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Wang J, Luo L, Meng Z, Ren Y, Tang M, Huang Z, Yang B, Niu Q, Zhou D, Wang M, Li J. Blood and CSF findings of cellular immunity in anti-NMDAR encephalitis. Int Immunopharmacol 2024; 130:111743. [PMID: 38430802 DOI: 10.1016/j.intimp.2024.111743] [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: 10/16/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To investigate the immunopathogenic mechanisms of anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) by characterizing the changes of immune cells in both peripheral blood (PB) and cerebrospinal fluid (CSF) of patients with NMDAR-E. METHODS Cytology and flow cytometry were used to explore and compare different immunological parameters in PB and CSF of patients with NMDAR-E, viral encephalitis (VE) and healthy volunteers. Moreover, different models were established to assess the possibility of identifying NMDAR-E patients based on PB and CSF parameters. RESULTS The neutrophil counts and monocyte-to-lymphocyte ratios (MLR) in PB are higher in NMDAR-E patients than in both VEs and controls (P < 0.001, respectively), while the percentages of CD3 + T, CD4 + T lymphocytes, and the leukocytes count in CSF were lower in NMDAR-Es than in VEs (P < 0.01, respectively). The higher percentages of CD8 + T cells in blood and CSF were both correlated with more severe NMDAR-E (P < 0.05, respectively). The poor neurological status group had significantly higher PB leukocytes but lower CSF leukocyte count (P < 0.05). Longitudinal observations in patients with NMDAR-E showed a decreasing trend of leukocyte count, neutrophils count, neutrophil-to-monocyte ratios (NMR), and neutrophil-to-lymphocyte ratios (NLR) with the gradual recovery of neurological function. CONCLUSIONS The expression patterns of T lymphocyte subsets were different in patients with NMDAR-E and viral encephalitis. The changing trends of leukocyte and lymphocyte populations in peripheral blood and cerebrospinal fluid may provide clues for the diagnosis of different types of encephalitides, including NMDARE, and can be used as immunological markers to assess and predict the prognosis.
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Affiliation(s)
- Jierui Wang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Limei Luo
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Zirui Meng
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Yan Ren
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Meng Tang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Zhuochun Huang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Bin Yang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Qian Niu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Minjin Wang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Guntermann A, Marcus K, May C. The good or the bad: an overview of autoantibodies in traumatic spinal cord injury. Biol Chem 2024; 405:79-89. [PMID: 37786927 DOI: 10.1515/hsz-2023-0252] [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: 06/30/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
Infections remain the most common cause of death after traumatic spinal cord injury, likely due to a developing immune deficiency syndrome. This, together with a somewhat contradictory development of autoimmunity in many patients, are two major components of the maladaptive systemic immune response. Although the local non-resolving inflammation in the lesioned spinal cord may lead to an antibody formation against autoantigens of the injured spinal cord tissue, there are also natural (pre-existing) autoantibodies independent of the injury. The way in which these autoantibodies with different origins affect the neuronal and functional outcome of spinal cord-injured patients is still controversial.
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Affiliation(s)
- Annika Guntermann
- Medical Proteome Analysis, Center for Protein Diagnostics (ProDi), Ruhr University Bochum, D-44801 Bochum, Germany
- Medizinisches Proteom-Center, Medical Faculty, ProDi E2.233, Ruhr University Bochum, Gesundheitscampus 4, D-44801 Bochum, Germany
| | - Katrin Marcus
- Medical Proteome Analysis, Center for Protein Diagnostics (ProDi), Ruhr University Bochum, D-44801 Bochum, Germany
- Medizinisches Proteom-Center, Medical Faculty, ProDi E2.233, Ruhr University Bochum, Gesundheitscampus 4, D-44801 Bochum, Germany
| | - Caroline May
- Medical Proteome Analysis, Center for Protein Diagnostics (ProDi), Ruhr University Bochum, D-44801 Bochum, Germany
- Medizinisches Proteom-Center, Medical Faculty, ProDi E2.233, Ruhr University Bochum, Gesundheitscampus 4, D-44801 Bochum, Germany
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3
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Budhram A, Flanagan EP. Optimizing the diagnostic performance of neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:365-382. [PMID: 38494290 DOI: 10.1016/b978-0-12-823912-4.00002-5] [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 detection of neural antibodies in patients with paraneoplastic and autoimmune encephalitis has majorly advanced the diagnosis and management of neural antibody-associated diseases. Although testing for these antibodies has historically been restricted to specialized centers, assay commercialization has made this testing available to clinical chemistry laboratories worldwide. This improved test accessibility has led to reduced turnaround time and expedited diagnosis, which are beneficial to patient care. However, as the utilization of these assays has increased, so too has the need to evaluate how they perform in the clinical setting. In this chapter, we discuss assays for neural antibody detection that are in routine use, draw attention to their limitations and provide strategies to help clinicians and laboratorians overcome them, all with the aim of optimizing neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Yaqub A, Khan SR, Vernooij MW, van Hagen PM, Peeters RP, Ikram MA, Chaker L, Dalm VASH. Serum immunoglobulins and biomarkers of dementia: a population-based study. Alzheimers Res Ther 2023; 15:194. [PMID: 37936180 PMCID: PMC10629143 DOI: 10.1186/s13195-023-01333-3] [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: 09/20/2022] [Accepted: 10/15/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Inflammation plays a key role in the development of dementia, but its link to early biomarkers, particularly those in plasma or neuroimaging, remains elusive. This study aimed to investigate the association between serum immunoglobulins and biomarkers of dementia. METHODS Between 1997 and 2009, serum immunoglobulins (IgA, IgG and IgM) were measured in dementia-free participants of the population-based Rotterdam Study. A random subset of participants had assessment of biomarkers in plasma (total tau (t-tau), neurofilament light chain (NfL), amyloid-β40 (Aβ-40), amyloid-β42 (Aβ-42), while another subset of participants underwent neuroimaging to quantify brain volume, white matter structural integrity and markers of cerebral small vessel disease. Linear regression models were constructed to determine cross-sectional associations between IgA, IgG, IgM and biomarkers of dementia, with adjustment for potential confounders. Multiple testing correction was applied using the false discovery rate. As a sensitivity analysis, we re-ran the models for participants within the reference range of immunoglobulins, excluding those using immunomodulating drugs, and conducted a stratified analysis by APOE-ε4 carriership and sex. RESULTS Of 8,768 participants with serum immunoglobulins, 3,455 participants (65.8 years [interquartile range (IQR): 61.5-72.0], 57.2% female) had plasma biomarkers available and 3,139 participants (57.4 years [IQR: 52.7-60.7], 54.4% female) had neuroimaging data. Overall, no associations between serum immunoglobulins and biomarkers of dementia remained significant after correction for multiple testing. However, several suggestive associations were noted: higher serum IgA levels concurred with lower plasma levels of Aβ-42 (standardized adjusted mean difference: -0.015 [95% confidence interval (CI): -0.029--0.002], p = 2.8 × 10-2), and a lower total brain volume, mainly driven by less gray matter (-0.027 [-0.046--0.008], p = 6.0 × 10-3) and more white matter hyperintensities (0.047 [0.016 - 0.077], p = 3.0 × 10-3). In sensitivity analyses, higher IgM was linked to lower t-tau, Aβ-40, and Aβ-42, but also a loss of white matter microstructural integrity. Stratified analyses indicate that these associations potentially differ between carriers and non-carriers of the APOE-ε4 allele and men and women. CONCLUSIONS While associations between serum immunoglobulins and early markers of dementia could not be established in this population-based sample, it may be valuable to consider factors such as APOE-ε4 allele carriership and sex in future investigations.
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Affiliation(s)
- Amber Yaqub
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Samer R Khan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Martin van Hagen
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Virgil A S H Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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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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6
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He S, Sun C, Zhu Q, Li L, Huang J, Wu G, Cao Y, Liao J, Lu Y, Su Q, Lin S, Ma X, Zhong C. A juvenile mouse model of anti-N-methyl-D-aspartate receptor encephalitis by active immunization. Front Mol Neurosci 2023; 16:1211119. [PMID: 37790883 PMCID: PMC10544982 DOI: 10.3389/fnmol.2023.1211119] [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: 04/24/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a common autoimmune encephalitis, and it is associated with psychosis, dyskinesia, and seizures. Anti-NMDAR encephalitis (NMDARE) in juveniles and adults presents different clinical charactreistics. However, the pathogenesis of juvenile anti-NMDAR encephalitis remains unclear, partly because of a lack of suitable animal models. Methods We developed a model of juvenile anti-NMDAR encephalitis using active immunization with an amino terminal domain peptide from the GluN1 subunit (GluN1356 - 385) against NMDARs in 3-week-old female C57BL/6J mice. Results Immunofluorescence staining suggested that autoantibody levels in the hippocampus increased, and HEK-293T cells staining identified the target of the autoantibodies as GluN1, suggesting that GluN1-specific immunoglobulin G was successfully induced. Behavior assessment showed that the mice suffered significant cognition impairment and sociability reduction, which is similar to what is observed in patients affected by anti-NMDAR encephalitis. The mice also exhibited impaired long-term potentiation in hippocampal CA1. Pilocarpine-induced epilepsy was more severe and had a longer duration, while no spontaneous seizures were observed. Conclusion The juvenile mouse model for anti-NMDAR encephalitis is of great importance to investigate the pathological mechanism and therapeutic strategies for the disease, and could accelerate the study of autoimmune encephalitis.
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Affiliation(s)
- Shuyu He
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
- Shenzhen Children's Hospital of China Medical University, Shenzhen, China
| | - Chongyang Sun
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qian Zhu
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Lin Li
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianyu Huang
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
| | - Ge Wu
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yi Cao
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
| | - Jianxiang Liao
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Yi Lu
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
| | - Qiru Su
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Sufang Lin
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaopeng Ma
- Department of Clinical Research, Department of Neurology, Surgery Division, Epilepsy Center, Shenzhen Children's Hospital, Shenzhen, China
| | - Cheng Zhong
- Shenzhen Key Laboratory of Precision Diagnosis and Treatment of Depression, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institution, Shenzhen, China
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Balint B. Relevance of Antibody Testing in Movement Disorders. Mov Disord Clin Pract 2023; 10:S32-S35. [PMID: 37637987 PMCID: PMC10448132 DOI: 10.1002/mdc3.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Bettina Balint
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
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8
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Zhu N, Hu L, Hu W, Li Q, Mao H, Wang M, Ke Z, Qi L, Wang J. Comparative Transcriptome Profiling of mRNA and lncRNA of Mouse Spleens Inoculated with the Group ACYW135 Meningococcal Polysaccharide Vaccine. Vaccines (Basel) 2023; 11:1295. [PMID: 37631863 PMCID: PMC10458039 DOI: 10.3390/vaccines11081295] [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: 05/17/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
The Group ACYW135 meningococcal polysaccharide vaccine (MPV-ACYW135) is a classical common vaccine used to prevent Neisseria meningitidis serogroups A, C, Y, and W135, but studies on the vaccine at the transcriptional level are still limited. In the present study, mRNAs and lncRNAs related to immunity were screened from the spleens of mice inoculated with MPV-ACYW135 and compared with the control group to identify differentially expressed mRNAs and lncRNAs in the immune response. The result revealed 34375 lncRNAs and 41321 mRNAs, including 405 differentially expressed (DE) lncRNAs and 52 DE mRNAs between the MPV group and the control group. Results of GO and KEGG enrichment analysis turned out that the main pathways related to the immunity of target genes of those DE mRNAs and DE lncRNAs were largely associated with positive regulation of T cell activation, CD8-positive immunoglobulin production in mucosal tissue, alpha-beta T cell proliferation, negative regulation of CD4-positive, and negative regulation of interleukin-17 production, suggesting that the antigens of MPV-ACYW135 capsular polysaccharide might activate T cell related immune reaction in the vaccine inoculation. In addition, it was noted that Bach2 (BTB and CNC homolog 2), the target gene of lncRNA MSTRG.17645, was involved in the regulation of immune response in MPV-ACYW135 vaccination. This study provided a preliminary catalog of both mRNAs and lncRNAs associated with the proliferation and differentiation of body immune cells, which was worthy of further research to enhance the understanding of the biological immune process regulated by MPV-ACYW135.
