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Tran TTT, Nguyen THN, Dauvilliers Y, Liblau R, Nguyen XH. Absence of specific autoantibodies in patients with narcolepsy type 1 as indicated by an unbiased random peptide-displayed phage screening. PLoS One 2024; 19:e0297625. [PMID: 38442093 PMCID: PMC10914298 DOI: 10.1371/journal.pone.0297625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/10/2024] [Indexed: 03/07/2024] Open
Abstract
Narcolepsy type 1 (NT1) is an enigmatic sleep disorder characterized by the selective loss of neurons producing orexin (also named hypocretin) in the lateral hypothalamus. Although NT1 is believed to be an autoimmune disease, the orexinergic neuron-specific antigens targeted by the pathogenic immune response remain elusive. In this study, we evaluated the differential binding capacity of various peptides to serum immunoglobin G from patients with NT1 and other hypersomnolence complaints (OHCs). These peptides were selected using an unbiased phage display technology or based on their significant presence in the serum of NT1 patients as identified from previous studies. Although the subtractive biopanning strategy successfully enriched phage clones with high reactivity against NT1 serum IgG, the 101 randomly selected individual phage clones could not differentiate the sera from NT1 and OHC. Compared to the OHC control group, serum from several NT1 patients exhibited increased reactivity to the 12-mer peptides derived from TRBV7, BCL-6, NRXN1, RXRG, HCRT, and RTN4 proteins, although not statistically significant. Collectively, employing both unbiased and targeted methodologies, we were unable to detect the presence of specific autoantibodies in our NT1 patient cohort. This further supports the hypothesis that the autoimmune response in NT1 patients likely stems primarily from T cell-mediated immunity rather than humoral immunity.
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Affiliation(s)
- Thi-Tuyet Trinh Tran
- Department of Biobank, Hi-Tech Center and Vinmec-VinUni Institute of Immunology, Vinmec Healthcare system, Hanoi, Vietnam
| | - Thi-Hong Nhung Nguyen
- Department of Biobank, Hi-Tech Center and Vinmec-VinUni Institute of Immunology, Vinmec Healthcare system, Hanoi, Vietnam
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorder Center, CHU Montpellier, Montpellier, France
| | - Roland Liblau
- Department of Inflammatory Diseases of the Central Nervous System: Mechanisms and Therapies, Toulouse Institute for Infection and Inflammatory Diseases, University of Toulouse, Toulouse, France
| | - Xuan-Hung Nguyen
- Department of Biobank, Hi-Tech Center and Vinmec-VinUni Institute of Immunology, Vinmec Healthcare system, Hanoi, Vietnam
- College of Health Sciences, VinUnivesity, Hanoi, Vietnam
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Valizadeh P, Momtazmanesh S, Plazzi G, Rezaei N. Connecting the dots: An updated review of the role of autoimmunity in narcolepsy and emerging immunotherapeutic approaches. Sleep Med 2024; 113:378-396. [PMID: 38128432 DOI: 10.1016/j.sleep.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Narcolepsy type 1 (NT1) is a chronic disorder characterized by pathological daytime sleepiness and cataplexy due to the disappearance of orexin immunoreactive neurons in the hypothalamus. Genetic and environmental factors point towards a potential role for inflammation and autoimmunity in the pathogenesis of the disease. This study aims to comprehensively review the latest evidence on the autoinflammatory mechanisms and immunomodulatory treatments aimed at suspected autoimmune pathways in NT1. METHODS Recent relevant literature in the field of narcolepsy, its autoimmune hypothesis, and purposed immunomodulatory treatments were reviewed. RESULTS Narcolepsy is strongly linked to specific HLA alleles and T-cell receptor polymorphisms. Furthermore, animal studies and autopsies have found infiltration of T cells in the hypothalamus, supporting T cell-mediated immunity. However, the role of autoantibodies has yet to be definitively established. Increased risk of NT1 after H1N1 infection and vaccination supports the autoimmune hypothesis, and the potential role of coronavirus disease 2019 and vaccination in triggering autoimmune neurodegeneration is a recent finding. Alterations in cytokine levels, gut microbiota, and microglial activation indicate a potential role for inflammation in the disease's development. Reports of using immunotherapies in NT1 patients are limited and inconsistent. Early treatment with IVIg, corticosteroids, plasmapheresis, and monoclonal antibodies has seldomly shown some potential benefits in some studies. CONCLUSION The current body of literature supports that narcolepsy is an autoimmune disorder most likely caused by T-cell involvement. However, the potential for immunomodulatory treatments to reverse the autoinflammatory process remains understudied. Further clinical controlled trials may provide valuable insights into this area.
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Affiliation(s)
- Parya Valizadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic, and Neural Sciences, Università Degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Liblau RS, Latorre D, Kornum BR, Dauvilliers Y, Mignot EJ. The immunopathogenesis of narcolepsy type 1. Nat Rev Immunol 2024; 24:33-48. [PMID: 37400646 DOI: 10.1038/s41577-023-00902-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/05/2023]
Abstract
Narcolepsy type 1 (NT1) is a chronic sleep disorder resulting from the loss of a small population of hypothalamic neurons that produce wake-promoting hypocretin (HCRT; also known as orexin) peptides. An immune-mediated pathology for NT1 has long been suspected given its exceptionally tight association with the MHC class II allele HLA-DQB1*06:02, as well as recent genetic evidence showing associations with polymorphisms of T cell receptor genes and other immune-relevant loci and the increased incidence of NT1 that has been observed after vaccination with the influenza vaccine Pandemrix. The search for both self-antigens and foreign antigens recognized by the pathogenic T cell response in NT1 is ongoing. Increased T cell reactivity against HCRT has been consistently reported in patients with NT1, but data demonstrating a primary role for T cells in neuronal destruction are currently lacking. Animal models are providing clues regarding the roles of autoreactive CD4+ and CD8+ T cells in the disease. Elucidation of the pathogenesis of NT1 will allow for the development of targeted immunotherapies at disease onset and could serve as a model for other immune-mediated neurological diseases.
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Affiliation(s)
- Roland S Liblau
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, Toulouse, France.
- Department of Immunology, Toulouse University Hospitals, Toulouse, France.
| | | | - Birgitte R Kornum
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, Montpellier, France
- INSERM Institute for Neurosciences of Montpellier, Montpellier, France
| | - Emmanuel J Mignot
- Stanford University, Center for Narcolepsy, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, USA.
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4
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Miano S, Barateau L, De Pieri M, Riccardi S, Thevenin C, Manconi M, Dauvilliers Y. A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele. J Clin Sleep Med 2023; 19:2053-2057. [PMID: 37539640 PMCID: PMC10692923 DOI: 10.5664/jcsm.10748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
STUDY OBJECTIVES We report data collected from 2 reference European sleep centers on a series of patients with narcolepsy with hypocretin-1 deficiency and absence of the human leukocyte antigens (HLA) DQB1*06:02 allele. METHODS Clinical data, HLA DQ markers, and cerebrospinal fluid assessments were collected retrospectively from Caucasian patients with a diagnosis of narcolepsy type 1 with cerebrospinal fluid hypocretin-1 deficiency (< 110 pg/ml) and absence of the HLA DQB1*06:02 allele, with follow-up with at least 1 visit within the last 4 years, consecutively admitted to 2 European sleep centers (Lugano, Switzerland and Montpellier, France). RESULTS Seven patients (3 of 29 patients in Lugano and 4 of 328 in Montpellier) were diagnosed with narcolepsy with hypocretin-1 deficiency and absence of HLA DQB1*06:02 (ie, 2% of patients with narcolepsy type 1). Regarding the HLA-DQB1 genotyping, 4 cases were positive for HLA DQB1*03:01, 1 for DQB1*03:02, and 3 for DQB1*02:01. Three patients had atypical cataplexy and 1 had no cataplexy. Only 2 patients had both a mean sleep latency of less than 8 minutes and more than 2 sleep onset rapid eye movement periods on the Multiple Sleep Latency Test, indicative of a less severe condition. CONCLUSIONS Although rare, this series of 7 cases confirms that hypocretin-deficient narcolepsy should not be excluded in the absence of HLA DQB1*06:02, especially if patients are carriers of other high-risk HLA-DQB1 alleles (DQB1*03:01, *03:02, *02:01). These data support the hypothesis that narcolepsy type 1 is a wider disease spectrum linked to the loss of hypocretin peptide. CITATION Miano S, Barateau L, De Pieri M, et al. A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele. J Clin Sleep Med. 2023;19(12):2053-2057.
