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Cleaver J, Jeffery K, Klenerman P, Lim M, Handunnetthi L, Irani SR, Handel A. The immunobiology of herpes simplex virus encephalitis and post-viral autoimmunity. Brain 2024; 147:1130-1148. [PMID: 38092513 PMCID: PMC10994539 DOI: 10.1093/brain/awad419] [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: 07/20/2023] [Revised: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 04/06/2024] Open
Abstract
Herpes simplex virus encephalitis (HSE) is the leading cause of non-epidemic encephalitis in the developed world and, despite antiviral therapy, mortality and morbidity is high. The emergence of post-HSE autoimmune encephalitis reveals a new immunological paradigm in autoantibody-mediated disease. A reductionist evaluation of the immunobiological mechanisms in HSE is crucial to dissect the origins of post-viral autoimmunity and supply rational approaches to the selection of immunotherapeutics. Herein, we review the latest evidence behind the phenotypic progression and underlying immunobiology of HSE including the cytokine/chemokine environment, the role of pathogen-recognition receptors, T- and B-cell immunity and relevant inborn errors of immunity. Second, we provide a contemporary review of published patients with post-HSE autoimmune encephalitis from a combined cohort of 110 patients. Third, we integrate novel mechanisms of autoimmunization in deep cervical lymph nodes to explore hypotheses around post-HSE autoimmune encephalitis and challenge these against mechanisms of molecular mimicry and others. Finally, we explore translational concepts where neuroglial surface autoantibodies have been observed with other neuroinfectious diseases and those that generate brain damage including traumatic brain injury, ischaemic stroke and neurodegenerative disease. Overall, the clinical and immunological landscape of HSE is an important and evolving field, from which precision immunotherapeutics could soon emerge.
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Affiliation(s)
- Jonathan Cleaver
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Katie Jeffery
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, OX1 3SY, UK
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital at Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH, UK
- Department Women and Children’s Health, School of Life Course Sciences, King’s College London, London, WC2R 2LS, UK
| | - Lahiru Handunnetthi
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, 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, Oxford, OX3 9DU, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
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Bakht A, Lantz P, Harrison W. HSV-associated chronic granulomatous encephalitis in a child. J Neuropathol Exp Neurol 2024; 83:205-208. [PMID: 38219251 DOI: 10.1093/jnen/nlad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Azad Bakht
- Department of Laboratory Medicine and Pathology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Hospital, Winston Salem, North Carolina, USA
| | - Patrick Lantz
- Department of Laboratory Medicine and Pathology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Hospital, Winston Salem, North Carolina, USA
| | - William Harrison
- Department of Laboratory Medicine and Pathology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Hospital, Winston Salem, North Carolina, USA
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Piao S, Bao Y, Yang L, Zhang Y, Hu B, Li H, Geng D, Li Y. Brain MRI features of anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis secondary to central nervous system infection in adult patients. Acta Radiol 2023; 64:760-768. [PMID: 35532900 DOI: 10.1177/02841851221091443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis secondary to central nervous system (CNS) infection is a unique subtype of the autoimmune-mediated disease, of which the imaging features are unclear. PURPOSE To compare the brain magnetic resonance imaging (MRI) features between the anti-NMDAR encephalitis secondary to CNS infection and that without initial infection. MATERIAL AND METHODS A total of 70 adult patients with anti-NMDAR encephalitis were retrospectively enrolled (24 in the post-infection group, 46 in the non-infection-related group). Their clinical and imaging features (lesion distribution, lesion shape, enhancement pattern, brain atrophy) were reviewed and summarized. Lesion distributions were compared between the two groups on lesion probability maps. RESULTS The patients with normal brain MRI scans in the post-infection group were less than those in the non-infection related group (29% vs. 63%; P = 0.0113). Among the 24 patients in the post-infection group, visible lesions were shown at the anti-NMDAR encephalitis onset in 17 patients; lesion distribution was more diffuse than the non-infection-related group, showing higher lesion peak probabilities in the bilateral hippocampus, frontal lobe, temporal lobe, insula, and cingulate. The lesions with contrast enhancement were also more common in the post-infection group than the non-infection-related group (7/13 vs. 2/10). Brain atrophy was observed in eight patients in the post-infection group and three in the non-infection-related group. CONCLUSION Anti-NMDAR encephalitis secondary to CNS infection has its imaging features-extensive lesion distribution, leptomeningeal enhancement, early atrophy, and necrosis-that could deepen the understanding of the pathophysiology and manifestation of the autoimmune encephalitis besides the classic type.