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Affiliation(s)
- Nan Zhu
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Liping Hu
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Wenlong Hu
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Qiang Li
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
- Aimei Vacin BioPharm (Zhejiang) Co., Ltd., Ningbo 315000, China
| | - Haiguang Mao
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
| | - Mengting Wang
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
| | - Zhijian Ke
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
| | - Lili Qi
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
| | - Jinbo Wang
- School of Biological and Chemical Engineering, NingboTech University, Qianhunan Road 1, Ningbo 315100, China; (N.Z.); (L.H.); (W.H.); (Q.L.); (M.W.); (Z.K.); (L.Q.)
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9
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Ariño H, Ruiz García R, Rioseras B, Naranjo L, Martinez-Hernandez E, Saiz A, Graus F, Dalmau J. Frequency and Referral Patterns of Neural Antibody Studies During the COVID-19 Pandemic: Experience From an Autoimmune Neurology Center. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200129. [PMID: 37311644 DOI: 10.1212/nxi.0000000000200129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether the frequency of paraneoplastic or autoimmune encephalitis antibodies examined in a referral center changed during the COVID-19 pandemic. METHODS The number of patients who tested positive for neuronal or glial (neural) antibodies during pre-COVID-19 (2017-2019) and COVID-19 (2020-2021) periods was compared. The techniques used for antibody testing did not change during these periods and included a comprehensive evaluation of cell-surface and intracellular neural antibodies. The chi-square test, Spearman correlation, and Python programming language v3 were used for statistical analysis. RESULTS Serum or CSF from 15,390 patients with suspected autoimmune or paraneoplastic encephalitis was examined. The overall positivity rate for antibodies against neural-surface antigens was similar in the prepandemic and pandemic periods (neuronal 3.2% vs 3.5%; glial 6.1 vs 5.2) with a mild single-disease increase in the pandemic period (anti-NMDAR encephalitis). By contrast, the positivity rate for antibodies against intracellular antigens was significantly increased during the pandemic period (2.8% vs 3.9%, p = 0.01), particularly Hu and GFAP. DISCUSSION Our findings do not support that the COVID-19 pandemic led to a substantial increase of known or novel encephalitis mediated by antibodies against neural-surface antigens. The increase in Hu and GFAP antibodies likely reflects the progressive increased recognition of the corresponding disorders.
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Affiliation(s)
- Helena Ariño
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Raquel Ruiz García
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Beatriz Rioseras
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Laura Naranjo
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Eugenia Martinez-Hernandez
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Albert Saiz
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Francesc Graus
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Josep Dalmau
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA.
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10
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Hemmeter L, Bien CG, Bien CI, Tipold A, Neßler J, Bathen‐Nöthen A, Matiasek K, Dahlhoff M, Rusbridge C, Rotter Black C, Rentmeister K, Volk HA, Fischer A. Investigation of the presence of specific neural antibodies in dogs with epilepsy or dyskinesia using murine and human assays. J Vet Intern Med 2023; 37:1409-1417. [PMID: 37232512 PMCID: PMC10365065 DOI: 10.1111/jvim.16744] [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: 09/15/2022] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Autoimmune mechanisms represent a novel category for causes of seizures and epilepsies in humans, and LGI1-antibody associated limbic encephalitis occurs in cats. HYPOTHESIS/OBJECTIVES To investigate the presence of neural antibodies in dogs with epilepsy or dyskinesia of unknown cause using human and murine assays modified for use in dogs. ANIMALS Fifty-eight dogs with epilepsy of unknown cause or suspected dyskinesia and 57 control dogs. METHODS Serum and CSF samples were collected prospectively as part of the diagnostic work-up. Clinical data including onset and seizure/episode type were retrieved from the medical records. Screening for neural antibodies was done with cell-based assays transfected with human genes for typical autoimmune encephalitis antigens and tissue-based immunofluorescence assays on mouse hippocampus slices in serum and CSF samples from affected dogs and controls. The commercial human und murine assays were modified with canine-specific secondary antibody. Positive controls were from human samples. RESULTS The commercial assays used in this study did not provide unequivocal evidence for presence of neural antibodies in dogs including one dog with histopathologically proven limbic encephalitis. Low titer IgLON5 antibodies were present in serum from one dog from the epilepsy/dyskinesia group and in one dog from the control group. CONCLUSION AND CLINICAL IMPORTANCE Specific neural antibodies were not detected using mouse and human target antigens in dogs with epilepsy and dyskinesia of unknown origin. These findings emphasize the need for canine-specific assays and the importance of control groups.
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Affiliation(s)
- Lea Hemmeter
- Section of Neurology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
| | - Christian G. Bien
- Department of Epileptology (Krankenhaus Mara)Bielefeld University, Medical SchoolBielefeldGermany
- Laboratory KroneBad SalzuflenGermany
| | | | - Andrea Tipold
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | - Jasmin Neßler
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | | | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
| | - Maik Dahlhoff
- Institute of In Vivo and In Vitro Models, University of Veterinary Medicine ViennaViennaAustria
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway LaneSurreyUK
- School of Veterinary Medicine, Faculty of Health & Medical SciencesUniversity of SurreySurreyUK
| | | | | | - Holger A. Volk
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | - Andrea Fischer
- Section of Neurology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
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11
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Amano R, Kim YJ, Yoshida T, Hara M, Nakajima H, Ohtsuka T, Yazawa M. Case report: Reversible brain atrophy with low titer anti-amphiphysin antibodies related to gastric adenocarcinoma. Front Neurol 2023; 14:1211814. [PMID: 37416304 PMCID: PMC10322512 DOI: 10.3389/fneur.2023.1211814] [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: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Amphiphysin (AMPH) autoimmunity is associated with a variety of neurological complications, including encephalitis, peripheral neuropathy, myelopathy, and cerebellar syndrome. Its diagnosis is based on clinical neurological deficits and the presence of serum anti-AMPH antibodies. Active immunotherapy, such as intravenous immunoglobulins, steroids, and other immunosuppressive therapies, has been reported to be effective in most patients. However, the extent of recovery varies depending on the case. Herein, we report the case of a 75-year-old woman with semi-rapidly progressive systemic tremors, visual hallucinations, and irritability. Upon hospitalization, she developed a mild fever and cognitive impairment. Brain magnetic resonance imaging (MRI) showed semi-rapidly progressive diffuse cerebral atrophy (DCA) over 3 months, while no clear abnormal intensities were observed. The nerve conduction study revealed sensory and motor neuropathy in the limbs. The fixed tissue-based assay (TBA) failed to detect antineuronal antibodies; however, based on commercial immunoblots, the presence of anti-AMPH antibodies was suspected. Therefore, serum immunoprecipitation was performed, which confirmed the presence of anti-AMPH antibodies. The patient also had gastric adenocarcinoma. High-dose methylprednisolone, and intravenous immunoglobulin were administered and tumor resection was performed, resulting in resolution of the cognitive impairment and improvement in the DCA on the post-treatment MRI. After immunotherapy and tumor resection, the patient's serum was analyzed using immunoprecipitation, which showed a decrease in the level of anti-AMPH antibodies. This case is noteworthy because the DCA showed improvement after immunotherapy and tumor resection. Additionally, this case demonstrates that negative TBA with positive commercial immunoblots do not necessarily indicate false positive results.
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Affiliation(s)
- Ryota Amano
- Department of Neurology, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, Nagano, Japan
- Department of Biochemistry, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Yeon-Jeong Kim
- Department of Biochemistry, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Toshikazu Yoshida
- Department of Neurology, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, Nagano, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshihisa Ohtsuka
- Department of Biochemistry, Graduate School of Medical Sciences, University of Yamanashi, Yamanashi, Japan
| | - Masanobu Yazawa
- Department of Neurology, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, Nagano, Japan
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12
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Bansal M, Mehta A, Sarma AK, Niu S, Silaghi DA, Khanna AK, Vallabhajosyula S. Anti-N-methyl-D-aspartate receptor encephalitis in pregnancy associated with teratoma. Proc AMIA Symp 2023; 36:524-527. [PMID: 37334098 PMCID: PMC10269377 DOI: 10.1080/08998280.2023.2205814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 06/20/2023] Open
Abstract
A 36-year-old pregnant woman with a prior history of depression and recent gunshot wounds presented with sudden deterioration in her mental status. Clinical examination revealed psychosis, hallucinations, and lack of orientation, with an otherwise normal neurological and cardiorespiratory examination. Computed tomographic scan of her head was normal, and she was diagnosed with acute psychosis and excited delirium. She did not respond to supraphysiologic dosages of antipsychotic therapy and needed physical restraints for combativeness and agitation. Her cerebrospinal fluid analysis was negative for an infectious etiology, but was positive for anti-N-methyl-D-aspartate receptor encephalitis antibodies. Abdominal imaging revealed a right-sided ovarian cyst. Subsequently she underwent right-sided oophorectomy. Postoperatively the patient continued to have intermittent episodes of agitation requiring antipsychotic medications. Later, she was safely transitioned to home care with family support.
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Affiliation(s)
- Mridul Bansal
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Aryan Mehta
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Anand Karthik Sarma
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Shuo Niu
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dan Alexandru Silaghi
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ashish K. Khanna
- Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Outcomes Research Consortium, Cleveland, Ohio
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Perioperative Outcomes and Informatics Collaborative, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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13
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Guarino M, La Bella S, Santoro M, Caposiena D, Di Lembo E, Chiarelli F, Iannetti G. The Leading Role of Brain and Abdominal Radiological Features in the Work-Up of Anti-NMDAR Encephalitis in Children: An Up-To-Date Review. Brain Sci 2023; 13:brainsci13040662. [PMID: 37190627 DOI: 10.3390/brainsci13040662] [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: 04/02/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (NMDARe) is the most common cause of nonviral encephalitis, mostly affecting young women and adolescents with a strong female predominance (F/M ratio of around 4:1). NMDARe is characterized by the presence of cerebrospinal fluid (CSF) antibodies against NMDARs, even though its pathophysiological mechanisms have not totally been clarified. The clinical phenotype of NMDARe is composed of both severe neurological and neuropsychiatric symptoms, including generalized seizures with desaturations, behavioral abnormalities, and movement disorders. NMDARe is often a paraneoplastic illness, mainly due to the common presence of concomitant ovarian teratomas in young women. Abdominal ultrasonography (US) is a key imaging technique that should always be performed in suspected patients. The timely use of abdominal US and the peculiar radiological features observed in NMDARe may allow for a quick diagnosis and a good prognosis, with rapid improvement after the resection of the tumor and the correct drug therapy.
