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Tzartos J, Karagiorgou K, Pechlivanidou M, Tzartos S, Dudeck L, Meyer-Lotz G, Guest PC, Steiner J. Absence of neuronal nicotinic acetylcholine receptor antibodies in sera and CSF from schizophrenia patients. Schizophr Res 2024; 267:39-41. [PMID: 38518476 DOI: 10.1016/j.schres.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Affiliation(s)
- John Tzartos
- Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | | | | | - Socrates Tzartos
- Tzartos NeuroDiagnostics, 115 23 Athens, Greece; Department of Neurobiology, Hellenic Pasteur Institute, 115 21 Athens, Greece; Department of Pharmacy, University of Patras, 265 00 Patras, Greece
| | - Leon Dudeck
- Department of Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Gabriela Meyer-Lotz
- Department of Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Paul C Guest
- Department of Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Johann Steiner
- Department of Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany; Center for Health and Medical Prevention (CHaMP), Magdeburg, Germany; German Center for Mental Health (DZPG), Partner Site Halle-Jena-Magdeburg, Magdeburg, Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Magdeburg, Germany.
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Ntanasis-Stathopoulos I, Kastritis E, Tzartos J, Terpos E, Dimopoulos MA, Gavriatopoulou M. Retinopathy in a Patient With IgM MGUS: Causal Association or an Epiphenomenon? In Vivo 2024; 38:954-957. [PMID: 38418115 PMCID: PMC10905461 DOI: 10.21873/invivo.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/25/2023] [Accepted: 12/08/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM The presence of a monoclonal gammopathy of undetermined significance (MGUS) even in small amounts may trigger tissue damage through immunological or other mechanisms, irrespective of the potential for malignant transformation. The aim of the study was to present a case of monoclonal gammopathy of clinical significance with ocular manifestations and discuss relevant literature. CASE REPORT In our case, a patient presented with vision disturbances that was eventually attributed to the underlying IgM MGUS after extensive workup to exclude other potential etiologies. The patient showed a clinical response with the fixed-duration DRC (dexamethasone, rituximab, cyclophosphamide) regimen that persisted for at least 1.5 years. Herein, we present, in detail, the patient management and discuss the underlying pathophysiology of this rare entity with few available published data in this field. CONCLUSION A high level of clinical suspicion is necessary in order to detect the association between MGUS and a clinical sign or symptom that cannot be attributed elsewhere.
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Affiliation(s)
- Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Tzartos
- 2 Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, °"Attikon" General University Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece;
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Tzartos J, Pechlivanidou M, Bosveli D, Ninou E, Yuceer H, Yalcin B, Kucukali CI, Tuzun E, Tzartos S, Turkdogan D. Kelch-like Protein 11 (KLHL11) Antibodies in Children With Seizures of Undetermined Cause. In Vivo 2024; 38:351-357. [PMID: 38148071 PMCID: PMC10756464 DOI: 10.21873/invivo.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM Kelch-like protein 11 (KLHL11)-antibody may be found in paraneoplastic neurological disorders presenting with epileptic seizures. The aim of this study was to investigate the prevalence and clinical significance of KLHL11-antibody in epilepsy. PATIENTS AND METHODS Sera of 42 pediatric and 59 adult patients with seizures of undetermined cause were screened using a cell-based assay. RESULTS KLHL11-antibody was found in three of 168 control patients with paraneoplastic neurological disorders and four pediatric patients (4-8-year-old, 2 boys/2 girls) with seizures of unknown cause presenting with myoclonic-atonic epilepsy, generalized epilepsy or childhood epilepsy with centrotemporal spikes. In these four cases, seizures continued for 2-7 months, responded promptly and favorably to conventional anti-seizure drugs and did not recur in follow-up durations ranging between 2-5 years. Patients had normal brain MRI findings and motor-mental development before and after seizures. KLHL11-antibody was not detected in adult epilepsy patients with undetermined cause, MOG antibody-positive patients and healthy controls. CONCLUSION KLHL11-antibody may be detected in pediatric epilepsy patients with a relatively benign disease course.