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Affiliation(s)
- Silvia Miano
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- National Reference Network for Narcolepsy, Montpellier, Institute for Neurosciences of Montpellier (INM), INSERM, University of Montpellier, Montpellier, France
| | - Marco De Pieri
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- General Psychiatry Service, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Silvia Riccardi
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Celine Thevenin
- Département d’Immunologie, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Mauro Manconi
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
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5
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Khajavi L, Nguyen XH, Queriault C, Chabod M, Barateau L, Dauvilliers Y, Zytnicki M, Liblau R. The transcriptomics profiling of blood CD4 and CD8 T-cells in narcolepsy type I. Front Immunol 2023; 14:1249405. [PMID: 38077397 PMCID: PMC10702585 DOI: 10.3389/fimmu.2023.1249405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Background Narcolepsy Type I (NT1) is a rare, life-long sleep disorder arising as a consequence of the extensive destruction of orexin-producing hypothalamic neurons. The mechanisms involved in the destruction of orexin neurons are not yet elucidated but the association of narcolepsy with environmental triggers and genetic susceptibility (strong association with the HLA, TCRs and other immunologically-relevant loci) implicates an immuno-pathological process. Several studies in animal models and on human samples have suggested that T-cells are the main pathogenic culprits. Methods RNA sequencing was performed on four CD4 and CD8 T-cell subsets (naive, effector, effector memory and central memory) sorted by flow cytometry from peripheral blood mononuclear cells (PBMCs) of NT1 patients and HLA-matched healthy donors as well as (age- and sex-) matched individuals suffering from other sleep disorders (OSD). The RNAseq analysis was conducted by comparing the transcriptome of NT1 patients to that of healthy donors and other sleep disorder patients (collectively referred to as the non-narcolepsy controls) in order to identify NT1-specific genes and pathways. Results We determined NT1-specific differentially expressed genes, several of which are involved in tubulin arrangement found in CD4 (TBCB, CCT5, EML4, TPGS1, TPGS2) and CD8 (TTLL7) T cell subsets, which play a role in the immune synapse formation and TCR signaling. Furthermore, we identified genes (GZMB, LTB in CD4 T-cells and NLRP3, TRADD, IL6, CXCR1, FOXO3, FOXP3 in CD8 T-cells) and pathways involved in various aspects of inflammation and inflammatory response. More specifically, the inflammatory profile was identified in the "naive" subset of CD4 and CD8 T-cell. Conclusion We identified NT1-specific differentially expressed genes, providing a cell-type and subset specific catalog describing their functions in T-cells as well as their potential involvement in NT1. Several genes and pathways identified are involved in the formation of the immune synapse and TCR activation as well as inflammation and the inflammatory response. An inflammatory transcriptomic profile was detected in both "naive" CD4 and CD8 T-cell subsets suggesting their possible involvement in the development or progression of the narcoleptic process.
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Affiliation(s)
- Leila Khajavi
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), L'Institut National de la Sante et de la Recherche Medicale (INSERM), Universite Paul-Sabatier de Toulouse (UPS), Toulouse, France
- Applied Mathematics and Informatics Unit of Toulouse (MIAT), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Toulouse, France
| | - Xuan-Hung Nguyen
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), L'Institut National de la Sante et de la Recherche Medicale (INSERM), Universite Paul-Sabatier de Toulouse (UPS), Toulouse, France
- Vinmec Institute of Applied Science and Regenerative Medicine, Vinmec Healthcare System and College of Health Sciences, VinUniveristy, Hanoi, Vietnam
| | - Clémence Queriault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), L'Institut National de la Sante et de la Recherche Medicale (INSERM), Universite Paul-Sabatier de Toulouse (UPS), Toulouse, France
| | - Marianne Chabod
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), L'Institut National de la Sante et de la Recherche Medicale (INSERM), Universite Paul-Sabatier de Toulouse (UPS), Toulouse, France
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier (INM), University Montpellier, Montpellier, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier (INM), University Montpellier, Montpellier, France
| | - Matthias Zytnicki
- Applied Mathematics and Informatics Unit of Toulouse (MIAT), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (INRAE), Toulouse, France
| | - Roland Liblau
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, Centre National de la Recherche Scientifique (CNRS), L'Institut National de la Sante et de la Recherche Medicale (INSERM), Universite Paul-Sabatier de Toulouse (UPS), Toulouse, France
- Department of Immunology, Toulouse University Hospital, Toulouse, France
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6
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Oh J, Cho E, Um YH, Oh SH, Hong SC. Narcolepsy is associated with an increased risk of HLA-related autoimmune diseases: Evidence from a nationwide healthcare system data in South Korea. Sleep Med 2023; 105:37-42. [PMID: 36958254 DOI: 10.1016/j.sleep.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 03/25/2023]
Abstract
STUDY OBJECTIVES To determine the incidence rate of narcolepsy in South Korea and closely examine the relationship between narcolepsy, which is believed to be an autoimmune response, and other systemic autoimmune diseases. METHODS We examined data from the South Korean nationwide health insurance claims database from 2010 to 2019. Our study included patients with narcolepsy as well as age- and sex-matched controls without narcolepsy. We estimated the incidence of narcolepsy and the odds ratio of narcolepsy and associated autoimmune comorbidities in South Korea. RESULTS We identified 8710 patients with narcolepsy (59.8% men and 40.2% women). The incidence of narcolepsy was 0.05%. Patients with narcolepsy were at a significantly high risk of ankylosing spondylitis, rheumatoid arthritis, and Sjögren's syndrome, which diseases are known to be related to human leukocyte antigen (HLA) genes. CONCLUSIONS Narcolepsy is closely related to systemic autoimmune diseases, particularly those related to HLA genes.
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Affiliation(s)
- Jihye Oh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, South Korea
| | - Eunhae Cho
- Department of Colorectal Surgery, Seoul Asan Medical Center, Ulsan University, South Korea
| | - Yoo-Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, South Korea
| | - Sei Hoon Oh
- Department of Environmental Horticulture, College of Natural Science, The University of Seoul, South Korea
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, South Korea; Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, South Korea.
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7
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Mogavero MP, DelRosso LM, Bruni O, Salemi M, Salsone M, Novellino F, Zucconi M, Ferini Strambi L, Ferri R. Genetics and epigenetics of rare hypersomnia. Trends Genet 2023; 39:415-429. [PMID: 36842900 DOI: 10.1016/j.tig.2023.02.003] [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: 10/24/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/28/2023]
Abstract
Herein we focus on connections between genetics and some central disorders of hypersomnolence - narcolepsy types 1 and 2 (NT1, NT2), idiopathic hypersomnia (IH), and Kleine-Levin syndrome (KLS) - for a better understanding of their etiopathogenetic mechanisms and a better diagnostic and therapeutic definition. Gene pleiotropism influences neurological and sleep disorders such as hypersomnia; therefore, genetics allows us to uncover common pathways to different pathologies, with potential new therapeutic perspectives. An important body of evidence has accumulated on NT1 and IH, allowing a better understanding of etiopathogenesis, disease biomarkers, and possible new therapeutic approaches. Further studies are needed in the field of epigenetics, which has a potential role in the modulation of biological specific hypersomnia pathways.
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Affiliation(s)
- Maria Paola Mogavero
- Vita-Salute San Raffaele University, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maria Salsone
- Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy
| | - Fabiana Novellino
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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8
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Bernard-Valnet R, Frieser D, Nguyen XH, Khajavi L, Quériault C, Arthaud S, Melzi S, Fusade-Boyer M, Masson F, Zytnicki M, Saoudi A, Dauvilliers Y, Peyron C, Bauer J, Liblau RS. Influenza vaccination induces autoimmunity against orexinergic neurons in a mouse model for narcolepsy. Brain 2022; 145:2018-2030. [PMID: 35552381 DOI: 10.1093/brain/awab455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022] Open
Abstract
Narcolepsy with cataplexy or narcolepsy type 1 is a disabling chronic sleep disorder resulting from the destruction of orexinergic neurons in the hypothalamus. The tight association of narcolepsy with HLA-DQB1*06:02 strongly suggest an autoimmune origin to this disease. Furthermore, converging epidemiological studies have identified an increased incidence for narcolepsy in Europe following Pandemrix® vaccination against the 2009-2010 pandemic 'influenza' virus strain. The potential immunological link between the Pandemrix® vaccination and narcolepsy remains, however, unknown. Deciphering these mechanisms may reveal pathways potentially at play in most cases of narcolepsy. Here, we developed a mouse model allowing to track and study the T-cell response against 'influenza' virus haemagglutinin, which was selectively expressed in the orexinergic neurons as a new self-antigen. Pandemrix® vaccination in this mouse model resulted in hypothalamic inflammation and selective destruction of orexin-producing neurons. Further investigations on the relative contribution of T-cell subsets in this process revealed that haemagglutinin-specific CD4 T cells were necessary for the development of hypothalamic inflammation, but insufficient for killing orexinergic neurons. Conversely, haemagglutinin-specific CD8 T cells could not initiate inflammation but were the effectors of the destruction of orexinergic neurons. Additional studies revealed pathways potentially involved in the disease process. Notably, the interferon-γ pathway was proven essential, as interferon-γ-deficient CD8 T cells were unable to elicit the loss of orexinergic neurons. Our work demonstrates that an immunopathological process mimicking narcolepsy can be elicited by immune cross-reactivity between a vaccine antigen and a neuronal self-antigen. This process relies on a synergy between autoreactive CD4 and CD8 T cells for disease development. This work furthers our understanding of the mechanisms and pathways potentially involved in the development of a neurological side effect due to a vaccine and, likely, to narcolepsy in general.