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Affiliation(s)
- Miriana Guarino
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Marco Santoro
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Daniele Caposiena
- Department of Radiology, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Enza Di Lembo
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara "G. D'Annunzio", Via Dei Vestini 5, Ospedale Clinicizzato Chieti (CH), 66100 Chieti, Italy
| | - Giovanni Iannetti
- Department of Internist Ultrasound, Pescara Public Hospital "Santo Spirito", 65124 Pescara, Italy
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14
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Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
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Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
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15
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Müller-Jensen L, Knauss S, Ginesta Roque L, Schinke C, Maierhof SK, Bartels F, Finke C, Rentzsch K, Ulrich C, Mohr R, Stenzel W, Endres M, Boehmerle W, Huehnchen P. Autoantibody profiles in patients with immune checkpoint inhibitor-induced neurological immune related adverse events. Front Immunol 2023; 14:1108116. [PMID: 36845122 PMCID: PMC9945255 DOI: 10.3389/fimmu.2023.1108116] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Background Neurological immune-related adverse events (irAE-n) are severe and potentially fatal toxicities of immune checkpoint inhibitors (ICI). To date, the clinical significance of neuronal autoantibodies in irAE-n is poorly understood. Here, we characterize neuronal autoantibody profiles in patients with irAE-n and compare these with ICI-treated cancer patients without irAE-n. Methods In this cohort study (DRKS00012668), we consecutively collected clinical data and serum samples of 29 cancer patients with irAE-n (n = 2 pre-ICI, n = 29 post-ICI) and 44 cancer control patients without irAE-n (n = 44 pre- and post-ICI). Using indirect immunofluorescence and immunoblot assays, serum samples were tested for a large panel of neuromuscular and brain-reactive autoantibodies. Results IrAE-n patients and controls received ICI treatment targeting programmed death protein (PD-)1 (61% and 62%), programmed death ligand (PD-L)1 (18% and 33%) or PD-1 and cytotoxic T-lymphocyte-associated protein (CTLA-)4 (21% and 5%). Most common malignancies were melanoma (both 55%) and lung cancer (11% and 14%). IrAE-n affected the peripheral nervous system (59%), the central nervous system (21%), or both (21%). Prevalence of neuromuscular autoantibodies was 63% in irAE-n patients, which was higher compared to ICI-treated cancer patients without irAE-n (7%, p <.0001). Brain-reactive autoantibodies targeting surface (anti-GABABR, -NMDAR, -myelin), intracellular (anti-GFAP, -Zic4, -septin complex), or unknown antigens were detected in 13 irAE-n patients (45%). In contrast, only 9 of 44 controls (20%) presented brain-reactive autoantibodies before ICI administration. However, seven controls developed de novo brain-reactive autoantibodies after ICI initiation, therefore, prevalence of brain-reactive autoantibodies was comparable between ICI-treated patients with and without irAE-n (p = .36). While there was no clear association between specific brain-reactive autoantibodies and clinical presentation, presence of at least one of six selected neuromuscular autoantibodies (anti-titin, anti-skeletal muscle, anti-heart muscle, anti-LRP4, anti-RyR, anti-AchR) had a sensitivity of 80% (95% CI 0.52-0.96) and a specificity of 88% (95% CI 0.76-0.95) for the diagnosis of myositis, myocarditis, or myasthenia gravis. Conclusion Neuromuscular autoantibodies may serve as a feasible marker to diagnose and potentially predict life-threatening ICI-induced neuromuscular disease. However, brain-reactive autoantibodies are common in both ICI-treated patients with and without irAE-n, hence, their pathogenic significance remains unclear.
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Affiliation(s)
- Leonie Müller-Jensen
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Knauss
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lorena Ginesta Roque
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany
| | - Christian Schinke
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Smilla K. Maierhof
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Bartels
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristin Rentzsch
- Clinical Immunological Laboratory Prof. Dr. med. Winfried Stöcker, Groß Grönau, Germany
| | - Claas Ulrich
- Hauttumorcentrum, Klinik für Dermatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Raphael Mohr
- Medizinische Klinik mit Schwerpunkt Gastroenterologie und Hepatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Werner Stenzel
- Institut für Neuropathologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Center for Stroke Research, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany,German Center for Neurodegenerative Diseases (DZNE), partner site, Berlin, Germany,German Center for Cardiovascular Research (DZHK), partner site, Berlin, Germany
| | - Wolfgang Boehmerle
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany,NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,*Correspondence: Wolfgang Boehmerle,
| | - Petra Huehnchen
- Klinik und Hochschulambulanz für Neurologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Berlin, Germany,Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany,NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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16
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Quade A, Rostasy K, Wickström R, Aydin ÖF, Sartori S, Nosadini M, Knierim E, Kluger G, Korinthenberg R, Stüve B, Waltz S, Leiz S, Häusler M. Autoimmune Encephalitis with Autoantibodies to NMDAR1 following Herpes Encephalitis in Children and Adolescents. Neuropediatrics 2023; 54:14-19. [PMID: 36543183 DOI: 10.1055/s-0042-1757706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Herpes simplex virus (HSV) type 1 is a frequent pathogen causing infectious encephalitis (HSVE). Early treatment with intravenous acyclovir has led to a significant decrease in mortality. However, especially in children, deterioration during or after HSVE may occur without any evidence of HSV reactivation or improvement following repeated antiviral therapy. Here, we report 15 patients (age range 3 months to 15 years) who suffered from autoimmune encephalitis with autoantibodies to NMDAR1 following Herpes encephalitis, presenting with movement abnormalities (young children) or neuropsychiatric symptoms (older children) as major complaints, respectively. The diagnosis was based on positive cerebrospinal fluid (CSF) and/or serum anti-NMDAR-antibodies with two children showing only positive CSF antibody findings. The time lag between first symptoms and diagnosis of autoimmune encephalitis was significantly longer than between first symptoms and diagnosis of HSVE (p <0.01). All patients improved during immunosuppressive treatment, during which plasmapheresis or rituximab treatments were applied in 11 patients, irrespective of their age. Despite immunotherapy, no patients relapsed with HSVE. Early diagnosis and treatment of autoimmune encephalitis after HSVE may be associated with a better outcome so that high clinical awareness and routine testing for anti-NMDAR-antibodies after HSVE seems advisable. If autoimmune encephalitis is suspected, antibody testing should also be performed on CSF if negative in serum.
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Affiliation(s)
- Annegret Quade
- Department of Pediatrics, Division of Neuropediatrics and Social Pediatrics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Kevin Rostasy
- Department of Paediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Witten, Germany
| | - Ronny Wickström
- Department of Women's and Children's Health, Division of Neuropediatrics, Karolinska Institute, Solna, Sweden
| | - Ömer Faruk Aydin
- Department of Pediatric Neurology, Medical Faculty, Ondokuz Mayis University, Turkey
| | - Stefano Sartori
- Department of Women's and Children's Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padua, Italy and Neuroimmunology Group, Paediatric Research Institute "Città della Speranza," Padova, Italy
| | - Margherita Nosadini
- Department of Women's and Children's Health, Paediatric Neurology and Neurophysiology Unit, University Hospital of Padua, Padua, Italy and Neuroimmunology Group, Paediatric Research Institute "Città della Speranza," Padova, Italy
| | - Ellen Knierim
- Department of Neuropediatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Gerhard Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, Vogtareuth, Germany.,Research Institute "Rehabilitation-Transition-Palliation," PMU Salzburg, Austria
| | - Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Burkhard Stüve
- Department of Neuropediatrics, Children's Hospital Siegen, Germany
| | - Stephan Waltz
- Neuropediatric Department, Children's Hospital Cologne, Germany
| | - Steffen Leiz
- Department of Pediatrics, Neuropediatrics, Klinikum Dritter Orden München - Nymphenburg, Germany
| | - Martin Häusler
- Department of Pediatrics, Division of Neuropediatrics and Social Pediatrics, Medical Faculty, RWTH Aachen University, Aachen, Germany
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17
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Gibson LL, Pollak TA, Hart M, Heslegrave A, Hye A, Church AJ, Lakdawala N, Nicholson TR, Batzu L, Rota S, Trivedi D, Zetterberg H, Chaudhuri KR, Aarsland D. NMDA Receptor Antibodies and Neuropsychiatric Symptoms in Parkinson's Disease. J Neuropsychiatry Clin Neurosci 2023:appineuropsych20220107. [PMID: 36710627 DOI: 10.1176/appi.neuropsych.20220107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE N-methyl-d-aspartate receptor (NMDAR) encephalitis is an autoantibody-mediated neurological syndrome with prominent cognitive and neuropsychiatric symptoms. The clinical relevance of NMDAR antibodies outside the context of encephalitis was assessed in this study. METHODS Plasma from patients with Parkinson's disease (PD) (N=108) and healthy control subjects (N=89) was screened at baseline for immunoglobulin A (IgA), IgM, and IgG NMDAR antibodies, phosphorylated tau 181 (p-tau181), and the neuroaxonal injury marker neurofilament light (NfL). Clinical assessment of the patients included measures of cognition (Mini-Mental State Examination [MMSE]) and neuropsychiatric symptoms (Hospital Anxiety and Depression Scale; Non-Motor Symptoms Scale for Parkinson's Disease). A subgroup of patients (N=61) was followed annually for up to 6 years. RESULTS Ten (9%) patients with PD tested positive for NMDAR antibodies (IgA, N=5; IgM, N=6; IgG, N=0), and three (3%) healthy control subjects had IgM NMDAR antibodies; IgA NMDAR antibodies were detected significantly more commonly among patients with PD than healthy control subjects (χ2=4.23, df=1, p=0.04). Age, gender, and disease duration were not associated with NMDAR antibody positivity. Longitudinally, antibody-positive patients had significantly greater decline in annual MMSE scores when the analyses were adjusted for education, age, disease duration, p-tau181, NfL, and follow-up duration (adjusted R2=0.26, p=0.01). Neuropsychiatric symptoms were not associated with antibody status, and no associations were seen between NMDAR antibodies and p-tau181 or NfL levels. CONCLUSIONS NMDAR antibodies were associated with greater cognitive impairment over time in patients with PD, independent of other pathological biomarkers, suggesting a potential contribution of these antibodies to cognitive decline in PD.
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Affiliation(s)
- Lucy L Gibson
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Thomas A Pollak
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Melanie Hart
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Amanda Heslegrave
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Abdul Hye
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Andrew J Church
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Neghat Lakdawala
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Timothy R Nicholson
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Lucia Batzu
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Silvia Rota
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Dhaval Trivedi
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Henrik Zetterberg
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Kallol Ray Chaudhuri
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Dag Aarsland
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
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18
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Ma Y, Wang J, Guo S, Meng Z, Ren Y, Xie Y, Wang M. Cytokine/chemokine levels in the CSF and serum of anti-NMDAR encephalitis: A systematic review and meta-analysis. Front Immunol 2023; 13:1064007. [PMID: 36761173 PMCID: PMC9903132 DOI: 10.3389/fimmu.2022.1064007] [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: 10/07/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives To summarize the cytokine/chemokine levels of anti-N-methyl-Daspartate receptor encephalitis (NMDAR-E) and explore the potential role of these molecules and immune cells in the pathogenic mechanism. Methods The PubMed, Cochrane Library, Embase, and Web of Science databases were searched for various articles that assessed the concentrations of cytokines/chemokines in the unstimulated cerebrospinal fluid (CSF) or serum of patients with NMDAR-E in this systematic review and meta-analysis. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated by Stata17.0. Results A total of 19 articles were included in the systematic review from 260 candidate papers, and cytokine/chemokine levels reported in the CSF/serum were examined in each article. This meta-analysis included 17 eligible studies comprising 579 patients with NMDAR-E, 367 patients with noninflammatory neurological disorders, and 42 healthy controls from China, Spain, South Korea, Australia, Czechia, and Sweden. The results indicated that the levels of different cytokines interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, IL-13, IL-1β, IL-12, and IL-17 and chemokine C-X-C motif ligand (CXCL)10 in the CSF were significantly higher in NMDAR-E patients with a large effect size. In addition, B cell activating factor (BAFF), CXCL13, and interferon (IFN)-γ levels in the CSF were higher in NMDAR-E patients with a middle effect size. In contrast, levels of IL-2 and IL-4 in the CSF and CXCL13 and BAFF in the serum did not show a significant difference between cases and controls. Conclusions These analyses showed that the central immune response in NMDAR-E is a process that involves multiple immune cell interactions mediated by cytokines/chemokines, and T cells play an important role in the pathogenesis of immunity. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022342485).
