cataplexy, central hypoventilation, and REM sleep behavior disorder. Polysomnographic evaluation may reveal disorganized sleep architecture involving both NREM and REM sleep, and REM sleep intrusions into wakefulness. The study of sleep disorders in the setting of autoimmune diseases (e.g., narcolepsy, anti-IgLON5 disease, paraneoplastic neurological syndromes) shows that an abnormal immune-mediated (humoral or cellular) response target the neuronal structures (e.g., brainstem, hypothalamus) and neurotransmitters systems (e.g., hypocretin) that regulate sleep resulting in sleep impairment. It is a window to examine the link between the autoimmune system and the sleep regulation at the molecular, cellular, and anatomic level.
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Nissen MS, Blaabjerg M. Anti-IgLON5 Disease: A Case With 11-Year Clinical Course and Review of the Literature. Front Neurol 2019; 10:1056. [PMID: 31632341 PMCID: PMC6783555 DOI: 10.3389/fneur.2019.01056] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 09/18/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Anti-IgLON5 disease is a novel disorder with a complex interplay between inflammation and neurodegeneration. Patients develop antibodies against IgLON5 but also deposition of neuronal tau protein. Symptoms often have an insidious onset, slow progression and mimic other neurological disorders. Here we report a case with severely prolonged 11-year disease course and provide a review of current reported cases with focus on presentation, work-up, treatment, and outcome. Method: All reported cases of anti-IgLON5 disease were evaluated. Cases reported twice (in case series and as single case reports), were carefully excluded. Results: Most patients display a characteristic sleep disorder with severe insomnia, non rapid eye movement (NREM) parasomnia, with finalistic movements and sleep disordered breathing (stridor and obstructive sleep apnea). Other symptoms are bulbar involvement, gait instability, movement disorders, oculomotor abnormalities, dysautonomia, and peripheral symptoms. Antibodies are present in both serum and CSF and there is a strong correlation with human leukocyte antigen (HLA) DRB1*10:01 and HLA-DQB1*05:01. Neuropathological examination reveals neurodegeneration with neuronal tau deposits in regions that correlate with the clinical presentation (e.g., predominantly hypothalamus and tegmentum of the brain stem). Majority of cases respond partially to immunotherapy. Cases, who received no treatment or treatment with IV corticosteroids alone, had a higher mortality than cases treated with more potent immunotherapy. Conclusion: The clinical spectrum of Anti-IgLON5 disease continues to expand. Further studies are needed to elucidate the pathophysiology, therapeutic strategies and outcome in this novel disorder. Aggressive immunotherapy seems to increase survival.
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Affiliation(s)
- Mette Scheller Nissen
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
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Blinder T, Lewerenz J. Cerebrospinal Fluid Findings in Patients With Autoimmune Encephalitis-A Systematic Analysis. Front Neurol 2019; 10:804. [PMID: 31404257 PMCID: PMC6670288 DOI: 10.3389/fneur.2019.00804] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/11/2019] [Indexed: 01/15/2023] Open
Abstract
Autoimmune encephalitides (AIE) comprise a group of inflammatory diseases of the central nervous system (CNS), which can be further characterized by the presence of different antineuronal antibodies. Recently, a clinical approach for diagnostic criteria for the suspected diagnosis of AIE as well as definitive AIE were proposed. These are intended to guide physicians when to order the antineuronal antibody testing and/or facilitate early diagnosis even prior to the availability of the specific disease-confirming test results to facilitate prompt treatment. These diagnostic criteria also include the results of basic cerebrospinal fluid (CSF) analysis. However, the different antibody-defined AIE subtypes might be highly distinct with regard to their immune pathophysiology, e.g., the pre-dominance of specific IgG subclasses, IgG1, or IgG4, or frequency of paraneoplastic compared to idiopathic origin. Thus, it is conceivable that the results of basic CSF analysis might also be very different. However, this has not been explored systematically. Here, we systematically reviewed the literature about the 10 most important AIE subtypes, AIE with antibodies against NMDA, AMPA, glycine, GABAA, and GABAB receptors as well as DPPX, CASPR2, LGI1, IgLON5, or glutamate decarboxylase (GAD), with respect to the reported basic CSF findings comprising CSF leukocyte count, total protein, and the presence of oligoclonal bands (OCB) restricted to the CSF as a sensitive measure for intrathecal IgG synthesis. Our results indicate that these basic CSF findings are profoundly different among the 10 different AIE subtypes. Whereas, AIEs with antibodies against NMDA, GABAB, and AMPA receptors as well as DPPX show rather frequent inflammatory CSF changes, in AIEs with either CASPR2, LGI1, GABAA, or glycine receptor antibodies CSF findings were mostly normal. Two subtypes, AIEs defined by either GAD, or IgLON5 antibodies, did not fit into this general pattern. In AIE with GAD antibodies, positive OCBs in the absence of other changes were typical, while the CSF in IgLON5 antibody-positive AIE was characterized by elevated protein.
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Affiliation(s)
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
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Neurological profiles beyond the sleep disorder in patients with anti-IgLON5 disease. Curr Opin Neurol 2019; 32:493-499. [DOI: 10.1097/wco.0000000000000677] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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