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Affiliation(s)
- Raphaël Bernard-Valnet
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France.,Service of Neurology, Clinical Neurosciences Department, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - David Frieser
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Xuan-Hung Nguyen
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France.,Vinmec Institute of Applied Science and Regenerative Medicine, Vinmec Healthcare System, Hanoi, Vietnam
| | - Leila Khajavi
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Clémence Quériault
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Sébastien Arthaud
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience, University of Lyon 1, Bron, France
| | - Silvia Melzi
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience, University of Lyon 1, Bron, France
| | | | - Frederick Masson
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Matthias Zytnicki
- Unité de Mathématiques et Informatique Appliquées, INRAE, Castanet-Tolosan, France
| | - Abdelhadi Saoudi
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, INSERM U1061, Montpellier, France
| | - Christelle Peyron
- INSERM U1028, CNRS UMR 5292, Center for Research in Neuroscience, University of Lyon 1, Bron, France
| | - Jan Bauer
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland S Liblau
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France.,Department of Immunology, Toulouse University Hospitals, Toulouse, France
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9
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Latorre D, Federica S, Bassetti CLA, Kallweit U. Narcolepsy: a model interaction between immune system, nervous system, and sleep-wake regulation. Semin Immunopathol 2022; 44:611-623. [PMID: 35445831 PMCID: PMC9519713 DOI: 10.1007/s00281-022-00933-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/22/2022] [Indexed: 12/21/2022]
Abstract
Narcolepsy is a rare chronic neurological disorder characterized by an irresistible excessive daytime sleepiness and cataplexy. The disease is considered to be the result of the selective disruption of neuronal cells in the lateral hypothalamus expressing the neuropeptide hypocretin, which controls the sleep-wake cycle. Diagnosis and management of narcolepsy represent still a substantial medical challenge due to the large heterogeneity in the clinical manifestation of the disease as well as to the lack of understanding of the underlying pathophysiological mechanisms. However, significant advances have been made in the last years, thus opening new perspective in the field. This review describes the current knowledge of clinical presentation and pathology of narcolepsy as well as the existing diagnostic criteria and therapeutic intervention for the disease management. Recent evidence on the potential immune-mediated mechanisms that may underpin the disease establishment and progression are also highlighted.
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Affiliation(s)
| | - Sallusto Federica
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland.,Center of Medical Immunology, Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | | | - Ulf Kallweit
- Clinical Sleep and Neuroimmunology, Institute of Immunology, University Witten/Herdecke, Witten, Germany.,Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
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10
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Warren RL, Birol I. HLA alleles measured from COVID-19 patient transcriptomes reveal associations with disease prognosis in a New York cohort. PeerJ 2021; 9:e12368. [PMID: 34722002 PMCID: PMC8522641 DOI: 10.7717/peerj.12368] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Human Leukocyte Antigen (HLA) gene locus plays a fundamental role in human immunity, and it is established that certain HLA alleles are disease determinants. Previously, we have identified prevalent HLA class I and class II alleles, including DPA1*02:02, in two small patient cohorts at the COVID-19 pandemic onset. METHODS We have since analyzed a larger public patient cohort data (n = 126 patients) with controls, associated demographic and clinical data. By combining the predictive power of multiple in silico HLA predictors, we report on HLA-I and HLA-II alleles, along with their associated risk significance. RESULTS We observe HLA-II DPA1*02:02 at a higher frequency in the COVID-19 positive cohort (29%) when compared to the COVID-negative control group (Fisher's exact test [FET] p = 0.0174). Having this allele, however, does not appear to put this cohort's patients at an increased risk of hospitalization. Inspection of COVID-19 disease severity outcomes, including admission to intensive care, reveal nominally significant risk associations with A*11:01 (FET p = 0.0078) and C*04:01 (FET p = 0.0087). The association with severe disease outcome is especially evident for patients with C*04:01, where disease prognosis measured by mechanical ventilation-free days was statistically significant after multiple hypothesis correction (Bonferroni p = 0.0323). While prevalence of some of these alleles falls below statistical significance after Bonferroni correction, COVID-19 patients with HLA-I C*04:01 tend to fare worse overall. This HLA allele may hold potential clinical value.
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Affiliation(s)
- René L. Warren
- Genome Sciences Centre, BC Cancer, Vancouver, CA-BC, Canada
| | - Inanc Birol
- Genome Sciences Centre, BC Cancer, Vancouver, CA-BC, Canada
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11
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Viste R, Lie BA, Viken MK, Rootwelt T, Knudsen-Heier S, Kornum BR. Narcolepsy type 1 patients have lower levels of effector memory CD4 + T cells compared to their siblings when controlling for H1N1-(Pandemrix™)-vaccination and HLA DQB1∗06:02 status. Sleep Med 2021; 85:271-279. [PMID: 34388506 DOI: 10.1016/j.sleep.2021.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVES Evidence suggests a cell-mediated autoimmune pathogenesis for narcolepsy type 1 (NT1), but it is not clear whether the disease is associated with overall changes in T cell subsets. The increase in NT1 incidence after H1N1 vaccination campaign with the Pandemrix™ vaccine suggests that disease-relevant changes in the immune system following this vaccination were important. In this study, we aimed to investigate differentiated T cell subsets and levels of CD25 and CD69 activation markers in a cohort of mainly Pandemrix™-vaccinated NT1 patients compared with their vaccinated and unvaccinated siblings. METHODS Peripheral blood mononuclear cells were collected in parallel and analysed with flow cytometry in 31 NT1 patients with disease onset after the 2009 influenza A (H1N1) pandemic and/or Pandemrix™ vaccination and 45 of their non-narcoleptic siblings (29/31 and 34/45 vaccinated, respectively). RESULTS We observed significantly lower effector memory CD4+ T cell levels in NT1 patients compared to their siblings, when controlling for HLA DQB1∗06:02 and vaccination status. Further, within the sibling group, vaccination status significantly affected frequencies of central memory and CD8+CD25+ T cells, and HLA DQB1∗06:02 status significantly affected frequencies of CD4+CD25+ T cells. CONCLUSION We confirm that NT1 is associated with lower levels of effector memory CD4+ T cells in peripheral blood. Importantly, this finding was only significant when controlling for vaccination and HLA status in both patients and controls. We thus demonstrate the importance of characterizing such factors (eg HLA and vaccination) when studying T cell subsets in NT1. This might explain earlier conflicting results.
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Affiliation(s)
- Rannveig Viste
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Benedicte A Lie
- Department of Immunology, University of Oslo and Oslo University Hospital, Norway; Department of Medical Genetics, University of Oslo and Oslo University Hospital, Norway
| | - Marte K Viken
- Department of Immunology, University of Oslo and Oslo University Hospital, Norway; Department of Medical Genetics, University of Oslo and Oslo University Hospital, Norway
| | - Terje Rootwelt
- Institute of Clinical Medicine, University of Oslo, Norway; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Norway
| | - Birgitte R Kornum
- Kornum Laboratory, Department of Neuroscience, University of Copenhagen, Denmark.
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12
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Vuorela A, Freitag TL, Leskinen K, Pessa H, Härkönen T, Stracenski I, Kirjavainen T, Olsen P, Saarenpää-Heikkilä O, Ilonen J, Knip M, Vaheri A, Partinen M, Saavalainen P, Meri S, Vaarala O. Enhanced influenza A H1N1 T cell epitope recognition and cross-reactivity to protein-O-mannosyltransferase 1 in Pandemrix-associated narcolepsy type 1. Nat Commun 2021; 12:2283. [PMID: 33863907 PMCID: PMC8052463 DOI: 10.1038/s41467-021-22637-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Narcolepsy type 1 (NT1) is a chronic neurological disorder having a strong association with HLA-DQB1*0602, thereby suggesting an immunological origin. Increased risk of NT1 has been reported among children or adolescents vaccinated with AS03 adjuvant-supplemented pandemic H1N1 influenza A vaccine, Pandemrix. Here we show that pediatric Pandemrix-associated NT1 patients have enhanced T-cell immunity against the viral epitopes, neuraminidase 175-189 (NA175-189) and nucleoprotein 214-228 (NP214-228), but also respond to a NA175-189-mimic, brain self-epitope, protein-O-mannosyltransferase 1 (POMT1675-689). A pathogenic role of influenza virus-specific T-cells and T-cell cross-reactivity in NT1 are supported by the up-regulation of IFN-γ, perforin 1 and granzyme B, and by the converging selection of T-cell receptor TRAV10/TRAJ17 and TRAV10/TRAJ24 clonotypes, in response to stimulation either with peptide NA175-189 or POMT1675-689. Moreover, anti-POMT1 serum autoantibodies are increased in Pandemrix-vaccinated children or adolescents. These results thus identify POMT1 as a potential autoantigen recognized by T- and B-cells in NT1.
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Affiliation(s)
- A Vuorela
- Clinicum, University of Helsinki, Helsinki, Finland
| | - T L Freitag
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland.
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.
| | - K Leskinen
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - H Pessa
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - T Härkönen
- Clinicum, University of Helsinki, Helsinki, Finland
| | - I Stracenski
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - T Kirjavainen
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - P Olsen
- Department of Child Neurology, Oulu University Hospital, Oulu, Finland
| | | | - J Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
- Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - M Knip
- Clinicum, University of Helsinki, Helsinki, Finland
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - A Vaheri
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - M Partinen
- Clinicum, University of Helsinki, Helsinki, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland
| | - P Saavalainen
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - S Meri
- Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - O Vaarala
- Clinicum, University of Helsinki, Helsinki, Finland
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13
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Ollila HM. Narcolepsy type 1: what have we learned from genetics? Sleep 2021; 43:5842137. [PMID: 32442260 PMCID: PMC7658635 DOI: 10.1093/sleep/zsaa099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/22/2020] [Indexed: 01/12/2023] Open
Abstract
Type-1 narcolepsy is a severe neurological disorder with distinct characteristic of loss of hypocretin neurotransmitter. Genetic analysis in type-1 narcolepsy have revealed a unique signal pointing toward autoimmune, rather than psychiatric origin. While type-1 narcolepsy has been intensively studied, the other subtypes of hypersomnolence, narcolepsy, and hypersomnia are less thoroughly understood. This review summarizes the latest breakthroughs in the field in narcolepsy. The goal of this article is to help the reader to understand better the risk from genetic factors and their interplay with immune, genetic, and epidemiological aspects in narcolepsy.