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Affiliation(s)
- Sirong Piao
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China
| | - Yifang Bao
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
| | - Liqin Yang
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
| | - Yi Zhang
- Department of Infectious Disease, Huashan Hospital, 159397Fudan University, Shanghai, PR China
| | - Bin Hu
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, PR China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, 535039Fudan University, Shanghai, PR China
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Duggan MR, Torkzaban B, Ahooyi TM, Khalili K. Potential Role for Herpesviruses in Alzheimer's Disease. J Alzheimers Dis 2021; 78:855-869. [PMID: 33074235 DOI: 10.3233/jad-200814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Across the fields of virology and neuroscience, the role of neurotropic viruses in Alzheimer's disease (AD) has received renewed enthusiasm, with a particular focus on human herpesviruses (HHVs). Recent genomic analyses of brain tissue collections and investigations of the antimicrobial responses of amyloid-β do not exclude a role of HHVs in contributing to or accelerating AD pathogenesis. Due to continued expansion in our aging cohort and the lack of effective treatments for AD, this composition examines a potential neuroviral theory of AD in light of these recent data. Consideration reveals a possible viral "Hit-and-Run" scenario of AD, as well as neurobiological mechanisms (i.e., neuroinflammation, protein quality control, oxidative stress) that may increase risk for AD following neurotropic infection. Although limitations exist, this theoretical framework reveals several novel therapeutic targets that may prove efficacious in AD.
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Affiliation(s)
- Michael R Duggan
- Department of Neuroscience and Center for Neurovirology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Bahareh Torkzaban
- Department of Neuroscience and Center for Neurovirology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Taha Mohseni Ahooyi
- Department of Neuroscience and Center for Neurovirology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Kamel Khalili
- Department of Neuroscience and Center for Neurovirology, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
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Iwai Y, Nishimura K, Fukushima T, Ito T, Watanabe Y, Noro M, Kuwabara S. An Adult Case of Herpes Simplex Virus-associated Granulomatous Encephalitis. Intern Med 2019; 58:1491-1494. [PMID: 30626834 PMCID: PMC6548933 DOI: 10.2169/internalmedicine.2046-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Brain granuloma occurs under certain conditions. Herpes simplex virus (HSV) causes granulomatous encephalitis in children; however, it has been rarely reported in adults. A 74-year-old man with a history of herpes simplex encephalitis suffered recurrent seizures. Brain magnetic resonance imaging revealed a mass lesion and resection was performed. A polymerase chain reaction using a brain biopsy specimen was positive for HSV DNA; thus, the patient was diagnosed with HSV-associated granulomatous encephalitis. After administering acyclovir, the patient showed improvement. HSV can cause granulomatous encephalitis in adults, and acyclovir can be used for its treatment.
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Affiliation(s)
- Yuta Iwai
- Department of Neurology, Matsudo City General Hospital, Japan
| | | | | | - Takashi Ito
- Department of Neurology, Matsudo City General Hospital, Japan
| | | | - Masahiro Noro
- Department of Pathology, Matsudo City General Hospital, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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Childs L, Lim G, Thompson A, Bates TR, Kho LK, Phatouros C. A rare suspected case of chronic nodular granulomatous herpes simplex encephalitis in an adult. BJR Case Rep 2018; 4:20170114. [PMID: 31489214 PMCID: PMC6711280 DOI: 10.1259/bjrcr.20170114] [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: 11/13/2017] [Revised: 02/24/2018] [Accepted: 02/27/2018] [Indexed: 11/09/2022] Open
Abstract
Herpes simplex encephalitis is the most common sporadic viral encephalitis in the
western world, HSV-1 (herpes simplex virus) being the mostly commonly implicated
serotype. The disease is usually monophasic, although patients may relapse
weeks, months or years after initial infection. This chronic granulomatous
inflammatory process is almost exclusively described in children and rarely
forms discrete enhancing parenchymal nodules. We present the clinical and
radiological features of an unusual case of chronic nodular granulomatous herpes
encephalitis with enhancing “mass-like” nodules in an adult. To
the author’s knowledge, this is the first reported case of macroscopic
“mass-like” nodular granuloma formation in an adult.
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Affiliation(s)
- Lucy Childs
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Guan Lim
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Andrew Thompson
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Timothy R Bates
- Stroke Unit, Swan District Hospital, Midland, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Lay Kun Kho
- Department of Neurology, Royal Perth Hospital, Perth, WA, Australia
| | - Constantine Chris Phatouros
- Neurological Imaging and Intervention Service Western Australia (NIISwa), Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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