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Affiliation(s)
- Yushan Ma
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China,Department of Laboratory Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Jierui Wang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuo Guo
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zirui Meng
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Xie
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Minjin Wang, ; Yi Xie,
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China,Department of Neurology, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Minjin Wang, ; Yi Xie,
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19
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Unexplained Progressive Neurological Deficits after Corpus Callosotomy May Be Caused by Autoimmune Encephalitis: A Case of Suspected Postoperative Anti-NMDAR Encephalitis. Brain Sci 2023; 13:brainsci13010135. [PMID: 36672116 PMCID: PMC9856623 DOI: 10.3390/brainsci13010135] [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: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The main causes of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis are ovarian teratoma and herpes simplex virus (HSV) encephalitis. We present a rare case of suspected anti-NMDAR encephalitis caused by corpus callosotomy (CC). An 18-year-old woman with Lennox-Gastaut syndrome underwent CC. Although left hemiplegic due to cerebral hemorrhage and impaired consciousness due to cerebral venous sinus thrombosis (CVST) appeared postoperatively, anticoagulant therapy quickly improved CVST and impaired consciousness. However, various unexplained symptoms such as insomnia, hallucination, impulsivity, impaired consciousness, and a new type of drug-resistant cluster seizures gradually developed over a 2-month period. Magnetic resonance imaging revealed the gradual extension of a hyperintense area from the right frontal lobe on fluid-attenuated inversion recovery images. Intravenous methylprednisolone pulse was initiated from postoperative day (POD) 74, followed by intravenous immunoglobulin (IVIg) therapy, although white blood cell counts were normal in all three cerebrospinal fluid (CSF) examinations. After IVIg therapy, the above unexplained symptoms promptly improved. On POD 103, antibodies against NMDAR were revealed in both the serum and CSF collected before these immunotherapies. The patient was transferred to a rehabilitation hospital due to residual left hemiplegia. Psychiatric symptoms and a new onset of drug-resistant seizures may be suggestive of postoperative anti-NMDAR encephalitis, even if CSF findings are mild.
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20
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Yokota Y, Hara M, Oshita N, Mizoguchi T, Nishimaki H, Hao H, Nakajima H. Case report: Anti- N-methyl-D-aspartate receptor antibody-associated autoimmunity triggered by primary central nervous system B-cell lymphoma. Front Neurol 2023; 13:1048953. [PMID: 36712446 PMCID: PMC9878211 DOI: 10.3389/fneur.2022.1048953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background We herein detail our experience with a unique patient with a primary central nervous system (PCNS) B-cell lymphoma concomitant with anti-N-methyl-d-aspartate receptor (NMDAR) antibodies that satisfied the criteria of "probable anti-NMDAR encephalitis (ProNMDARE)" based on the Graus criteria 2016. Case presentation A 73-year-old Japanese woman presented with acute pyrexia, agitation, and disturbance of consciousness. She gradually developed a reduction in speech frequency and truncal dystonia causing abnormal posture. Brain magnetic resonance imaging (MRI) demonstrated high-intensity lesions in the bilateral frontal lobes, and her cerebrospinal fluid revealed mild pleocytosis. She was diagnosed with acute encephalitis and treated with acyclovir and intravenous dexamethasone; however, no improvement was observed. She was transferred to our hospital 6 weeks after the onset of her symptoms, and anti-NMDAR antibodies were identified in her cerebrospinal fluid through indirect immunolabeling with rat brain frozen sections and cell-based assays with NR1/NR2 transfected HEK cells. Follow-up MRI showed enlargement of the lesions in the right frontal lobe with gadolinium enhancement, suggesting a brain tumor. Stereotactic surgery was implemented, with subsequent pathological examination revealing that the tumor was consistent with diffuse large B-cell lymphoma (DLBCL) without evidence of systemic satellite lesions. Stereotactic irradiative therapies were then added to her treatment regimen, which partly improved her neurological symptoms with only mild cognitive dysfunction still remaining. A decrease in anti-NMDAR antibody titer was also confirmed after immunotherapy and tumor removal. Conclusions We herein report our experience with a novel case of PCNS-DLBCL masquerading as anti-NMDAR encephalitis that satisfied the diagnostic criteria of "proNMDARE." Treatment, including tumor removal, ameliorated disease severity and antibody titers of the patient. Our findings suggest that anti-NMDAR antibody-associated autoimmunity can be triggered by PCNS B-cell tumors, although primary brain tumors need to be excluded before establishing a diagnosis of autoimmune encephalitis.
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Affiliation(s)
- Yuki Yokota
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan,*Correspondence: Makoto Hara ✉
| | - Natsuki Oshita
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tomotaka Mizoguchi
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Haruna Nishimaki
- Division of Oncologic Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroyuki Hao
- Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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21
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Endres D, Pankratz B, Thiem S, Runge K, Schlump A, Feige B, Nickel K, Reisert M, Mast H, Urbach H, Schiele MA, Domschke K, Berger B, Venhoff N, Prüss H, Tebartz van Elst L. Novel anti-cytoplasmic antibodies in cerebrospinal fluid and serum of patients with chronic severe mental disorders. World J Biol Psychiatry 2022; 23:794-801. [PMID: 35168497 DOI: 10.1080/15622975.2022.2042599] [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] [Indexed: 01/25/2023]
Abstract
OBJECTIVES There is an emerging role of autoimmune causes related to severe mental disorders (SMD). The clinical approach in patients with chronic SMD and novel anti-central nervous system antibodies is complex. METHODS Two corresponding cumulative cases are presented. Cerebrospinal fluid (CSF) and serum were investigated using tissue-based assays. RESULTS Both patients suffered from chronic SMD and were negative for well-characterized neuronal antibodies. Patient 1 suffered from a dysexecutive and neurocognitive syndrome with mild abnormalities in automated electroencephalography analysis, elevated CSF protein levels, several serum autoantibodies (including antibodies against endothelial cells), and novel antibodies with a "dotted/scalloped" binding against cytoplasmic structures in CSF. Patient 2 with obsessive-compulsive disorder had left temporal abnormalities on automated magnetic resonance imaging analysis, an elevated CSF/serum albumin quotient, and novel atypical cytoplasmic "spotted" antibody staining in the serum. Patient 1 improved with immunotherapy using high-dose steroids, but patient 2 did not improve under the same treatment. CONCLUSIONS The detection of autoantibodies in CSF of chronic SMD may be beneficial in selecting some patients for immunotherapy. The possible impact of novel anti-cytoplasmic antibodies in this context is critically discussed. Further research is needed to establish the underlying pathophysiological processes as well as their diagnostic and therapeutic implications.
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Affiliation(s)
- Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Benjamin Pankratz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sarah Thiem
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Andrea Schlump
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marco Reisert
- Department of Diagnostic and Interventional Radiology, Medical Physics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hansjörg Mast
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Center for Basics in Neuromodulation, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Benjamin Berger
- Clinic of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Helios Clinic Pforzheim, Department of Neurology, Pforzheim, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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22
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Chen BY, Hsu CC, Chen YZ, Lin JJ, Tseng HH, Jang FL, Chen PS, Chen WN, Chen CS, Lin SH. Profiling antibody signature of schizophrenia by Escherichia coli proteome microarrays. Brain Behav Immun 2022; 106:11-20. [PMID: 35914698 DOI: 10.1016/j.bbi.2022.07.162] [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: 03/30/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 02/09/2023] Open
Abstract
Schizophrenia (SZ) is influenced by genetic and environmental factors, and associated with chronic neuroinflammation. If the symptoms express after adolescence, environmental impacts are more substantial, and the disease is defined as adult-onset schizophrenia (AOS). Effects of environmental factors on antibody responses such as Escherichia coli (E. coli) to immunoglobulin G (IgG) and immunoglobulin M (IgM) might increase the severity of symptoms in SZ via the gut-brain axis. The purpose of this study is to reveal antibody profiles of SZ against bacterial protein antigens. We analyzed the IgG and IgM antibodies using E. coli proteome microarrays from 80 SZ patients and 40 healthy controls (HC). Using support vector machine to select panels of proteins differentiating between groups and conducted enrichment analysis for those proteins. We identified that the groL, pldA, yjjU, livG, and ftsE can classify IgGs in AOS vs HC achieved accuracy of 0.7. The protein yjjU, livG and ftsE can form the best combination panel to classify IgG in AOS vs HC with accuracy of 0.8. The enrichment results are highly related to ABC (ATP binding cassette) transporter in the protein domain and cellular component. We further found that the human ATP binding cassette subfamily b member 1 (ABCB1) autoantibody level in AOS is significantly higher than in HC. The findings suggest that AOS had different immunoglobulin production compared to early-onset schizophrenia (EOS) and HC. We also identified potential antibody biomarkers of AOS and found their antigens are enriched in ABC transporter related domains, including human ABCB1 protein.
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Affiliation(s)
- Bao-Yu Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chu-Chun Hsu
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - You-Zuo Chen
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jin-Jia Lin
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Lin Jang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Ni Chen
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Sheng Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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23
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Akimoto T, Hara M, Tasaki K, Kurosawa Y, Nakamoto T, Hirose S, Mizoguchi T, Yokota Y, Ninomiya S, Nakajima H. Delayed encephalopathy after COVID-19: A case series of six patients. Medicine (Baltimore) 2022; 101:e31029. [PMID: 36281140 PMCID: PMC9592135 DOI: 10.1097/md.0000000000031029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RATIONALE Acute encephalopathy is a severe neurological complication of coronavirus disease 2019 (COVID-19). Most cases of acute encephalopathy associated with COVID-19 occur within several weeks of COVID-19 onset. We describe a case series of 6 patients who developed delayed encephalopathy (DE) after COVID-19. PATIENT CONCERNS AND DIAGNOSES We evaluated patients who recovered from COVID-19 and showed acute disturbance of consciousness or focal neurological deficits without recurrence of pneumonitis. Six patients, 2 females and 4 males, with ages ranging from 65 to 83 years were included. Durations of hospitalization due to COVID-19 were between 25 and 44 days. The severity of COVID-19 was moderate in 5 and severe in 1 patient. Patients were rehospitalized for acute disturbance of consciousness concomitant with postural tremor and, abnormal behavior, hemiplegia, aphasia, or apraxia between 34 and 67 days after the onset of COVID-19. Chest computed tomography showed no exacerbation of pneumonitis. Brain magnetic resonance imaging showed no specific findings except in 1 patient with an acute lacunar infarction. Electroencephalogram demonstrated diffuse slowing in all patients. Repeat electroencephalogram after recovery from encephalopathy demonstrated normal in all patients. One of the 6 patients had cerebrospinal fluid (CSF) pleocytosis. CSF protein levels were elevated in all patients, ranging from 51 to 115 mg/dL. CSF interleukin-6 levels ranged from 2.9 to 10.9 pg/mL. The immunoglobulin index was 0.39 to 0.44. Qlim(alb) < QAlb indicating dysfunction of the blood-brain barrier was observed in all patients. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction of CSF was negative in all patients. Neuronal autoantibodies were absent in serum and CSF. INTERVENTIONS AND OUTCOMES Immunotherapy including steroid pulses was administered to 3 patients; however, symptoms of encephalopathy resolved within several days in all patients, regardless of treatment with immunotherapy, and their consciousness levels were recovered fully. Notably, postural tremor remained for 2 weeks to 7 months. LESSONS In our patients, DE after COVID-19 was characterized by symptoms of acute encephalopathy accompanied with tremor in the absence of worsening pneumonitis after the fourth week of COVID-19 onset. Our findings indicate blood-brain barrier dysfunction may contribute to the pathogenesis of DE after COVID-19.