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Affiliation(s)
- Hanna M Ollila
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA
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14
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Dietmann A, Wenz E, van der Meer J, Ringli M, Warncke JD, Edwards E, Schmidt MH, Bernasconi CA, Nirkko A, Strub M, Miano S, Manconi M, Acker J, von Manitius S, Baumann CR, Valko PO, Yilmaz B, Brunner AD, Tzovara A, Zhang Z, Largiadèr CR, Tafti M, Latorre D, Sallusto F, Khatami R, Bassetti CLA. The Swiss Primary Hypersomnolence and Narcolepsy Cohort study (SPHYNCS): Study protocol for a prospective, multicentre cohort observational study. J Sleep Res 2021; 30:e13296. [PMID: 33813771 PMCID: PMC8519114 DOI: 10.1111/jsr.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022]
Abstract
Narcolepsy type 1 (NT1) is a disorder with well‐established markers and a suspected autoimmune aetiology. Conversely, the narcoleptic borderland (NBL) disorders, including narcolepsy type 2, idiopathic hypersomnia, insufficient sleep syndrome and hypersomnia associated with a psychiatric disorder, lack well‐defined markers and remain controversial in terms of aetiology, diagnosis and management. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a comprehensive multicentre cohort study, which will investigate the clinical picture, pathophysiology and long‐term course of NT1 and the NBL. The primary aim is to validate new and reappraise well‐known markers for the characterization of the NBL, facilitating the diagnostic process. Seven Swiss sleep centres, belonging to the Swiss Narcolepsy Network (SNaNe), joined the study and will prospectively enrol over 500 patients with recent onset of excessive daytime sleepiness (EDS), hypersomnia or a suspected central disorder of hypersomnolence (CDH) during a 3‐year recruitment phase. Healthy controls and patients with EDS due to severe sleep‐disordered breathing, improving after therapy, will represent two control groups of over 50 patients each. Clinical and electrophysiological (polysomnography, multiple sleep latency test, maintenance of wakefulness test) information, and information on psychomotor vigilance and a sustained attention to response task, actigraphy and wearable devices (long‐term monitoring), and responses to questionnaires will be collected at baseline and after 6, 12, 24 and 36 months. Potential disease markers will be searched for in blood, cerebrospinal fluid and stool. Analyses will include quantitative hypocretin measurements, proteomics/peptidomics, and immunological, genetic and microbiota studies. SPHYNCS will increase our understanding of CDH and the relationship between NT1 and the NBL. The identification of new disease markers is expected to lead to better and earlier diagnosis, better prognosis and personalized management of CDH.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maya Ringli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ellen Edwards
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado A Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Jens Acker
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | | | | | - Philip O Valko
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Andreas-David Brunner
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern, Switzerland.,Department of Neurology, Sleep Wake Epilepsy Center, NeuroTec, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Zhongxing Zhang
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Carlo R Largiadèr
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mehdi Tafti
- Department of Biomedical Science, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Federica Sallusto
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland.,Institute for Research in Biomedicine, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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15
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Abstract
Narcolepsy Type 1 (NT1) is hypothesized to be an autoimmune disease targeting the hypocretin/orexin neurons in the lateral hypothalamus. Ample genetic and epidemiologic evidence point in the direction of a pathogenesis involving the immune system. Many autoantibodies have been detected in blood samples from NT1 patients, but none in a consistent manner. Importantly, T cells directed toward hypocretin/orexin neurons have been detected in samples from NT1 patients. However, it remains to be seen if these potentially autoreactive T cells are also present in the hypothalamus and if they are pathogenic. For this reason, NT1 does still not fully meet the criteria for being classified as a genuine autoimmune disease, even though more and more results are pointing in that direction as will be described in this chapter. The autoimmune hypothesis has led to many attempts at slowing or stopping disease progression with immunomodulatory treatment, but so far the overall results have not been very encouraging. It is clear that more research into the pathogenesis of NT1 is needed to establish the precise role of the immune system in disease development.
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16
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Giannoccaro MP, Liguori R, Plazzi G, Pizza F. Reviewing the Clinical Implications of Treating Narcolepsy as an Autoimmune Disorder. Nat Sci Sleep 2021; 13:557-577. [PMID: 34007229 PMCID: PMC8123964 DOI: 10.2147/nss.s275931] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy type 1 (NT1) is a lifelong sleep disorder, primarily characterized clinically by excessive daytime sleepiness and cataplexy and pathologically by the loss of hypocretinergic neurons in the lateral hypothalamus. Despite being a rare disorder, the NT1-related burden for patients and society is relevant due to the early onset and chronic nature of this condition. Although the etiology of narcolepsy is still unknown, mounting evidence supports a central role of autoimmunity. To date, no cure is available for this disorder and current treatment is symptomatic. Based on the hypothesis of the autoimmune etiology of this disease, immunotherapy could possibly represent a valid therapeutic option. However, contrasting and limited results have been provided so far. This review discusses the evidence supporting the use of immunotherapy in narcolepsy, the outcomes obtained so far, current issues and future directions.
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Affiliation(s)
- Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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17
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Warren RL, Birol I. Retrospective in silico HLA predictions from COVID-19 patients reveal alleles associated with disease prognosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.10.27.20220863. [PMID: 33140057 PMCID: PMC7605564 DOI: 10.1101/2020.10.27.20220863] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The Human Leukocyte Antigen (HLA) gene locus plays a fundamental role in human immunity, and it is established that certain HLA alleles are disease determinants. METHODS By combining the predictive power of multiple in silico HLA predictors, we have previously identified prevalent HLA class I and class II alleles, including DPA1*02:02, in two small cohorts at the COVID-19 pandemic onset. Since then, newer and larger patient cohorts with controls and associated demographic and clinical data have been deposited in public repositories. Here, we report on HLA-I and HLA-II alleles, along with their associated risk significance in one such cohort of 126 patients, including COVID-19 positive (n=100) and negative patients (n=26). RESULTS We recapitulate an enrichment of DPA1*02:02 in the COVID-19 positive cohort (29%) when compared to the COVID-negative control group (Fisher's exact test [FET] p=0.0174). Having this allele, however, does not appear to put this cohort's patients at an increased risk of hospitalization. Inspection of COVID-19 disease severity outcomes reveal nominally significant risk associations with A*11:01 (FET p=0.0078), C*04:01 (FET p=0.0087) and DQA1*01:02 (FET p=0.0121). CONCLUSIONS While enrichment of these alleles falls below statistical significance after Bonferroni correction, COVID-19 patients with the latter three alleles tend to fare worse overall. This is especially evident for patients with C*04:01, where disease prognosis measured by mechanical ventilation-free days was statistically significant after multiple hypothesis correction (Bonferroni p = 0.0023), and may hold potential clinical value.
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Affiliation(s)
- René L Warren
- Genome Sciences Centre, BC Cancer, Vancouver, BC, V5Z 4S6, Canada
| | - Inanç Birol
- Genome Sciences Centre, BC Cancer, Vancouver, BC, V5Z 4S6, Canada
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18
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Schinkelshoek M, Fronczek R, Verduijn W, Haasnoot G, Overeem S, Donjacour C, van der Heide A, Roelen D, Claas F, Lammers GJ. HLA associations in narcolepsy type 1 persist after the 2009 H1N1 pandemic. J Neuroimmunol 2020; 342:577210. [PMID: 32179327 DOI: 10.1016/j.jneuroim.2020.577210] [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: 12/04/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/27/2022]
Abstract
We aimed to compare HLA-DQB1-associations in narcolepsy type 1 (NT1) patients with disease onset before and after the 2009 H1N1 pandemic in a large Dutch cohort. 525 NT1 patients and 1272 HLA-DQB1*06:02-positive healthy controls were included. Because of the discussion that has arisen on the existence of sporadic and post-H1N1 NT1, HLA-DQB1-associations in pre- and post-H1N1 NT1 patients were compared. The associations between HLA-DQB1 alleles and NT1 were not significantly different between pre- and post-H1N1 NT1 patients. Both HLA-DQB1-associations with pre- and -post H1N1 NT1 reported in recent smaller studies were replicated. Our findings combine the results of studies in pre- and post-H1N1 NT1 and argue against considering post-H1N1 NT1 as a different entity.
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Affiliation(s)
- Mink Schinkelshoek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands.