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Affiliation(s)
- John Tzartos
- 2 Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | | | | | | | - Hande Yuceer
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Beyzanur Yalcin
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Cem Ismail Kucukali
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey;
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece
- Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
- Department of Pharmacy, University of Patras, Patras, Greece
| | - Dilsad Turkdogan
- Division of Child Neurology, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Chroni E, Veltsista D, Tzartos J, Triantafyllou E, Kefalopoulou Z. Subcutaneous immunoglobulin as maintenance therapy for autoimmune autonomic ganglionopathy. Acta Neurol Belg 2023:10.1007/s13760-023-02461-1. [PMID: 38133851 DOI: 10.1007/s13760-023-02461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Elisabeth Chroni
- Department of Neurology, Medical School, University of Patras, 26504, Rio-Patras, Greece.
| | - Dimitra Veltsista
- Department of Neurology, Medical School, University of Patras, 26504, Rio-Patras, Greece
| | - John Tzartos
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Zinovia Kefalopoulou
- Department of Neurology, Medical School, University of Patras, 26504, Rio-Patras, Greece
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Topaloudi A, Jain P, Martinez MB, Bryant JK, Reynolds G, Zagoriti Z, Lagoumintzis G, Zamba-Papanicolaou E, Tzartos J, Poulas K, Kleopa KA, Tzartos S, Georgitsi M, Drineas P, Paschou P. PheWAS and cross-disorder analysis reveal genetic architecture, pleiotropic loci and phenotypic correlations across 11 autoimmune disorders. Front Immunol 2023; 14:1147573. [PMID: 37809097 PMCID: PMC10552152 DOI: 10.3389/fimmu.2023.1147573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Autoimmune disorders (ADs) are a group of about 80 disorders that occur when self-attacking autoantibodies are produced due to failure in the self-tolerance mechanisms. ADs are polygenic disorders and associations with genes both in the human leukocyte antigen (HLA) region and outside of it have been described. Previous studies have shown that they are highly comorbid with shared genetic risk factors, while epidemiological studies revealed associations between various lifestyle and health-related phenotypes and ADs. Methods Here, for the first time, we performed a comparative polygenic risk score (PRS) - Phenome Wide Association Study (PheWAS) for 11 different ADs (Juvenile Idiopathic Arthritis, Primary Sclerosing Cholangitis, Celiac Disease, Multiple Sclerosis, Rheumatoid Arthritis, Psoriasis, Myasthenia Gravis, Type 1 Diabetes, Systemic Lupus Erythematosus, Vitiligo Late Onset, Vitiligo Early Onset) and 3,254 phenotypes available in the UK Biobank that include a wide range of socio-demographic, lifestyle and health-related outcomes. Additionally, we investigated the genetic relationships of the studied ADs, calculating their genetic correlation and conducting cross-disorder GWAS meta-analyses for the observed AD clusters. Results In total, we identified 508 phenotypes significantly associated with at least one AD PRS. 272 phenotypes were significantly associated after excluding variants in the HLA region from the PRS estimation. Through genetic correlation and genetic factor analyses, we identified four genetic factors that run across studied ADs. Cross-trait meta-analyses within each factor revealed pleiotropic genome-wide significant loci. Discussion Overall, our study confirms the association of different factors with genetic susceptibility for ADs and reveals novel observations that need to be further explored.