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Affiliation(s)
- Takayoshi Akimoto
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
- *Correspondence: Takayoshi Akimoto, Division of Neurology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamicho, Itabashi-ku, Tokyo 173-8610, Japan (e-mail: )
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Kenta Tasaki
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yusuke Kurosawa
- Division of Respiratory Disease, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tadaharu Nakamoto
- Division of Respiratory Disease, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoshi Hirose
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tomotaka Mizoguchi
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yuki Yokota
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Satoko Ninomiya
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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24
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Murayama A, Sugaya K, Hara M, Kawazoe T, Tobisawa S, Nakajima H, Takahashi K. Leucine-rich Glioma-inactivated 1 Encephalitis Followed by Isaacs Syndrome: Alternating Presence of Pathogenic Autoantibodies to Leucine-rich Glioma-inactivated 1 and Contactin-associated Protein-like 2. Intern Med 2022. [PMID: 36223927 DOI: 10.2169/internalmedicine.9670-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The coexistence of leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) autoantibodies in the same individual is surprisingly often observed. We herein report the first case of LGI1 encephalitis followed by Isaacs syndrome in which LGI1 and CASPR2 antibodies in the serum and cerebrospinal fluid (CSF) were measured during the entire disease course. After the resolution of limbic encephalitis, LGI1 antibodies disappeared from the CSF simultaneously with the appearance of CASPR2 antibodies in the serum. The alternating presence of these pathogenic autoantibodies along with the clinical and phenotypic alternations suggested that LGI1 encephalitis was associated with CASPR2 autoantibody production in the peripheral tissue, leading to CASPR2-associated Isaacs syndrome.
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Affiliation(s)
- Aki Murayama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Keizo Sugaya
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Tomoya Kawazoe
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Shinsuke Tobisawa
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Kazushi Takahashi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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25
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Mizoguchi T, Hara M, Nakajima H. Neurosyphilis presenting as autoimmune limbic encephalitis: A case report and literature review. Medicine (Baltimore) 2022; 101:e30062. [PMID: 35984192 PMCID: PMC9388039 DOI: 10.1097/md.0000000000030062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Neurosyphilis presenting as limbic encephalitis (LE) is an important differential diagnosis of autoimmune LE (ALE) defined by Graus in 2016. However, data on the clinical differences and similarities between neurosyphilis presenting as LE and ALE are limited. Herein, we report neurosyphilis presenting as ALE that fulfilled the main items of the Graus ALE criteria. Moreover, a literature review of neurosyphilis presenting as LE was performed. PATIENT CONCERNS A 66-year-old Japanese man developed nonconvulsive status epilepticus. He presented with progressive personality change and working memory deficits within 3 months prior to admission. A hyperintense lesion localized in the bilateral medial temporal area was observed on T2-weighted fluid-attenuated inversion recovery brain magnetic resonance imaging. Cerebrospinal fluid analysis showed mild pleocytosis and the presence of oligoclonal band. However, in-house assays did not detect antineuronal antibodies. Electroencephalogram showed lateralized rhythmic delta activity in the right temporal area. The serum and cerebrospinal fluid serological and antigen tests for syphilis had positive results. DIAGNOSIS ALE was initially suspected based on the patient's symptoms and ancillary test findings that fulfilled the Graus ALE criteria. However, based on the positive confirmatory test results for syphilis, a diagnosis of neurosyphilis was eventually made. INTERVENTION The patient received intravenous midazolam, oral levetiracetam, and lacosamide to control nonconvulsive status epilepticus. In addition, he was treated with intravenous benzylpenicillin at a dose of 24 million units/day for 14 days. OUTCOMES The patient's cognitive function relatively improved after antibiotic treatment. However, he presented with persistent mild working memory deficit, which was evaluated with the Wechsler Adult Intelligence Scale, 3rd edition. Therefore, on day 103 of hospitalization, he was transferred to another hospital for rehabilitation and long-term care due to limitations in performing activities of daily living. LESSONS The present case was diagnosed with neurosyphilis presenting as ALE, but meanwhile, in most case, neurosyphilis presenting as LE developed at a slower progressive rate, and it had a broader or restricted involvement on brain MRI than ALE based on the literature review. Therefore, an appropriate differential diagnosis of LE can be obtained by identifying clinical differences between the 2 conditions.
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Affiliation(s)
- Tomotaka Mizoguchi
- Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
- *Correspondence: Makoto Hara, Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-ku, Tokyo 173-8610, Japan (e-mail: )
| | - Hideto Nakajima
- Division of Neurology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
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26
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Huang K, Tang Y, Chen Z, Ding S, Zeng H, Zhao Y, Yu Q, Liu Y. Comparison of Hematological Parameters Between First-Episode Schizophrenia and Anti-NMDAR Encephalitis. Front Cell Dev Biol 2022; 10:895178. [PMID: 35874840 PMCID: PMC9298502 DOI: 10.3389/fcell.2022.895178] [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: 03/13/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background: First-episode schizophrenia (FES) and anti-NMDAR encephalitis are different disorders with similar psychiatric symptoms, and both diseases are associated with the inflammatory system. In this study, we compared hematological parameters and inflammation ratios in anti-NMDAR encephalitis, FES, and healthy control. Methods: We enrolled 106 patients (53 FES patients and 53 anti-NMDAR encephalitis patients) and 59 healthy controls. The values of the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) were used to evaluate inflammation. Other parameters such as the white blood cell (WBC), platelet (PLT), uric acid (UA), total bilirubin (TBIL), total bile acid (TBA), and serum albumin counts were also used to compare inflammation ratios between these two diseases. Results: SII, NLR, PLR, MLR, and serum albumin levels were statistically significantly different between these three groups (p < 0.05). The values of SII, NLR, PLR, and MLR were significantly higher in the anti-NMDAR encephalitis group than those in the FES group (p < 0.05), and the values in both diseases were more increased than those in HC (p < 0.05). The serum albumin level was significantly lower in anti-NMDAR encephalitis than in FES (p < 0.05). WBC, neutrophil, lymphocyte, and monocyte counts showed significantly higher levels in the anti-NMDAR encephalitis group and FES group separately (p < 0.05). Other parameters like TBA, TBIL, and UA showed no difference between groups. Conclusion: In summary, this is a relatively new study that is innovative by comparing some inflammation markers of peripheral blood in two diseases with clinically psychotic symptoms. These two diseases are related to the inflammatory system, proving that NMDAR dysfunction is related to psychotic symptoms. Besides, NLR, PLR, MLR, and serum albumin can be used as biomarkers to distinguish the two diseases. The serum albumin level in patients with anti-NMDAR encephalitis was lower than that in patients with schizophrenia.
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Affiliation(s)
- Kai Huang
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yamei Tang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiheng Chen
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shan Ding
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongtao Zeng
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuxu Zhao
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qi Yu
- School of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Yong Liu
- Department of Psychiatry and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Yong Liu,
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27
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DeLong JH, Ohashi SN, O'Connor KC, Sansing LH. Inflammatory Responses After Ischemic Stroke. Semin Immunopathol 2022; 44:625-648. [PMID: 35767089 DOI: 10.1007/s00281-022-00943-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022]
Abstract
Ischemic stroke generates an immune response that contributes to neuronal loss as well as tissue repair. This is a complex process involving a range of cell types and effector molecules and impacts tissues outside of the CNS. Recent reviews address specific aspects of this response, but several years have passed and important advances have been made since a high-level review has summarized the overall state of the field. The present review examines the initiation of the inflammatory response after ischemic stroke, the complex impacts of leukocytes on patient outcome, and the potential of basic science discoveries to impact the development of therapeutics. The information summarized here is derived from broad PubMed searches and aims to reflect recent research advances in an unbiased manner. We highlight valuable recent discoveries and identify gaps in knowledge that have the potential to advance our understanding of this disease and therapies to improve patient outcomes.
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Affiliation(s)
- Jonathan Howard DeLong
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Naomi Ohashi
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin Charles O'Connor
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Lauren Hachmann Sansing
- Departments of Neurology and Immunobiology, Yale University School of Medicine, New Haven, CT, USA.
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28
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Serum anti-NMDA-receptor antibodies and cognitive function after ischemic stroke (PROSCIS-B). J Neurol 2022; 269:5521-5530. [PMID: 35718820 PMCID: PMC9468072 DOI: 10.1007/s00415-022-11203-x] [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: 02/06/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022]
Abstract
Objective We aimed to investigate whether serum anti-N-methyl-D-aspartate-receptor GluN1 (previously NR1) antibody (NMDAR1-abs) seropositivity impacts cognitive function (CF) in the long term following ischemic stroke. Methods Data were used from the PROSpective Cohort with Incident Stroke-Berlin. NMDAR1-abs (IgM/IgA/IgG) were measured with cell-based assays from serum obtained within 7 days after the first-ever stroke. Seropositivity was defined as titers ≥ 1:10, low titers as ≤ 1:100 and high titers as > 1:100. We assessed CF at 1, 2 and 3 years after stroke with the Telephone Interview for Cognitive Status-modified (TICS-m) and used crude and propensity score adjusted inverse probability weighted generalized linear models to estimate the impact of NMDAR1-abs serostatus on TICS-m. Results Data on NMDAR1-abs (median day of sampling = 4[IQR = 2–5]) were available in 583/621 PROSCIS-B patients (39% female; median NIHSS = 2[IQR = 1–4]; median MMSE = 28[IQR:26–30]), of whom 76(13%) were seropositive (IgM: n = 48/IgA: n = 43/IgG: n = 2). Any NMDAR1-abs seropositivity had no impact on TICS-m compared to seronegative patients (βcrude = 0.69[95%CI = – 0.84 to 2.23]; βadjusted = 0.65[95%CI = – 1.00 to 2.30]). Patients with low titers scored better on TICS-m compared to seronegative patients (βcrude = 2.33[95%CI = 0.76 to 3.91]; βadjusted = 2.47[95%CI = 0.75 to 4.19]); in contrast, patients with high titers scored lower on TICS-m (βcrude = –2.82[95%CI = – 4.90 to – 0.74], βadjusted = – 2.96[95%CI = – 5.13 to – 0.80]), compared to seronegative patients. Conclusion In our study, NMDAR1-abs seropositivity did not affect CF over 3 years after a first mild to moderate ischemic stroke. CF differed according to NMDAR1-abs serum titer, with patients with high NMDAR1-abs titers having a less favorable cognitive outcome compared to seronegative patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11203-x.
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29
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Mizoguchi T, Hara M, Hirose S, Nakajima H. Novel qEEG Biomarker to Distinguish Anti-NMDAR Encephalitis From Other Types of Autoimmune Encephalitis. Front Immunol 2022; 13:845272. [PMID: 35242143 PMCID: PMC8885512 DOI: 10.3389/fimmu.2022.845272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/24/2022] [Indexed: 01/15/2023] Open
Abstract
Objective To establish the diagnostic biomarker of electroencephalogram (EEG) to distinguish between anti-N-methyl-d-aspartate receptor encephalitis (NMDARE) and other types of autoimmune encephalitis (other AEs). Methods We reviewed the clinical records of 90 patients with acute encephalitis who were treated in our institution between January 2014 and October 2020. We enrolled the patients who fulfilled the diagnostic criteria for possible AE (pAE) defined by Graus et al. (pAE criteria) and then classified into definite NMDARE and other AEs. We investigated the main syndrome and analyzed all admission EEGs using EEG power value (PV). Statistical significance was tested using the Mann–Whitney U test or Fisher’s exact test. Results Twenty-five patients fulfilled the pAE criteria and were classified into 9 with definite NMDARE (median age: 21 years; 8 women) and 12 with other AEs (median age: 37.5 years; 6 women). Four were eventually excluded. Speech dysfunction (9/9 vs. 4/12, p = 0.005) and movement disorders (6/9 vs. 1/12, p = 0.016) were more frequent in NMDARE than in other AEs. The PV analyses revealed the novel quantitative EEG (qEEG) index, namely, fast slow ratio (FSR) (PV of total beta/PV of total theta + delta). The median FSR (0.139 vs. 0.029, p = 0.004) was higher for NMDARE than other AEs, and the receiver operating characteristic curve area of FSR was 0.86 (95% CI 0.70–1.00). A cutoff value of 0.047 yielded a specificity of 0.75 and a sensitivity of 1.00. Focusing on patients who did not meet the “probable NMDARE criteria” in Graus 2016 (proNMDARE criteria) (n = 10), the pretest probability of NMDAR antibody test was 0.30 (3/10), which increased in patients with an FSR greater than the cutoff (n = 5) to 0.60 (3/5). Conclusions The NMDARE group highlighted speech dysfunction and movement disorders, and a novel qEEG index FSR accurately distinguished the NMDARE patients from other AEs. The FSR is a promising diagnostic marker for NMDARE that indicates the positive results of NMDAR antibodies in patients with AE when combined with the proNMDARE criteria.