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands
| | - Willem Verduijn
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Geert Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, PO Box 61, 5590, AB, Heeze, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, The Netherlands
| | - Claire Donjacour
- Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Dokter Denekampweg 20, 8025, BV, Zwolle, The Netherlands
| | - Astrid van der Heide
- Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, The Netherlands
| | - Dave Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Frans Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands; Sleep Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103, SW, Heemstede, The Netherlands
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19
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Giannoccaro MP, Sallemi G, Liguori R, Plazzi G, Pizza F. Immunotherapy in Narcolepsy. Curr Treat Options Neurol 2020; 22:2. [PMID: 31997035 DOI: 10.1007/s11940-020-0609-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Narcolepsy type 1 (NT1) is a chronic and disabling sleep disorder due to the loss of hypocretinergic neurons in the lateral hypothalamus pathophysiologically linked to an autoimmune process. Current treatment is symptomatic, and no cure is available to date. Immunotherapy is considered a promising future therapeutic option, and this review discusses the rationale for immunotherapy in narcolepsy, current evidences of its effects, outcome measures, and future directions. RECENT FINDINGS A limited number of case reports and uncontrolled small case series have reported the effect of different immunotherapies in patients with NT1. These studies were mainly based on the use of intravenous immunoglobulin (IVig), followed by corticosteroids, plasmapheresis, and monoclonal antibodies. Although initial reports showed an improvement of symptoms, particularly when patients were treated close to disease onset, other observations have not confirmed these results. Inadequate timing of treatment, placebo effects, and spontaneous improvement due to the natural disease course can account for these contrasting findings. Moreover, clear endpoints and standardized outcome measures have not been used and are currently missing in the pediatric population. On the basis of the available data, there are no enough evidences to support the use of immunotherapy in NT1. Randomized, controlled studies using clear endpoints and new outcome measures are needed to achieve a definitive answer about the usefulness of these treatments in narcolepsy.
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Affiliation(s)
- Maria Pia Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, piano 1, Via Altura 3, 40139 Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giombattista Sallemi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, piano 1, Via Altura 3, 40139 Bologna, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, piano 1, Via Altura 3, 40139 Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, piano 1, Via Altura 3, 40139 Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Ospedale Bellaria, Padiglione G, piano 1, Via Altura 3, 40139 Bologna, Italy. .,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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20
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Affiliation(s)
- Birgitte Rahbek Kornum
- Department of Neuroscience, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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21
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Lérias JR, Paraschoudi G, de Sousa E, Martins J, Condeço C, Figueiredo N, Carvalho C, Dodoo E, Castillo-Martin M, Beltrán A, Ligeiro D, Rao M, Zumla A, Maeurer M. Microbes as Master Immunomodulators: Immunopathology, Cancer and Personalized Immunotherapies. Front Cell Dev Biol 2020; 7:362. [PMID: 32039196 PMCID: PMC6989410 DOI: 10.3389/fcell.2019.00362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
The intricate interplay between the immune system and microbes is an essential part of the physiological homeostasis in health and disease. Immunological recognition of commensal microbes, such as bacterial species resident in the gut or lung as well as dormant viral species, i.e., cytomegalovirus (CMV) or Epstein-Barr virus (EBV), in combination with a balanced immune regulation, is central to achieve immune-protection. Emerging evidence suggests that immune responses primed to guard against commensal microbes may cause unexpected pathological outcomes, e.g., chronic inflammation and/or malignant transformation. Furthermore, translocation of immune cells from one anatomical compartment to another, i.e., the gut-lung axis via the lymphatics or blood has been identified as an important factor in perpetrating systemic inflammation, tissue destruction, as well as modulating host-protective immune responses. We present in this review immune response patterns to pathogenic as well as non-pathogenic microbes and how these immune-recognition profiles affect local immune responses or malignant transformation. We discuss personalized immunological therapies which, directly or indirectly, target host biological pathways modulated by antimicrobial immune responses.
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Affiliation(s)
- Joana R. Lérias
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Eric de Sousa
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - João Martins
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carolina Condeço
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Figueiredo
- Digestive Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carlos Carvalho
- Digestive Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | | | - Antonio Beltrán
- Department of Pathology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dário Ligeiro
- Lisbon Centre for Blood and Transplantation, Instituto Português do Sangue e Transplantação, Lisbon, Portugal
| | - Martin Rao
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Alimuddin Zumla
- Division of Infection and Immunity, NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
| | - Markus Maeurer
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
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22
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Cogswell AC, Maski K, Scammell TE, Tucker D, Orban ZS, Koralnik IJ. Children with Narcolepsy type 1 have increased T-cell responses to orexins. Ann Clin Transl Neurol 2019; 6:2566-2572. [PMID: 31730293 PMCID: PMC6917326 DOI: 10.1002/acn3.50908] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
Narcolepsy type 1 (NT1) is caused by severe loss of the orexin neurons, and is highly associated with HLA DQB1*06:02. Using intracellular cytokine staining, we observed a higher frequency of IFN‐γ‐ and TNF‐α‐producing CD4+ and CD8+ T‐cells in response to orexins in 27 children with NT1 compared to 15 healthy control children. Conversely, no such difference was observed between 14 NT1 and 16 HC adults. In addition, priming with flu peptides amplified the T‐cell response to orexins in children with NT1. Our data suggests that NT1 may be caused by an autoimmune T‐cell response to orexins, possibly triggered by flu antigens.
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Affiliation(s)
- Andrew C Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Kiran Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Thomas E Scammell
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dominique Tucker
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Zachary S Orban
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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23
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Likhachev SA, Chechyk NM, Haliyeuskaya OV, Rushkevich YN. [Psychogenically induced narcolepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:99-104. [PMID: 31626225 DOI: 10.17116/jnevro201911909199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Based on own clinical experience in diagnostics and treatment of 4 patients, the authors describe main clinical presentations of narcolepsy. A case report of a 20-year female patient with psychogenic narcolepsy induced by a conflict in the family is described in details. According to polysomnography and Multiple Sleep Latency Test, a reduction in latency to sleep is 22 sec - 3 min 30 sec and the time of occurrence of REM sleep is 7 min 30 sec. The diagnosis is made on the basis of diagnostic criteria of narcolepsy. On average, it takes about 7-10 years to diagnose narcolepsy that reduces the quality of life of patients and leads to social and household maladaptation. Physicians should be wary of early identification of this disease for dynamic monitoring, the appointment of symptomatic therapy, prevention of anxiety and depression and the generation of behavior algorithm in the patient and his relatives in order to maximize social and household adaptation.
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Affiliation(s)
- S A Likhachev
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
| | - N M Chechyk
- Republican Clinical Medical Center of the Presidential Administration of the Republic Belarus, Minsk, Republic Belarus
| | - O V Haliyeuskaya
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
| | - Yu N Rushkevich
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Republic Belarus
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24
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Juvodden HT, Viken MK, Nordstrand SEH, Viste R, Westlye LT, Thorsby PM, Lie BA, Knudsen-Heier S. HLA and sleep parameter associations in post-H1N1 narcolepsy type 1 patients and first-degree relatives. Sleep 2019; 43:5586722. [DOI: 10.1093/sleep/zsz239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
To explore HLA (human leukocyte antigen) in post-H1N1 narcolepsy type 1 patients (NT1), first-degree relatives and healthy controls, and assess HLA associations with clinical and sleep parameters in patients and first-degree relatives.
Methods
Ninety post-H1N1 NT1 patients and 202 of their first-degree relatives were HLA-genotyped (next generation sequencing) and phenotyped (semistructured interviews, Stanford Sleep Questionnaire, polysomnography, and multiple sleep latency test). HLA allele distributions were compared between DQB1*06:02-heterozygous individuals (77 patients, 59 parents, 1230 controls). A subsample (74 patients, 114 relatives) was investigated for associations between HLA-loci and continuous sleep variables using logistic regression. Identified candidate HLA-loci were explored for HLA allele associations with hypnagogic hallucinations and sleep paralysis in 90 patients, and patient allele findings were checked for similar associations in 202 relatives.
Results
DQB1*06:02 heterozygous post-H1N1 NT1 patients (84.4% H1N1-vaccinated) showed several significant HLA associations similar to those reported previously in samples of mainly sporadic NT1, i.e. DQB1*03:01, DRB1*04:01, DRB1*04:02, DRB1*04:07, DRB1*11:04, A*25:01, B*35:03, and B*51:01, and novel associations, i.e. B*14:02, C*01:02, and C*07:01. Parents HLA alleles did not deviate significantly from controls. The HLA-C locus was associated with sleep parameters in patients and relatives. In patients C*02:02 seems to be associated with protective effects against sleep paralysis and hypnagogic hallucinations.
Conclusions
Our findings of similar risk/protective HLA-alleles in post-H1N1 as in previous studies of mainly sporadic narcolepsy support similar disease mechanisms. We also report novel allelic associations. Associations between HLA-C and sleep parameters were seen independent of NT1 diagnosis, supporting involvement of HLA-C in sleep subphenotypes.
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Affiliation(s)
- Hilde T Juvodden
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Ullevål, Norway, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Marte K Viken
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Norway
| | - Sebjørg E H Nordstrand
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Ullevål, Norway, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Rannveig Viste
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Ullevål, Norway, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Lars T Westlye
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Department of Psychology, University of Oslo, Norway
| | - Per M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Aker, Norway Norway
| | - Benedicte A Lie
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Norway
- Department of Medical Genetics, University of Oslo and Oslo University Hospital, Norway
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital, Ullevål, Norway, Norway
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25
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Narcolepsy — clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol 2019; 15:519-539. [DOI: 10.1038/s41582-019-0226-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
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26
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Beltrán E, Nguyen XH, Quériault C, Barateau L, Dauvilliers Y, Dornmair K, Liblau RS. Shared T cell receptor chains in blood memory CD4 + T cells of narcolepsy type 1 patients. J Autoimmun 2019; 100:1-6. [PMID: 30948158 DOI: 10.1016/j.jaut.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022]
Abstract
Convergent evidence points to the involvement of T cells in the pathogenesis of narcolepsy type 1 (NT1). Here, we hypothesized that expanded disease-specific T cell clones could be detected in the blood of NT1 patients. We compared the TCR repertoire of circulating antigen-experienced CD4+ and CD8+ T cells from 13 recently diagnosed NT1 patients and 11 age-, sex-, and HLA-DQB1*06:02-matched healthy controls. We detected a bias in the usage of TRAV3 and TRAV8 families, with public CDR3α motifs only present in CD4+ T cells from patients with NT1. These findings may offer a unique tool to identify disease-relevant antigens.