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Affiliation(s)
- Apostolia Topaloudi
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Pritesh Jain
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Melanie B. Martinez
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Josephine K. Bryant
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
| | - Grace Reynolds
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
- West Lafayette High School, West Lafayette, IN, United States
| | - Zoi Zagoriti
- Department of Pharmacy, University of Patras, Rio, Greece
| | | | - Eleni Zamba-Papanicolaou
- Department of Neuroepidemiology and Centre for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - John Tzartos
- B’ Neurology Department, School of Medicine, National & Kapodistrian University of Athens, “Attikon” University Hospital., Athens, Greece
| | | | - Kleopas A. Kleopa
- Department of Neuroscience and Centre for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Socrates Tzartos
- Department of Pharmacy, University of Patras, Rio, Greece
- Tzartos NeuroDiagnostics, Athens, Greece
| | - Marianthi Georgitsi
- Department of Molecular Biology and Genetics, School of Health Sciences, Democritus University of Thrace, Alexandroupoli, Greece
| | - Petros Drineas
- Department of Computer Science, Purdue University, West Lafayette, IN, United States
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, United States
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Pechlivanidou M, Xenou K, Tzanetakos D, Koutsos E, Stergiou C, Andreadou E, Voumvourakis K, Giannopoulos S, Kilidireas C, Tüzün E, Tsivgoulis G, Tzartos S, Tzartos J. Potential Role of Antibodies against Aquaporin-1 in Patients with Central Nervous System Demyelination. Int J Mol Sci 2023; 24:12982. [PMID: 37629163 PMCID: PMC10455752 DOI: 10.3390/ijms241612982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/09/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Aquaporins (AQPs; AQP0-AQP12) are water channels expressed in many and diverse cell types, participating in various functions of cells, tissues, and systems, including the central nervous system (CNS). AQP dysfunction and autoimmunity to AQPs are implicated in several diseases. The best-known example of autoimmunity against AQPs concerns the antibodies to AQP4 which are involved in the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD), an autoimmune astrocytopathy, causing also CNS demyelination. The present review focuses on the discovery and the potential role of antibodies against AQP1 in the CNS, and their potential involvement in the pathophysiology of NMOSD. We describe (a) the several techniques developed for the detection of the AQP1-antibodies, with emphasis on methods that specifically identify antibodies targeting the extracellular domain of AQP1, i.e., those of potential pathogenic role, and (b) the available evidence supporting the pathogenic relevance of AQP1-antibodies in the NMOSD phenotype.
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Affiliation(s)
- Maria Pechlivanidou
- Tzartos NeuroDiagnostics, 11523 Athens, Greece; (M.P.); (K.X.); (E.K.); (C.S.); (S.T.)
| | - Konstantina Xenou
- Tzartos NeuroDiagnostics, 11523 Athens, Greece; (M.P.); (K.X.); (E.K.); (C.S.); (S.T.)
| | - Dimitrios Tzanetakos
- Second Department of Neurology ‘’Attikon’’ University Hospital, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece; (D.T.); (K.V.); (S.G.); (G.T.)
| | - Emmanuel Koutsos
- Tzartos NeuroDiagnostics, 11523 Athens, Greece; (M.P.); (K.X.); (E.K.); (C.S.); (S.T.)
| | - Christos Stergiou
- Tzartos NeuroDiagnostics, 11523 Athens, Greece; (M.P.); (K.X.); (E.K.); (C.S.); (S.T.)
| | - Elisabeth Andreadou
- First Department of Neurology, ‘’Aiginiteion’’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (C.K.)
| | - Konstantinos Voumvourakis
- Second Department of Neurology ‘’Attikon’’ University Hospital, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece; (D.T.); (K.V.); (S.G.); (G.T.)
| | - Sotirios Giannopoulos
- Second Department of Neurology ‘’Attikon’’ University Hospital, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece; (D.T.); (K.V.); (S.G.); (G.T.)
| | - Constantinos Kilidireas
- First Department of Neurology, ‘’Aiginiteion’’ University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (C.K.)
- Second Department of Neurology, Henry Dunant Hospital Center, 11526 Athens, Greece
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, 34093 Istanbul, Turkey;
| | - Georgios Tsivgoulis
- Second Department of Neurology ‘’Attikon’’ University Hospital, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece; (D.T.); (K.V.); (S.G.); (G.T.)
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, 11523 Athens, Greece; (M.P.); (K.X.); (E.K.); (C.S.); (S.T.)
- Department of Neurobiology, Hellenic Pasteur Institute, 11521 Athens, Greece
- Department of Pharmacy, University of Patras, 26504 Patras, Greece
| | - John Tzartos
- Second Department of Neurology ‘’Attikon’’ University Hospital, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece; (D.T.); (K.V.); (S.G.); (G.T.)