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Affiliation(s)
- Tomotaka Mizoguchi
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Makoto Hara
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hirose
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideto Nakajima
- Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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30
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Al-Diwani A, Theorell J, Damato V, Bull J, McGlashan N, Green E, Kienzler AK, Harrison R, Hassanali T, Campo L, Browne M, Easton A, Soleymani majd H, Tenaka K, Iorio R, Dale RC, Harrison P, Geddes J, Quested D, Sharp D, Lee ST, Nauen DW, Makuch M, Lennox B, Fowler D, Sheerin F, Waters P, Leite MI, Handel AE, Irani SR. Cervical lymph nodes and ovarian teratomas as germinal centres in NMDA receptor-antibody encephalitis. Brain 2022; 145:2742-2754. [PMID: 35680425 PMCID: PMC9486890 DOI: 10.1093/brain/awac088] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 01/14/2023] Open
Abstract
Autoantibodies against the extracellular domain of the N-methyl-d-aspartate receptor (NMDAR) NR1 subunit cause a severe and common form of encephalitis. To better understand their generation, we aimed to characterize and identify human germinal centres actively participating in NMDAR-specific autoimmunization by sampling patient blood, CSF, ovarian teratoma tissue and, directly from the putative site of human CNS lymphatic drainage, cervical lymph nodes. From serum, both NR1-IgA and NR1-IgM were detected more frequently in NMDAR-antibody encephalitis patients versus controls (both P < 0.0001). Within patients, ovarian teratoma status was associated with a higher frequency of NR1-IgA positivity in serum (OR = 3.1; P < 0.0001) and CSF (OR = 3.8, P = 0.047), particularly early in disease and before ovarian teratoma resection. Consistent with this immunoglobulin class bias, ovarian teratoma samples showed intratumoral production of both NR1-IgG and NR1-IgA and, by single cell RNA sequencing, contained expanded highly-mutated IgA clones with an ovarian teratoma-restricted B cell population. Multiplex histology suggested tertiary lymphoid architectures in ovarian teratomas with dense B cell foci expressing the germinal centre marker BCL6, CD21+ follicular dendritic cells, and the NR1 subunit, alongside lymphatic vessels and high endothelial vasculature. Cultured teratoma explants and dissociated intratumoral B cells secreted NR1-IgGs in culture. Hence, ovarian teratomas showed structural and functional evidence of NR1-specific germinal centres. On exploring classical secondary lymphoid organs, B cells cultured from cervical lymph nodes of patients with NMDAR-antibody encephalitis produced NR1-IgG in 3/7 cultures, from patients with the highest serum NR1-IgG levels (P < 0.05). By contrast, NR1-IgG secretion was observed neither from cervical lymph nodes in disease controls nor in patients with adequately resected ovarian teratomas. Our multimodal evaluations provide convergent anatomical and functional evidence of NMDAR-autoantibody production from active germinal centres within both intratumoral tertiary lymphoid structures and traditional secondary lymphoid organs, the cervical lymph nodes. Furthermore, we develop a cervical lymph node sampling protocol that can be used to directly explore immune activity in health and disease at this emerging neuroimmune interface.
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Affiliation(s)
- Adam Al-Diwani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jakob Theorell
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Damato
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Joshua Bull
- Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, Oxford, UK
| | - Nicholas McGlashan
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Edward Green
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Anne Kathrin Kienzler
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ruby Harrison
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tasneem Hassanali
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Leticia Campo
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Molly Browne
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | - Alistair Easton
- Translational Histopathology Laboratory, Department of Oncology, University of Oxford, Oxford, UK
| | | | - Keiko Tenaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, Japan
| | - Raffaele Iorio
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Russell C Dale
- Kids Neuroscience Centre, Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Paul Harrison
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - John Geddes
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Digby Quested
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - David W Nauen
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mateusz Makuch
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Belinda Lennox
- University Department of Psychiatry, University of Oxford, Oxford, UK
| | - Darren Fowler
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Fintan Sheerin
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Adam E Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Sarosh R Irani
- Correspondence to: Professor Sarosh Irani Oxford Autoimmune Neurology Group West Wing, Level 6, John Radcliffe Hospital Oxford OX3 9DU, UK E-mail:
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Joubert B, Petit-Pedrol M, Planagumà J, Mannara F, Radosevic M, Marsal M, Maudes E, García-Serra A, Aguilar E, Andrés-Bilbé A, Gasull X, Loza-Alvarez P, Sabater L, Rosenfeld MR, Dalmau J. Human CASPR2 antibodies reversibly alter memory and the CASPR2 protein complex. Ann Neurol 2022; 91:801-813. [PMID: 35253937 DOI: 10.1002/ana.26345] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The encephalitis associated with antibodies against contactin-associated protein-like 2 (CASPR2) is presumably antibody-mediated but the antibody effects and whether they cause behavioral alterations are not well-known. Here, we used a mouse model of patients' IgG transfer and super-resolution microscopy to demonstrate the antibody pathogenicity. METHODS IgG from patients with anti-CASPR2 encephalitis or healthy controls were infused into the cerebroventricular system of mice. The levels and colocalization of CASPR2 with transient axonal glycoprotein-1 (TAG1) were determined with Stimulated Emission Depletion (STED) microscopy (40-70μm lateral resolution). Hippocampal clusters of Kv1.1 voltage-gated potassium channels (VGKC) and GluA1-containing AMPA receptors were quantified with confocal microscopy. Behavioral alterations were assessed with standard behavioral paradigms. Cultured neurons were used to determine the levels of intracellular CASPR2 and TAG1 after exposure to patients' IgG. RESULTS Infusion of patients' IgG, but not control IgG, caused memory impairment along with hippocampal reduction of surface CASPR2 clusters and decreased CASPR2/TAG1 colocalization. In cultured neurons, patients' IgG led to an increase of intracellular CASPR2 without affecting TAG1, suggesting selective CASPR2 internalization. Additionally, mice infused with patients' IgG showed decreased levels of Kv1.1 and GluA1 (two CASPR2 regulated proteins). All these alterations and the memory deficit reverted to normal after removing patients' IgG. INTERPRETATION IgG from patients with anti-CASPR2 encephalitis cause reversible memory impairment, inhibit the interaction of CASPR2/TAG1, and decrease the levels of CASPR2 and related proteins (VGKC, AMPAR). These findings fulfill the postulates of antibody-mediated disease and provide a biological basis for antibody-removing treatment approaches. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bastien Joubert
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mar Petit-Pedrol
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jesús Planagumà
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology (BIST) , Castelldefels (Barcelona), Spain
| | - Francesco Mannara
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Marija Radosevic
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria Marsal
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology (BIST) , Castelldefels (Barcelona), Spain
| | - Estibaliz Maudes
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Anna García-Serra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Esther Aguilar
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Alba Andrés-Bilbé
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Neurophysiology Laboratory, Department of Biomedicine, School of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Xavier Gasull
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Neurophysiology Laboratory, Department of Biomedicine, School of Medicine, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Pablo Loza-Alvarez
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology (BIST) , Castelldefels (Barcelona), Spain
| | - Lidia Sabater
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Myrna R Rosenfeld
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
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32
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Bastiaansen AEM, de Bruijn MAAM, Schuller SL, Martinez-Hernandez E, Brenner J, Paunovic M, Crijnen YS, Mulder MJHL, Schreurs MWJ, de Graaff E, Smitt PAE, Neuteboom RF, de Vries JM, Titulaer MJ. Anti-NMDAR Encephalitis in the Netherlands, Focusing on Late-Onset Patients and Antibody Test Accuracy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1127. [PMID: 34937737 PMCID: PMC8696553 DOI: 10.1212/nxi.0000000000001127] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/10/2021] [Indexed: 01/21/2023]
Abstract
Background and Objectives To describe the clinical features of anti-NMDAR encephalitis, emphasizing on late-onset patients and antibody test characteristics in serum and CSF. Methods Nationwide observational Dutch cohort study, in patients diagnosed with anti-NMDAR encephalitis between 2007 and 2019. Results One hundred twenty-six patients with anti-NMDAR encephalitis were included with a median age of 24 years (range 1–86 years). The mean annual incidence was 1.00/million (95% CI 0.62–1.59). Patients ≥45 years of age at onset (19%) had fewer seizures (46% vs 71%, p = 0.021), fewer symptoms during disease course (3 vs 6 symptoms, p = 0.020), and more often undetectable serum antibodies compared with younger patients (p = 0.031). In the late-onset group, outcome was worse, and all tumors were carcinomas (both p < 0.0001). CSF was more accurate than serum to detect anti-NMDAR encephalitis (sensitivity 99% vs 68%, p < 0.0001). Using cell-based assay (CBA), CSF provided an unconfirmed positive test result in 11/2,600 patients (0.4%); 6/11 had a neuroinflammatory disease (other than anti-NMDAR encephalitis). Patients with anti-NMDAR encephalitis, who tested positive in CSF only, had lower CSF antibody titers (p = 0.003), but appeared to have an equally severe disease course. Discussion Anti-NMDAR encephalitis occurs at all ages and is less rare in the elderly patients than initially anticipated. In older patients, the clinical phenotype is less outspoken, has different tumor association, and a less favorable recovery. Detection of antibodies in CSF is the gold standard, and although the CBA has very good validity, it is not perfect. The clinical phenotype should be leading, and confirmation in a research laboratory is recommended, when in doubt.
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Affiliation(s)
- Anna E M Bastiaansen
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Marienke A A M de Bruijn
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Sabine L Schuller
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Eugenia Martinez-Hernandez
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Juliëtte Brenner
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Manuela Paunovic
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Yvette S Crijnen
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Maxim J H L Mulder
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Marco W J Schreurs
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Esther de Graaff
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Peter A E Smitt
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Rinze F Neuteboom
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Juna M de Vries
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (A.E.M.B., M.A.A.M.d.B., J.B., M.P., Y.S.C., M.J.H.L.M., P.A.E.S., R.F.N., J.M.d.V., M.J.T.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (M.A.A.M.d.B.), Elisabeth Tweesteden Medical Center, the Netherlands; Bachlelor Student Psychobiology (S.L.S.), University of Amsterdam, the Netherlands; Neuroimmunology Program and Department of Neurology (E.M.-H.), Hospital Clínic, University of Barcelona, Spain; Department of Immunology (M.W.J.S.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biology (E.d.G.), Faculty of Science, Utrecht University, Utrecht, the Netherlands.
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Wright MA, Trandafir CC, Nelson GR, Hersh AO, Inman CJ, Zielinski BA. Diagnosis and Management of Suspected Pediatric Autoimmune Encephalitis: A Comprehensive, Multidisciplinary Approach and Review of Literature. J Child Neurol 2022; 37:303-313. [PMID: 34927485 DOI: 10.1177/08830738211064673] [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] [Indexed: 12/23/2022]
Abstract
Autoimmune encephalitis is an increasingly recognized entity in children. When treated promptly, favorable outcomes are seen in a majority of pediatric patients. However, recognition of autoimmune encephalitis in young patients is challenging. Once autoimmune encephalitis is suspected, additional difficulties exist regarding timing of treatment initiation and duration of treatment, as evidence to guide management of these patients is emerging. Here, we review available literature regarding pediatric autoimmune encephalitis and present our institution's comprehensive approach to the evaluation and management of the disease. These guidelines were developed through an iterative process involving both pediatric neurologists and rheumatologists.