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Affiliation(s)
- Eduardo Beltrán
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Xuan-Hung Nguyen
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France; Vinmec Research Institute of Stem Cell and Gene Technology (VRISG), Vinmec International Hospital, Hanoi, Viet Nam
| | - Clémence Quériault
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, INSERM U1061, Montpellier, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, INSERM U1061, Montpellier, France
| | - Klaus Dornmair
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Roland S Liblau
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France.
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27
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Pedersen NW, Holm A, Kristensen NP, Bjerregaard AM, Bentzen AK, Marquard AM, Tamhane T, Burgdorf KS, Ullum H, Jennum P, Knudsen S, Hadrup SR, Kornum BR. CD8 + T cells from patients with narcolepsy and healthy controls recognize hypocretin neuron-specific antigens. Nat Commun 2019; 10:837. [PMID: 30783092 PMCID: PMC6381094 DOI: 10.1038/s41467-019-08774-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/28/2019] [Indexed: 12/19/2022] Open
Abstract
Narcolepsy Type 1 (NT1) is a neurological sleep disorder, characterized by the loss of hypocretin/orexin signaling in the brain. Genetic, epidemiological and experimental data support the hypothesis that NT1 is a T-cell-mediated autoimmune disease targeting the hypocretin producing neurons. While autoreactive CD4+ T cells have been detected in patients, CD8+ T cells have only been examined to a minor extent. Here we detect CD8+ T cells specific toward narcolepsy-relevant peptides presented primarily by NT1-associated HLA types in the blood of 20 patients with NT1 as well as in 52 healthy controls, using peptide-MHC-I multimers labeled with DNA barcodes. In healthy controls carrying the disease-predisposing HLA-DQB1*06:02 allele, the frequency of autoreactive CD8+ T cells was lower as compared with both NT1 patients and HLA-DQB1*06:02-negative healthy individuals. These findings suggest that a certain level of CD8+ T-cell reactivity combined with HLA-DQB1*06:02 expression is important for NT1 development.
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Affiliation(s)
- Natasja Wulff Pedersen
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Anja Holm
- Department of Clinical Biochemistry, Molecular Sleep Laboratory, Rigshospitalet, 2600 Glostrup, Denmark
| | - Nikolaj Pagh Kristensen
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Anne-Mette Bjerregaard
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Amalie Kai Bentzen
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Andrea Marion Marquard
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Tripti Tamhane
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark
| | - Kristoffer Sølvsten Burgdorf
- Department of Clinical Immunology 2034, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology 2034, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, 2600 Glostrup, Denmark
| | - Stine Knudsen
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, 2600 Glostrup, Denmark
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (Nevsom), Department of Rare Disorders, Oslo University Hospital, Ullevål, 0424 Oslo, Norway
| | - Sine Reker Hadrup
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, 2800 Kgs Lyngby, Denmark.
| | - Birgitte Rahbek Kornum
- Department of Clinical Biochemistry, Molecular Sleep Laboratory, Rigshospitalet, 2600 Glostrup, Denmark.
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, 2600 Glostrup, Denmark.
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark.
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28
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Abstract
Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins (also known as hypocretins) sparked great advances in the field. Here, we review the current understanding of how orexin neurons regulate sleep-wake behaviour and the consequences of the loss of orexin neurons. We also summarize the developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.
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Affiliation(s)
- Carrie E Mahoney
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrew Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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29
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Couvineau A, Voisin T, Nicole P, Gratio V, Abad C, Tan YV. Orexins as Novel Therapeutic Targets in Inflammatory and Neurodegenerative Diseases. Front Endocrinol (Lausanne) 2019; 10:709. [PMID: 31695678 PMCID: PMC6817618 DOI: 10.3389/fendo.2019.00709] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/02/2019] [Indexed: 02/05/2023] Open
Abstract
Orexins [orexin-A (OXA) and orexin-B (OXB)] are two isoforms of neuropeptides produced by the hypothalamus. The main biological actions of orexins, focused on the central nervous system, are to control the sleep/wake process, appetite and feeding, energy homeostasis, drug addiction, and cognitive processes. These effects are mediated by two G protein-coupled receptor (GPCR) subtypes named OX1R and OX2R. In accordance with the synergic and dynamic relationship between the nervous and immune systems, orexins also have neuroprotective and immuno-regulatory (i.e., anti-inflammatory) properties. The present review gathers recent data demonstrating that orexins may have a therapeutic potential in several pathologies with an immune component including multiple sclerosis, Alzheimer's disease, narcolepsy, obesity, intestinal bowel diseases, septic shock, and cancers.
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Affiliation(s)
- Alain Couvineau
- INSERM UMR1149/Inflammation Research Center (CRI), Team “From Inflammation to Cancer in Digestive Diseases” Labeled by “la Ligue Nationale Contre le Cancer”, University of Paris, Paris, France
- *Correspondence: Alain Couvineau
| | - Thierry Voisin
- INSERM UMR1149/Inflammation Research Center (CRI), Team “From Inflammation to Cancer in Digestive Diseases” Labeled by “la Ligue Nationale Contre le Cancer”, University of Paris, Paris, France
| | - Pascal Nicole
- INSERM UMR1149/Inflammation Research Center (CRI), Team “From Inflammation to Cancer in Digestive Diseases” Labeled by “la Ligue Nationale Contre le Cancer”, University of Paris, Paris, France
| | - Valérie Gratio
- INSERM UMR1149/Inflammation Research Center (CRI), Team “From Inflammation to Cancer in Digestive Diseases” Labeled by “la Ligue Nationale Contre le Cancer”, University of Paris, Paris, France
| | - Catalina Abad
- University of Rouen Normandy, INSERM U1234 PANTHER, IRIB, Rouen, France
| | - Yossan-Var Tan
- University of Rouen Normandy, INSERM U1234 PANTHER, IRIB, Rouen, France
- Yossan-Var Tan
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30
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Capittini C, De Silvestri A, Terzaghi M, Scotti V, Rebuffi C, Pasi A, Manni R, Martinetti M, Tinelli C. Correlation between HLA-DQB1*06:02 and narcolepsy with and without cataplexy: approving a safe and sensitive genetic test in four major ethnic groups. A systematic meta-analysis. Sleep Med 2018; 52:150-157. [DOI: 10.1016/j.sleep.2018.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/24/2018] [Accepted: 08/21/2018] [Indexed: 01/06/2023]
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31
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Lippert J, Young P, Gross C, Meuth SG, Dräger B, Schirmacher A, Heidbreder A. Specific T-cell activation in peripheral blood and cerebrospinal fluid in central disorders of hypersomnolence. Sleep 2018; 42:5185207. [DOI: 10.1093/sleep/zsy223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Julian Lippert
- Institute for Sleep Medicine and Neuromuscular Disorders, University of Muenster, Germany
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Young
- Institute for Sleep Medicine and Neuromuscular Disorders, University of Muenster, Germany
| | - Catharina Gross
- Clinic of Neurology with Institute for Translational Neurology, University of Muenster, Germany
| | - Sven G Meuth
- Clinic of Neurology with Institute for Translational Neurology, University of Muenster, Germany
| | - Bianca Dräger
- Institute for Sleep Medicine and Neuromuscular Disorders, University of Muenster, Germany
| | - Anja Schirmacher
- Institute for Sleep Medicine and Neuromuscular Disorders, University of Muenster, Germany
| | - Anna Heidbreder
- Institute for Sleep Medicine and Neuromuscular Disorders, University of Muenster, Germany
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32
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Intravenous Immunoglobulin Therapy Administered Early after Narcolepsy Type 1 Onset in Three Patients Evaluated by Clinical and Polysomnographic Follow-Up. Behav Neurol 2018; 2018:1671072. [PMID: 30410634 PMCID: PMC6205306 DOI: 10.1155/2018/1671072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022] Open
Abstract
Narcolepsy type 1 is a rare disabling sleep disorder mainly characterized by excessive daytime sleepiness and cataplexy, an emotion-triggered sudden loss of muscle tone. Patients have a selective degeneration of hypocretin-producing neurons in the dorsolateral posterior hypothalamus with growing evidence supporting the hypothesis of an autoimmune mechanism. Few case studies that reported intravenous immunoglobulin therapy (IVIg) suggest the efficacy of IVIg when administered early after disease onset, but the results are controversial. In these retrospective case observations, IVIg cycles were initiated within one to four months after cataplexy onset in a twenty-seven-year-old man, a ten-year-old girl, and a seven-year-old boy, all three with early onset typical narcolepsy type 1. Efficacy of treatment (three IVIg cycles of 1 g/kg administered at four-week intervals) was evaluated based on clinical, polysomnographic, and multiple sleep latency test (mean latency and SOREM) follow-up. Two patients reported decreased cataplexy frequency and ameliorated daytime sleepiness, but no significant amelioration of polysomnographic parameters was observed. Given the possibility of spontaneous improvement of cataplexy frequency with self-behavioral adjustments, these observations would need to be confirmed by larger controlled studies. Based on the present study and current literature, proof of concept is still missing thus prohibiting the consideration of IVIg as an efficient treatment option.