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Vakrakou AG, Karachaliou E, Chroni E, Zouvelou V, Tzanetakos D, Salakou S, Papadopoulou M, Tzartos S, Voumvourakis K, Kilidireas C, Giannopoulos S, Tsivgoulis G, Tzartos J. Immunotherapies in MuSK-positive Myasthenia Gravis; an IgG4 antibody-mediated disease. Front Immunol 2023; 14:1212757. [PMID: 37564637 PMCID: PMC10410455 DOI: 10.3389/fimmu.2023.1212757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Muscle-specific kinase (MuSK) Myasthenia Gravis (MG) represents a prototypical antibody-mediated disease characterized by predominantly focal muscle weakness (neck, facial, and bulbar muscles) and fatigability. The pathogenic antibodies mostly belong to the immunoglobulin subclass (Ig)G4, a feature which attributes them their specific properties and pathogenic profile. On the other hand, acetylcholine receptor (AChR) MG, the most prevalent form of MG, is characterized by immunoglobulin (Ig)G1 and IgG3 antibodies to the AChR. IgG4 class autoantibodies are impotent to fix complement and only weakly bind Fc-receptors expressed on immune cells and exert their pathogenicity via interfering with the interaction between their targets and binding partners (e.g. between MuSK and LRP4). Cardinal differences between AChR and MuSK-MG are the thymus involvement (not prominent in MuSK-MG), the distinct HLA alleles, and core immunopathological patterns of pathology in neuromuscular junction, structure, and function. In MuSK-MG, classical treatment options are usually less effective (e.g. IVIG) with the need for prolonged and high doses of steroids difficult to be tapered to control symptoms. Exceptional clinical response to plasmapheresis and rituximab has been particularly observed in these patients. Reduction of antibody titers follows the clinical efficacy of anti-CD20 therapies, a feature implying the role of short-lived plasma cells (SLPB) in autoantibody production. Novel therapeutic monoclonal against B cells at different stages of their maturation (like plasmablasts), or against molecules involved in B cell activation, represent promising therapeutic targets. A revolution in autoantibody-mediated diseases is pharmacological interference with the neonatal Fc receptor, leading to a rapid reduction of circulating IgGs (including autoantibodies), an approach already suitable for AChR-MG and promising for MuSK-MG. New precision medicine approaches involve Chimeric autoantibody receptor T (CAAR-T) cells that are engineered to target antigen-specific B cells in MuSK-MG and represent a milestone in the development of targeted immunotherapies. This review aims to provide a detailed update on the pathomechanisms involved in MuSK-MG (cellular and humoral aberrations), fostering the understanding of the latest indications regarding the efficacy of different treatment strategies.
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Affiliation(s)
- Aigli G. Vakrakou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karachaliou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tzanetakos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Salakou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece
- Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
- Department of Pharmacy, University of Patras, Patras, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Kilidireas
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Henry Dunant Hospital Center, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - John Tzartos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Andrikopoulou A, Koutsoukos K, Chatziralli I, Theodossiadis P, Tsivgoulis G, Tzartos J, Anastasakis A, Zagouri F, Dimopoulos MA. Intravenous rituximab and oral cyclophosphamide for the treatment of cancer‑associated retinopathy in a patient with epithelial ovarian cancer: A case report. Oncol Lett 2023; 26:308. [PMID: 37332336 PMCID: PMC10272954 DOI: 10.3892/ol.2023.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/15/2023] [Indexed: 06/20/2023] Open
Abstract
Cancer-associated retinopathy (CAR) is a rare paraneoplastic disorder mediated by auto-antibodies that cross-react with retinal antigens leading to gradual visual defects. Early diagnosis and initiation of treatment is crucial to avoid permanent visual loss. Although most patients with CAR respond to intravenous steroids and intravenous immunoglobulin (IVIG), there are some cases refractory to the aforementioned treatment strategies. The present study describes a case of CAR in a patient with ovarian cancer that was initially resistant to most treatment regimens (chemotherapy, steroids, IVIG). Treatment with rituximab at 375 mg/m2 and oral cyclophosphamide was administered and the patient showed marked improvement of visual acuity. Electroretinogram showed a 40 and 10% improvement in scotopic and photopic vision, respectively. Notably, at the most recent follow up, the patient was still in remission. In conclusion, treatment with intravenous rituximab and oral cyclophosphamide is a promising treatment option for those cases of CAR that do not respond to steroids, immunomodulatory agents and IVIG.