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Affiliation(s)
- Melissa A Wright
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Cristina C Trandafir
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Gary R Nelson
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - C J Inman
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Brandon A Zielinski
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Department of Neurology, 14434University of Utah, Salt Lake City, UT, USA
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34
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Vaux A, Robinson K, Saglam B, Cheuk N, Kilpatrick T, Evans A, Monif M. Autoimmune Encephalitis in Long-Standing Schizophrenia: A Case Report. Front Neurol 2022; 12:810926. [PMID: 35222231 PMCID: PMC8873086 DOI: 10.3389/fneur.2021.810926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/27/2021] [Indexed: 01/17/2023] Open
Abstract
Anti-N-methyl-D-aspartate (NMDA) receptor antibody (anti-NMDAR Ab)-mediated encephalitis is an autoimmune disorder involving the production of antibodies against NMDARs in the central nervous system that leads to neurological or psychiatric dysfunction. Initially described as a paraneoplastic syndrome in young women with teratomas, increased testing has found it to be a heterogeneous condition that affects both the sexes with varying clinical manifestations, severity, and aetiology. This case report describes a 67-year-old man with a 40-year history of relapsing, severe, treatment-refractory schizophrenia. Due to the worsening of his condition during a prolonged inpatient admission for presumed relapse of psychosis, a revisit of the original diagnosis was considered with extensive investigations performed including an autoimmune panel. This revealed anti-NMDAR Abs in both the serum and cerebrospinal fluid on two occasions. Following treatment with intravenous immunoglobulin and methylprednisolone, he demonstrated rapid symptom improvement. This is a rare case of a long-standing psychiatric presentation with a preexisting diagnosis of schizophrenia subsequently found to have anti-NMDAR Ab-mediated encephalitis. Whether the case is one of initial NMDAR encephalitis vs. overlap syndrome is unknown. Most importantly, this case highlights the need for vigilance and balanced consideration for treatment in cases of long-standing psychiatric presentation where the case remains treatment refractory to antipsychotics or when atypical features including seizures and autonomic dysfunction or focal neurology are observed.
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Affiliation(s)
- Amy Vaux
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- *Correspondence: Amy Vaux
| | - Karen Robinson
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Burcu Saglam
- Department of Psychiatry, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Nathan Cheuk
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
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35
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Murashko AA, Pavlov KA, Pavlova OV, Gurina OI, Shmukler A. Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review. Neuropsychobiology 2022; 81:1-18. [PMID: 34000730 DOI: 10.1159/000515930] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to provide comprehensive evidence synthesis including all available up-to-date data about the prevalence of N-methyl D-aspartate receptor (NMDAR) antibodies (ABs) in psychotic patients in order to evaluate the clinical relevance of ABs as well as to specify potential explanations of the heterogeneity of the findings and determine areas for further research. METHODS A literature search was conducted using the PubMed/Medline, Web of Knowledge, and Scopus databases. RESULTS Forty-seven studies and 4 systematic reviews (including 2 meta-analyses) were included in the present review. Studies that used cell-based assays (CBAs) provided heterogeneous results on AB prevalence, obviously depending on the type of detection assay and sample characteristics. Improvement of AB detection methods is necessary to determine the real prevalence of ABs across different groups of patients and healthy people. Live CBAs seem to have better sensitivity but probably poorer specificity than fixed CBAs. Moreover, some links between AB-positive status and acute symptoms are possible. A small amount of data on immunotherapy in AB-positive patients raises the possibility of its effectiveness but obviously require further research. CONCLUSIONS NMDAR ABs are definitely present in a subset of psychotic patients. NMDAR ABs might shape psychosis and underlie some symptoms, and immunotherapy might be regarded as a treatment option for patients failing to respond to other therapies.
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Affiliation(s)
- Alexey A Murashko
- Department of Translational Psychiatry, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Konstantin A Pavlov
- Department of Fundamental and Applied Neurobiology, V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Olga V Pavlova
- Department of Fundamental and Applied Neurobiology, V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Olga I Gurina
- Department of Fundamental and Applied Neurobiology, V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Alexander Shmukler
- Department of Translational Psychiatry, Moscow Research Institute of Psychiatry, The Branch of V. Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
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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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Höppner-Buchmann J, Seidel D, Block F, Briedigkeit L, Tietke M, Nürnberger J, Frank B. [Creutzfeldt-Jakob Disease Versus Anti-NMDA Receptor Encephalitis A Case Report]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:163-168. [PMID: 34986490 DOI: 10.1055/a-1682-7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinically differentiating between autoimmune and neurodegenerative disorders can often pose a diagnostic challenge. The differential diagnosis of rapidly progressing neurological and cognitive symptoms includes central nervous system tumours, cerebral vasculitis, and inflammatory, autoimmune, or paraneoplastic encephalopathies. Rarer neurodegenerative diseases such as Creutzfeldt-Jakob disease should also be considered. Detection of treatable causes, such as autoimmune disorders, remains important when potentially occurring in conjunction with Creutzfeldt-Jakob disease. The following report describes a rare case in which autoimmune encephalopathy and prion disease were considered as possible comorbidities.
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Affiliation(s)
| | - Desiree Seidel
- Klinik für Psychiatrie und Psychotherapie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Frank Block
- Klinik für Neurologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Lutz Briedigkeit
- Institut für Laboratoriums- und Transfusionsmedizin, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Marc Tietke
- Institut für Radiologie, Kinder- und Neuroradiologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Jens Nürnberger
- Klinik für Nephrologie und Dialyse, HELIOS Kliniken Schwerin, Schwerin, Deutschland
| | - Bernd Frank
- Akutklinik für Frührehabilitation und interdisziplinäres Rehabilitationszentrum, HELIOS Klinik Leezen GmbH, Leezen, Deutschland
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Ma Y, Wang J, Guo S, Meng Z, Ren Y, Xie Y, Wang M. Cytokine/chemokine levels in the CSF and serum of anti-NMDAR encephalitis: A systematic review and meta-analysis. Front Immunol 2022; 13:1064007. [PMID: 36761173 DOI: 10.3389/fimmu.2022.919979/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/23/2022] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES To summarize the cytokine/chemokine levels of anti-N-methyl-Daspartate receptor encephalitis (NMDAR-E) and explore the potential role of these molecules and immune cells in the pathogenic mechanism. METHODS The PubMed, Cochrane Library, Embase, and Web of Science databases were searched for various articles that assessed the concentrations of cytokines/chemokines in the unstimulated cerebrospinal fluid (CSF) or serum of patients with NMDAR-E in this systematic review and meta-analysis. The standardized mean difference (SMD) and 95% confidence interval (CI) were calculated by Stata17.0. RESULTS A total of 19 articles were included in the systematic review from 260 candidate papers, and cytokine/chemokine levels reported in the CSF/serum were examined in each article. This meta-analysis included 17 eligible studies comprising 579 patients with NMDAR-E, 367 patients with noninflammatory neurological disorders, and 42 healthy controls from China, Spain, South Korea, Australia, Czechia, and Sweden. The results indicated that the levels of different cytokines interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, IL-13, IL-1β, IL-12, and IL-17 and chemokine C-X-C motif ligand (CXCL)10 in the CSF were significantly higher in NMDAR-E patients with a large effect size. In addition, B cell activating factor (BAFF), CXCL13, and interferon (IFN)-γ levels in the CSF were higher in NMDAR-E patients with a middle effect size. In contrast, levels of IL-2 and IL-4 in the CSF and CXCL13 and BAFF in the serum did not show a significant difference between cases and controls. CONCLUSIONS These analyses showed that the central immune response in NMDAR-E is a process that involves multiple immune cell interactions mediated by cytokines/chemokines, and T cells play an important role in the pathogenesis of immunity. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022342485).
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Affiliation(s)
- Yushan Ma
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Laboratory Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Jierui Wang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuo Guo
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zirui Meng
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Ren
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Xie
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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Hansen N. NMDAR autoantibodies in psychiatric disease - An immunopsychiatric continuum and potential predisposition for disease pathogenesis. J Transl Autoimmun 2022; 5:100165. [PMID: 36176328 PMCID: PMC9513762 DOI: 10.1016/j.jtauto.2022.100165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Translational Psychoneuroscience, University Medical Center Göttingen, Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.
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Ciano-Petersen NL, Cabezudo-García P, Muñiz-Castrillo S, Honnorat J, Serrano-Castro PJ, Oliver-Martos B. Current Status of Biomarkers in Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Int J Mol Sci 2021; 22:13127. [PMID: 34884930 PMCID: PMC8658717 DOI: 10.3390/ijms222313127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
The discovery of biomarkers in rare diseases is of paramount importance to allow a better diagnosis, improve predictions of outcomes, and prompt the development of new treatments. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare autoimmune disorder associated with the presence of antibodies targeting the GluN1 subunit of the NMDAR. Since it was discovered in 2007, large efforts have been made towards the identification of clinical, paraclinical, and molecular biomarkers to better understand the immune mechanisms that govern the course of the disease as well as to define predictors of treatment response and long-term outcomes. However, most of these biomarkers are still in an exploratory phase, with only a few candidates reaching the final phases of the always-complex process of biomarker development, mainly due to the low incidence of the disease and its recent description. Clinical and paraclinical markers are probably the most widely explored in anti-NMDAR encephalitis, five of them combined in a clinical score to predict 1 year outcome. On the contrary, soluble molecules, such as persistent antibody positivity, antibody titers, cytokines, and other inflammatory mediators, have been proposed as biomarkers of clinical activity, inflammation, prognosis, and treatment response, but further studies are required for their clinical validation including larger and more homogenous cohorts of patients. Similarly, genetic susceptibility biomarkers are still in the exploratory phase and, therefore, weak conclusions can for now only be achieved. Thus, further studies are warranted to define biomarkers and unravel the underlying mechanisms driving rare diseases such as anti-NMDAR encephalitis. Future international collaborative studies with prospective designs that enable the enrollment of large cohorts will allow for the identification and validation of novel biomarkers for clinical decision-making.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pablo Cabezudo-García
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pedro Jesús Serrano-Castro
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Begoña Oliver-Martos
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- Department of Cell Biology, Genetics and Physiology, Physiology Area, University of Malaga, 29010 Málaga, Spain
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Abstract
Fluorescence imaging techniques play a pivotal role in our understanding of the nervous system. The emergence of various super-resolution microscopy methods and specialized fluorescent probes enables direct insight into neuronal structure and protein arrangements in cellular subcompartments with so far unmatched resolution. Super-resolving visualization techniques in neurons unveil a novel understanding of cytoskeletal composition, distribution, motility, and signaling of membrane proteins, subsynaptic structure and function, and neuron-glia interaction. Well-defined molecular targets in autoimmune and neurodegenerative disease models provide excellent starting points for in-depth investigation of disease pathophysiology using novel and innovative imaging methodology. Application of super-resolution microscopy in human brain samples and for testing clinical biomarkers is still in its infancy but opens new opportunities for translational research in neurology and neuroscience. In this review, we describe how super-resolving microscopy has improved our understanding of neuronal and brain function and dysfunction in the last two decades.
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Affiliation(s)
- Christian Werner
- Department of Biotechnology & Biophysics, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Markus Sauer
- Department of Biotechnology & Biophysics, Biocenter, University of Würzburg, 97074 Würzburg, Germany
| | - Christian Geis
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Characteristics of clinical relapses and patient-oriented long-term outcomes of patients with anti-N-methyl-D-aspartate receptor encephalitis. J Neurol 2021; 269:2486-2492. [PMID: 34613453 DOI: 10.1007/s00415-021-10828-8] [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: 03/31/2021] [Revised: 08/07/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The main syndrome of anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) is well-characterized, however, the difference in main symptoms between the initial episode and relapses and patient-oriented long-term outcomes has not been previously described. METHODS To investigate the difference in syndrome symptoms between episodes and patient-oriented outcomes, we administered a structured questionnaire survey for the patients with anti-NMDARE or their family members. From the answers, we analyzed the frequency of main symptoms (e.g., prodromes, abnormal behaviors, memory deficit, speech disorders, involuntary movements, hypo-ventilation) between episodes and patient-oriented outcomes that included the recovery rate for return to previous work or school. RESULTS Fifty-six patients were enrolled, and 14 (25%) showed clinical relapse. Details of symptoms at relapse were obtained from 11 patients. Prodrome (27% vs. 96%, p < 0.001), decreased level of consciousness (55% vs. 88%, p = 0.021), seizures (36% vs. 77%, p = 0.012), and involuntary movements (27% vs. 84%, p < 0.001) were significantly less frequent at relapse than initial episode. Although 80% (35/44) of the patients achieved favorable long-term outcomes (modified Rankin Scale score, 0-2), only 61% (27/44) returned to their previous work or school life. CONCLUSION Anti-NMDARE can relapse with milder and more limited symptoms than those of initial episode, and some patients did not return to their previous activities even after achieving a neurologically favorable outcome.