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33
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Abstract
The principal focus of this paper is to consider the implications of head and neck transplantation surgery on the issue of personal identity. To this end, it is noted that the immune system has not only been established to impose a level of self-identity on bodily cells, it has also been implicated in mental development and the regulation of mental state. In this it serves as a paradigm for the mind as the product of cephalic and extracephalic systems. The importance of bodily systems in identity is then discussed in relation to phantom tissue syndrome. The data strongly indicate that, even if surgically successful, head and neck transplantation will result in the loss of the continuity of personal identity.
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34
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Zhang L, Fu YH. The molecular genetics of human sleep. Eur J Neurosci 2018; 51:422-428. [PMID: 30144347 DOI: 10.1111/ejn.14132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
It has been known for many years that genetic influences account for some of the individual differences in human sleep parameters, but the underlying molecular mechanisms remain unclear. With major advances of molecular biology and the recognition of heritable sleep behaviors in humans over the past 30 years, a number of genetic variants have been identified to be associated with human sleep timing, duration and quality, both in healthy individuals and under pathological conditions. Some of these variants were further validated and characterized in animal models, shedding light on the mechanism of how these variants likely alter sleep in humans, which may provide new insights into developing more effective treatments to improve human sleep.
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Affiliation(s)
- Luoying Zhang
- Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and Technology and Institute of Brain Research, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying-Hui Fu
- Department of Neurology, University of California, San Francisco, California
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35
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36
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Abstract
PURPOSE OF REVIEW This article focuses on the clinical presentation, pathophysiology, diagnosis, differential diagnosis, and management of narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, Kleine-Levin syndrome, and other central disorders of hypersomnolence, as defined in the International Classification of Sleep Disorders, Third Edition (ICSD-3). RECENT FINDINGS In ICSD-3, the names of some central disorders of hypersomnolence have been changed: narcolepsy with cataplexy and narcolepsy without cataplexy have been renamed narcolepsy type 1 and narcolepsy type 2, respectively. A low level of hypocretin-1/orexin-A in the CSF is now theoretically sufficient to diagnose narcolepsy type 1, as it is a highly specific and sensitive biomarker. Conversely, other central hypersomnias are less well-defined disorders with variability in the phenotype, and few reliable biomarkers have been discovered so far. The epidemiologic observation that influenza A (H1N1) infection and vaccination are potential triggering factors of narcolepsy type 1 (discovered during the 2009 H1N1 pandemic) has increased interest in this rare disease, and progress is being made to better understand the process (highly suspected to be autoimmune) responsible for the destruction of hypocretin neurons. Treatment of narcolepsy remains largely symptomatic, usually initially with modafinil or armodafinil or with higher-potency stimulants such as methylphenidate or amphetamines. Several newer wake-promoting agents and psychostimulants have also been developed, including sodium oxybate, which has a role in the treatment of cataplexy and as an adjunctive wake-promoting agent, and pitolisant, a selective histamine H3 receptor inverse agonist that is currently only available in Europe. SUMMARY Although far less common than many other sleep disorders, central hypersomnias are among the most severe and disabling diseases in the field of sleep medicine, and their early recognition is of major importance for patients, especially children, to maximize their quality of life and functioning in activities of daily living.
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37
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Abstract
PURPOSE OF REVIEW After the connection between AS03-adjuvanted pandemic H1N1 vaccine Pandemrix and narcolepsy was recognized in 2010, research on narcolepsy has been more intensive than ever before. The purpose of this review is to provide the reader with current concepts and recent findings on the Pandemrix-associated narcolepsy. RECENT FINDINGS After the Pandemrix vaccination campaign in 2009-2010, the risk of narcolepsy was increased 5- to 14-fold in children and adolescents and 2- to 7-fold in adults. According to observational studies, the risk of narcolepsy was elevated for 2 years after the Pandemrix vaccination. Some confounding factors and potential diagnostic biases may influence the observed narcolepsy risk in some studies, but it is unlikely that they would explain the clearly increased incidence in all the countries where Pandemrix was used. An increased risk of narcolepsy after natural H1N1 infection was reported from China, where pandemic influenza vaccination was not used. There is more and more evidence that narcolepsy is an autoimmune disease. All Pandemrix-associated narcolepsy cases have been positive for HLA class II DQB1*06:02 and novel predisposing genetic factors directly linking to the immune system have been identified. Even though recent studies have identified autoantibodies against multiple neuronal structures and other host proteins and peptides, no specific autoantigens that would explain the disease mechanism in narcolepsy have been identified thus far. There was a marked increase in the incidence of narcolepsy after Pandemrix vaccination, especially in adolescents, but also in young adults and younger children. All vaccine-related cases were of narcolepsy type 1 characterized by hypocretin deficiency in the central nervous system. The disease phenotype and the severity of symptoms varied considerably in children and adolescents suffering from Pandemrix-associated narcolepsy, but they were indistinguishable from the symptoms of idiopathic narcolepsy. Narcolepsy type 1 is most likely an autoimmune disease, but the mechanisms have remained elusive.
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Vaccine-associated inflammatory diseases of the central nervous system: from signals to causation. Curr Opin Neurol 2018; 29:362-71. [PMID: 27023738 DOI: 10.1097/wco.0000000000000318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW As the most cost-effective intervention in preventive medicine and as a crucial element of any public health program, vaccination is used extensively with over 90% coverage in many countries. As approximately 5-8% of the population in developed countries suffer from an autoimmune disorder, people with an autoimmune disease are most likely to be exposed to some vaccines before or after the disease onset. In fact, a number of inflammatory disorders of the central nervous system have been associated with the administration of various vaccines. These adverse events, be they spurious associations or genuine reactions to the vaccine, may lead to difficulties in obtaining public trust in mass vaccination programs. There is, thus, an urgent need to understand whether vaccination triggers or enhances autoimmune responses. RECENT FINDINGS By reviewing vaccine-associated inflammatory diseases of the central nervous system, this study describes the current knowledge on whether the safety signal was coincidental, as in the case of multiple sclerosis with several vaccines, or truly reflected a causal link, as in narcolepsy with cataplexy following pandemic H1N1 influenza virus vaccination. SUMMARY The lessons learnt emphasize a central role of thorough, ideally prospective, epidemiological studies followed, if the signal is deemed plausible or real, by immunological investigations.
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Abstract
PURPOSE OF REVIEW Summarize the recent findings in narcolepsy focusing on the environmental and genetic risk factors in disease development. RECENT FINDINGS Both genetic and epidemiological evidence point towards an autoimmune mechanism in the destruction of orexin/hypocretin neurons. Recent studies suggest both humoral and cellular immune responses in the disease development. SUMMARY Narcolepsy is a severe sleep disorder, in which neurons producing orexin/hypocretin in the hypothalamus are destroyed. The core symptoms of narcolepsy are debilitating, extreme sleepiness, cataplexy, and abnormalities in the structure of sleep. Both genetic and epidemiological evidence point towards an autoimmune mechanism in the destruction of orexin/hypocretin neurons. Importantly, the highest environmental risk is seen with influenza-A infection and immunization. However, how the cells are destroyed is currently unknown. In this review we summarize the disease symptoms, and focus on the immunological findings in narcolepsy. We also discuss the environmental and genetic risk factors as well as propose a model for disease development.
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Affiliation(s)
- Melodie Bonvalet
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Palo Alto, CA 94304, USA
| | - Hanna M. Ollila
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Palo Alto, CA 94304, USA
- National Institute for Health and Welfare, Public Genomics Unit, Helsinki, Finland
- Institute for Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Aditya Ambati
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Palo Alto, CA 94304, USA
| | - Emmanuel Mignot
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Palo Alto, CA 94304, USA
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Ramberger M, Högl B, Stefani A, Mitterling T, Reindl M, Lutterotti A. CD4+ T-Cell Reactivity to Orexin/Hypocretin in Patients With Narcolepsy Type 1. Sleep 2017; 40:2741264. [PMID: 28364420 PMCID: PMC5806576 DOI: 10.1093/sleep/zsw070] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Narcolepsy type 1 is accompanied by a selective loss of orexin/hypocretin (hcrt) neurons in the lateral hypothalamus caused by yet unknown mechanisms. Epidemiologic and genetic associations strongly suggest an immune-mediated pathogenesis of the disease. Methods We compared specific T-cell reactivity to orexin/hcrt peptides in peripheral blood mononuclear cells of narcolepsy type 1 patients to healthy controls by a carboxyfluorescein succinimidyl ester proliferation assay. Orexin/hcrt-specific T-cell reactivity was also determined by cytokine (interferon gamma and granulocyte-macrophage colony-stimulating factor) analysis. Individuals were considered as responders if the cell division index of CD3+CD4+ T cells and both stimulation indices of cytokine secretion exceeded the cutoff 3. Additionally, T-cell reactivity to orexin/hcrt had to be confirmed by showing reactivity to single peptides present in different peptide pools. Results Using these criteria, 3/15 patients (20%) and 0/13 controls (0%) showed orexin/hcrt-specific CD4+ T-cell proliferation (p = .2262). The heterogeneous reactivity pattern did not allow the identification of a preferential target epitope. Conclusions A significant role of orexin/hcrt-specific T cells in narcolepsy type 1 patients could not be confirmed in this study. Further studies are needed to assess the exact role of CD4+ T cells and possible target antigens in narcolepsy type 1 patients.