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Tripathi S, Michaelson NM, Segal A. Persistent seropositivity in oophorectomy-resistant anti-NMDA receptor encephalitis. BMJ Case Rep 2021; 14:e241878. [PMID: 34479877 PMCID: PMC8420666 DOI: 10.1136/bcr-2021-241878] [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: 07/23/2021] [Indexed: 11/03/2022] Open
Abstract
To discuss (1) the significance of seropositivity in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and (2) clinical decision making in oophorectomy resistant disease. Patient A (a 35-year-old woman) had high CSF and serum anti-NMDA antibody titres, a complicated hospital course, little improvement with first and second-line therapies, and remained with high CSF and serum antibody titres despite unilateral oophorectomy, requiring a nearly 13-month long hospitalisation. Conversely, patient B (a 29-year-old woman) had low CSF titres, seronegative disease and quickly recovered to her baseline with first line therapies and oophorectomy. Anti-NMDAR antibodies are themselves pathological, causing signalling dysfunction and internalisation of the NMDAR. Seropositivity with anti-NMDAR antibodies likely reflects leakage from the blood-brain barrier, with high serum titres being a downstream effect of high CSF titres. Empiric bilateral oophorectomies is controversial but appropriate on a case-by-case basis in extremely treatment-resistant NMDAR encephalitis given the possibility of antigenic microteratomas, which may not be detected on imaging or even bilateral ovarian biopsies.
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Affiliation(s)
- Susmit Tripathi
- Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
- Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nara M Michaelson
- Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
- Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alan Segal
- Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
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Graus F, Dalmau J. Autoimmune encephalitis or autoimmune psychosis? Eur Neuropsychopharmacol 2021; 50:112-114. [PMID: 34102603 DOI: 10.1016/j.euroneuro.2021.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Francesc Graus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Josep Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Nissen MS, Ørvik MS, Nilsson AC, Ryding M, Lydolph M, Blaabjerg M. NMDA-receptor encephalitis in Denmark from 2009 to 2019: a national cohort study. J Neurol 2021; 269:1618-1630. [PMID: 34351472 DOI: 10.1007/s00415-021-10738-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To describe the national Danish N-methyl-D-aspartate receptor encephalitis (NMDARE) cohort. METHODS All NMDAR immunoglobulin G (IgG) positive cases in Denmark from 2009 to 2019 were included. Medical information was assessed retrospectively for clinical phenotype, workup, treatment and outcome. RESULTS Seventy-seven patients were NMDAR IgG positive in serum/CSF. Fifty-five fulfilled the criteria of NMDARE, 18 did not and 4 had missing data. Incidence was 0.17/100,000 persons per year in 2018, and incidence rates increased since 2009. Of the 55 NMDARE patients (median age 27; 60% female), 9 had post-herpes simplex (HSE) NMDARE and 7 had a tumor (four teratomas). MRI was normal in 51% of patients. Brain FDG PET was performed in 17 patients, and was abnormal in 47% of patients with a normal MRI. First-line therapy was administered to 91%, and 24% required second-line therapy. Maintenance therapy during recovery was given 84% of patients, with no effect on relapse-risk. ICU admission occurred in 29%. Poor outcome (mRS > 2) was reported in 27% and dependent on age and etiology. Patients > 45 years had a poorer outcome (71% vs 8%, p < 0.0001), more frequently post-HSE NMDARE (47% vs 3%, p < 0.0001) and underlying malignancies (18% vs 0%). CONCLUSION The incidence of NMDARE in Denmark is currently 0.17/100,000 persons per year, and has increased since 2009. NMDARE patients in Denmark display a higher median age, lower female:male ratio, a less frequent tumor association and need for ICU admission. Maintenance therapy did not reduce relapse rate. Poor outcome was seen with higher age, likely related to underlying etiology.
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Affiliation(s)
- Mette Scheller Nissen
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Brain Research-Inter Disciplinary Guided Excellence (BRIDGE), Odense, Denmark.
| | | | - Anna Christine Nilsson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Matias Ryding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Brain Research-Inter Disciplinary Guided Excellence (BRIDGE), Odense, Denmark
| | - Magnus Lydolph
- Danish National Biobank, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Brain Research-Inter Disciplinary Guided Excellence (BRIDGE), Odense, Denmark.
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
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Chen B, Lopez Chiriboga AS, Sirven JI, Feyissa AM. Autoimmune Encephalitis-Related Seizures and Epilepsy: Diagnostic and Therapeutic Approaches. Mayo Clin Proc 2021; 96:2029-2039. [PMID: 34353466 DOI: 10.1016/j.mayocp.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Baibing Chen
- Department of Neurology, Mayo Clinic, Jacksonville, FL
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Giannoccaro MP, Gastaldi M, Rizzo G, Jacobson L, Vacchiano V, Perini G, Capellari S, Franciotta D, Costa A, Liguori R, Vincent A. Antibodies to neuronal surface antigens in patients with a clinical diagnosis of neurodegenerative disorder. Brain Behav Immun 2021; 96:106-112. [PMID: 34022370 DOI: 10.1016/j.bbi.2021.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Autoimmune encephalitis due to antibodies against neuronal surface antigens (NSA-Ab) frequently presents with cognitive impairment, often as the first and prevalent manifestation, but few studies have systematically assessed the frequency of NSA-Ab in consecutive patients with established neurodegenerative disorders. METHODS We studied sera of 93 patients (41F, 52 M), aged 69.2 ± 9.4 years, with neurodegenerative conditions, and of 50 population controls aged over 60 years. Specific NSA-Abs were investigated by antigen-specific cell-based assays (CBAs). After testing, we evaluated the association between the NSA-Abs and clinical, CSF and radiological features. RESULTS The patients included 13/93 (13.8%) who had specific antibodies to neuronal surface antigens: 6 GlyR, 3 GABAAR (1 also positive for AMPAR), 2 LGI1, 1 CASPR2 and 1 GABABR. One of the 50 controls (2%) was positive for NMDAR antibody and the others were negative on all tests (P = 0.020). No difference was observed in antibody frequency between patients presenting with parkinsonism and those presenting with dementia (P = 0.55); however, NSA-Ab were more frequent in those with unclassified forms of dementia (5/13, 38.5%) than in those with unclassified parkinsonism (2/9, 22.2%) or with classified forms of dementia (4/43, 9.3%) or parkinsonism (2/28, 7.1%) (P = 0.03). A logistic regression analysis demonstrated that an unclassified diagnosis (P = 0.02) and an irregular progression (P = 0.024) were predictors of seropositive status. CONCLUSIONS NSA-Abs are relatively frequent in patients with neurodegenerative disorders, particularly in those with an irregular disease progression of atypical clinical features, inconsistent with a recognized diagnosis. The significance of these antibodies and their possible primary or secondary roles need to be investigated in prospective studies.
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Affiliation(s)
- Maria Pia Giannoccaro
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italy.
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italy
| | - Giulia Perini
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sabina Capellari
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italy
| | | | - Alfredo Costa
- Unit of Behavioral Neurology, IRCCS Fondazione Mondino, and Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Hansen N. Current Nosology of Neural Autoantibody-Associated Dementia. Front Aging Neurosci 2021; 13:711195. [PMID: 34393763 PMCID: PMC8355817 DOI: 10.3389/fnagi.2021.711195] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/02/2021] [Indexed: 01/02/2023] Open
Abstract
Background The detection of neural autoantibodies in patients with cognitive decline is an increasingly frequent phenomenon in memory clinics, and demanding as it does a specific diagnostic approach and therapeutic management, it deserves greater attention. It is this review’s aim to present the latest nosology of neural autoantibody-associated dementia. Methods A specific literature research via PubMed was conducted to describe the nosology of neural autoantibody-associated dementia. Results An autoimmune dementia comprises with an early onset, atypical clinical presentation and rapid progression in conjunction with neural antibodies, signs of inflammation in the cerebrospinal fluid, and a non-neurodegenerative pattern in neuroimaging. An autoimmune dementia is probably present if the patient responds to immunotherapy. Atypical dementia involving neural autoantibodies with mostly N-methyl-D-aspartate receptor antibodies might not fulfill all the autoimmune-dementia criteria, thus it may constitute an independent disease entity. Finally, a neurodegenerative dementia such as the frontotemporal type also coincides with neural autoantibodies such as the subunit ionotropic glutamate receptors 3 of amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibodies, dementia with Lewy bodies with myelin oligodendrocytic protein, myelin basic protein antibodies, or Creutzfeldt-Jakob disease with Zic4 or voltage gated potassium channel antibodies. These dementia entities may well overlap in their clinical features and biomarkers, i.e., their neural autoantibodies or neuroimaging patterns. Conclusion There are three main forms of neural autoantibody-associated dementia we can distinguish that might also share certain features in their clinical and laboratory presentation. More research is urgently necessary to improve the diagnosis and therapy of these patients, as the progression of their dementia might thus be improved or even reversed.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
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Sechi E, Flanagan EP. Antibody-Mediated Autoimmune Diseases of the CNS: Challenges and Approaches to Diagnosis and Management. Front Neurol 2021; 12:673339. [PMID: 34305787 PMCID: PMC8292678 DOI: 10.3389/fneur.2021.673339] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022] Open
Abstract
Antibody-mediated disorders of the central nervous system (CNS) are increasingly recognized as neurologic disorders that can be severe and even life-threatening but with the potential for reversibility with appropriate treatment. The expanding spectrum of newly identified autoantibodies targeting glial or neuronal (neural) antigens and associated clinical syndromes (ranging from autoimmune encephalitis to CNS demyelination) has increased diagnostic precision, and allowed critical reinterpretation of non-specific neurological syndromes historically associated with systemic disorders (e.g., Hashimoto encephalopathy). The intracellular vs. cell-surface or synaptic location of the different neural autoantibody targets often helps to predict the clinical characteristics, potential cancer association, and treatment response of the associated syndromes. In particular, autoantibodies targeting intracellular antigens (traditionally termed onconeural autoantibodies) are often associated with cancers, rarely respond well to immunosuppression and have a poor outcome, although exceptions exist. Detection of neural autoantibodies with accurate laboratory assays in patients with compatible clinical-MRI phenotypes allows a definite diagnosis of antibody-mediated CNS disorders, with important therapeutic and prognostic implications. Antibody-mediated CNS disorders are rare, and reliable autoantibody identification is highly dependent on the technique used for detection and pre-test probability. As a consequence, indiscriminate neural autoantibody testing among patients with more common neurologic disorders (e.g., epilepsy, dementia) will necessarily increase the risk of false positivity, so that recognition of high-risk clinical-MRI phenotypes is crucial. A number of emerging clinical settings have recently been recognized to favor development of CNS autoimmunity. These include antibody-mediated CNS disorders following herpes simplex virus encephalitis or occurring in a post-transplant setting, and neurological autoimmunity triggered by TNFα inhibitors or immune checkpoint inhibitors for cancer treatment. Awareness of the range of clinical and radiological manifestations associated with different neural autoantibodies, and the specific settings where autoimmune CNS disorders may occur is crucial to allow rapid diagnosis and early initiation of treatment.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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