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Affiliation(s)
- Melanie Ramberger
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Birgit Högl
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Ambra Stefani
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Thomas Mitterling
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
| | - Andreas Lutterotti
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.,Thomas Mitterling is now at Department of Neurology, Wagner-Jauregg Hospital, Wagner-Jauregg Weg 15, A-4020 Linz, Austria.,Andreas Lutterotti is now at Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich and University of Zurich, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland
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Abstract
Narcolepsy type 1 (NT1) is a rare sleep disorder caused by the very specific loss of hypothalamic hypocretin (Hcrt)/orexin neurons. The exact underlying process leading to this destruction is yet unknown, but indirect evidence strongly supports an autoimmune origin. The association with immune-related genetic factors, in particular the strongest association ever reported in a disease with an allele of a human leukocyte antigen (HLA) gene, and with environmental factors (i.e., the H1N1 influenza infection and vaccination during the pandemic in 2009) are in favor of such a hypothesis. The loss of Hcrt neurons is irreversible, and NT1 is currently an incurable and disabling condition. Patients are managed with symptomatic medication, targeting the main symptoms (excessive daytime sleepiness, cataplexy, disturbed nocturnal sleep), and they require a lifelong treatment. Improved diagnostic tools, together with an increased understanding of the pathogenesis of NT1, may lead to new therapeutic and even preventive interventions. One future treatment could include Hcrt replacement, but this neuropeptide does not cross the blood-brain barrier. However, Hcrt receptor agonists may be promising candidates to treat NT1. Another option is immune-based therapies, administered at disease onset, with already some initiatives to slow down or stop the dysimmune process. Whether immune-based therapy could be beneficial in NT1 remains, however, to be proven.
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44
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Absence of autoreactive CD4 + T-cells targeting HLA-DQA1*01:02/DQB1*06:02 restricted hypocretin/orexin epitopes in narcolepsy type 1 when detected by EliSpot. J Neuroimmunol 2017; 309:7-11. [DOI: 10.1016/j.jneuroim.2017.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
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45
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Gupta AK, Sahoo S, Grover S. Narcolepsy in Adolescence-A Missed Diagnosis: A Case Report. INNOVATIONS IN CLINICAL NEUROSCIENCE 2017; 14:20-23. [PMID: 29616151 PMCID: PMC5880369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Narcolepsy is an uncommon sleep cycle disorder with a usual onset in adolescence, but it is often misdiagnosed and underdiagnosed. Rarely is the tetrad of excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis seen in patients. The clinical characteristics of narcolepsy are often confused with many psychiatric and neurologic disorders. Lack of clinical awareness about narcolepsy leads to frequent prescriptions of antiepileptics and psychotropics, which can adversely affect the quality of life of children and adolescents. We report a case of an adolescent male who presented with all four cardinal symptoms of narcolepsy and had been misdiagnosed with epilepsy, psychosis, and depression. We discuss various issues regarding narcolepsy in children and adolescents.
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Affiliation(s)
- Anoop K Gupta
- Dr. Gupta is a junior resident, Dr. Sahoo is a senior resident, and Dr. Grover is a professor in the Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Dr. Gupta is a junior resident, Dr. Sahoo is a senior resident, and Dr. Grover is a professor in the Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dr. Gupta is a junior resident, Dr. Sahoo is a senior resident, and Dr. Grover is a professor in the Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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46
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Pintwala S, Peever J. Circuit mechanisms of sleepiness and cataplexy in narcolepsy. Curr Opin Neurobiol 2017; 44:50-58. [DOI: 10.1016/j.conb.2017.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
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47
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Veatch OJ, Keenan BT, Gehrman PR, Malow BA, Pack AI. Pleiotropic genetic effects influencing sleep and neurological disorders. Lancet Neurol 2017; 16:158-170. [PMID: 28102151 DOI: 10.1016/s1474-4422(16)30339-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/04/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Research evidence increasingly points to the large impact of sleep disturbances on public health. Many aspects of sleep are heritable and genes influencing traits such as timing, EEG characteristics, sleep duration, and response to sleep loss have been identified. Notably, large-scale genome-wide analyses have implicated numerous genes with small effects on sleep timing. Additionally, there has been considerable progress in the identification of genes influencing risk for some neurological sleep disorders. For restless legs syndrome, implicated variants are typically in genes associated with neuronal development. By contrast, genes conferring risk for narcolepsy function in the immune system. Many genetic variants associated with sleep disorders are also implicated in neurological disorders in which sleep abnormalities are common; for example, variation in genes involved in synaptic homoeostasis are implicated in autism spectrum disorder and sleep-wake control. Further investigation into pleiotropic roles of genes influencing both sleep and neurological disorders could lead to new treatment strategies for a variety of sleep disturbances.
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Affiliation(s)
- Olivia J Veatch
- Department of Neurology, Vanderbilt University, Nashville, TN, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Brendan T Keenan
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Philip R Gehrman
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Beth A Malow
- Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Allan I Pack
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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48
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Bomfim IL, Lamb F, Fink K, Szakács A, Silveira A, Franzén L, Azhary V, Maeurer M, Feltelius N, Darin N, Hallböök T, Arnheim-Dahlström L, Kockum I, Olsson T. The immunogenetics of narcolepsy associated with A(H1N1)pdm09 vaccination (Pandemrix) supports a potent gene-environment interaction. Genes Immun 2017; 18:75-81. [PMID: 28332559 DOI: 10.1038/gene.2017.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
The influenza A(H1N1)pdm09 vaccination campaign from 2009 to 2010 was associated with a sudden increase in the incidence of narcolepsy in several countries. Narcolepsy with cataplexy is strongly associated with the human leukocyte antigen (HLA) class II DQB1*06:02 allele, and protective associations with the DQB1*06:03 allele have been reported. Several non-HLA gene loci are also associated, such as common variants of the T-cell receptor-α (TRA), the purinergic receptor P2RY11, cathepsin H (CTSH) and TNFSF4/OX40L/CD252. In this retrospective multicenter study, we investigated if these predisposing gene loci were also involved in vaccination-associated narcolepsy. We compared HLA- along with single-nucleotide polymorphism genotypes for non-HLA regions between 42 Pandemrix-vaccinated narcolepsy cases and 1990 population-based controls. The class II gene loci associations supported previous findings. Nominal association (P-value<0.05) with TRA as well as suggestive (P-value<0.1) associations with P2RY11 and CTSH were found. These associations suggest a very strong gene-environment interaction, in which the influenza A(H1N1)pdm09 strain or Pandemrix vaccine can act as potent environmental triggers.
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Affiliation(s)
- I L Bomfim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - F Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - A Szakács
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - A Silveira
- Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - L Franzén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - V Azhary
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Stockholm, Sweden.,Center for Allogeneic Stem Cell Transplantation (CAST), Karolinska University Hospital, Stockholm, Sweden
| | | | - N Darin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T Hallböök
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Arnheim-Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - I Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden
| | - T Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Centre for Molecular Medicine, Karolinska University Hospital, Solna, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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49
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Abstract
Narcolepsy is a chronic sleep disorder that has a typical onset in adolescence and is characterized by excessive daytime sleepiness, which can have severe consequences for the patient. Problems faced by patients with narcolepsy include social stigma associated with this disease, difficulties in obtaining an education and keeping a job, a reduced quality of life and socioeconomic consequences. Two subtypes of narcolepsy have been described (narcolepsy type 1 and narcolepsy type 2), both of which have similar clinical profiles, except for the presence of cataplexy, which occurs only in patients with narcolepsy type 1. The pathogenesis of narcolepsy type 1 is hypothesized to be the autoimmune destruction of the hypocretin-producing neurons in the hypothalamus; this hypothesis is supported by immune-related genetic and environmental factors associated with the disease. However, direct evidence in support of the autoimmune hypothesis is currently unavailable. Diagnosis of narcolepsy encompasses clinical, electrophysiological and biological evaluations, but simpler and faster procedures are needed. Several medications are available for the symptomatic treatment of narcolepsy, all of which have quite good efficacy and safety profiles. However, to date, no treatment hinders or slows disease development. Improved diagnostic tools and increased understanding of the pathogenesis of narcolepsy type 1 are needed and might lead to therapeutic or even preventative interventions.
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Affiliation(s)
- Birgitte R Kornum
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Forskerparken, Nordre Ringvej 69, 2600 Glostrup, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Hanna M Ollila
- Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Stanford University, Stanford, California, USA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Yves Dauvilliers
- Sleep Unit, Narcolepsy Reference Center, Department of Neurology, Gui de Chauliac Hospital, INSERM 1061, Montpellier, France
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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50
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Ahmed SS, Steinman L. Narcolepsy and influenza vaccination-induced autoimmunity. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:25. [PMID: 28164110 PMCID: PMC5253292 DOI: 10.21037/atm.2016.12.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/01/2016] [Indexed: 11/06/2022]
Affiliation(s)
- S. Sohail Ahmed
- Immunology, Inflammation and Infectious Diseases, Roche Pharma Research & Early Development, Basel 4070, Switzerland
| | - Lawrence Steinman
- Neurology and Neuroscience, Stanford University School of Medicine, Stanford, CA 94305, USA
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