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Affiliation(s)
- Angeliki Andrikopoulou
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Konstantinos Koutsoukos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Irini Chatziralli
- Second Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Theodossiadis
- Second Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - John Tzartos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anastasios Anastasakis
- Department of Clinical Electrophysiology of Vision, Athens Eye Hospital, 16675 Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Pafiti A, Krashias G, Tzartos J, Tzartos S, Stergiou C, Gaglia E, Smoleski I, Christodoulou C, Pantzaris M, Lambrianides A. A Comparison of Two Analytical Approaches for the Quantification of Neurofilament Light Chain, a Biomarker of Axonal Damage in Multiple Sclerosis. Int J Mol Sci 2023; 24:10787. [PMID: 37445963 DOI: 10.3390/ijms241310787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Neurofilament light chain (NfL), is a neuron-specific cytoskeletal protein detected in extracellular fluid following axonal damage. Extensive research has focused on NfL quantification in CSF, establishing it as a prognostic biomarker of disability progression in Multiple Sclerosis (MS). Our study used a new commercially available Enzyme-Linked Immunosorbent Assay (ELISA) kit and Single Molecular Array (Simoa) advanced technology to assess serum NfL levels in MS patients and Healthy Controls (HC). Verifying the most accurate, cost-effective methodology will benefit its application in clinical settings. Blood samples were collected from 54 MS patients and 30 HC. Protocols accompanying the kits were followed. The ELISA thershold was set as 3 S.D. above the mean of the HC. For Simoa, the Z-score calculation created by Jens Kuhle's group was applied (with permission). Samples exceeding the threshold or z-score ≥1.5 indicated subclinical disease activity. To our knowledge, this is the first study to find strong-positive correlation between ELISA and Simoa for the quantification of NfL in serum (r = 0.919). Despite the strong correlation, Simoa has better analytical sensitivity and can detect small changes in samples making it valuable in clinical settings. Further research is required to evaluate whether serum NfL quantification using ELISA could be utilized to predict disability progression.
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Affiliation(s)
- Anna Pafiti
- Postgraduate School, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Neuroimmunology Department, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - George Krashias
- Postgraduate School, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Department of Molecular Virology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - John Tzartos
- B' Neurology Department, School of Medicine, National and Kapodistrian University of Athens, "Attikon" Univeristy Hospital, 10676 Athens, Greece
- Tzartos NeuroDiagnostics, 3, Eslin Street, 11523 Athens, Greece
| | | | | | - Eftychia Gaglia
- Clinical Sciences, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Irene Smoleski
- Clinical Sciences, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Christina Christodoulou
- Postgraduate School, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Department of Molecular Virology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Marios Pantzaris
- Postgraduate School, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Neuroimmunology Department, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Anastasia Lambrianides
- Postgraduate School, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Neuroimmunology Department, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
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10
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Alentorn A, Berzero G, Alexopoulos H, Tzartos J, Reyes Botero G, Morales Martínez A, Muñiz-Castrillo S, Vogrig A, Joubert B, García Jiménez FA, Cabrera D, Tobon JV, Delgado C, Sandoval P, Troncoso M, Galleguillos L, Giry M, Benazra M, Hernández Verdin I, Dade M, Picard G, Rogemond V, Weiss N, Dalakas MC, Boëlle PY, Delattre JY, Honnorat J, Psimaras D. Spatial and Ecological Factors Modulate the Incidence of Anti-NMDAR Encephalitis-A Systematic Review. Biomedicines 2023; 11:1525. [PMID: 37371620 DOI: 10.3390/biomedicines11061525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/29/2023] Open
Abstract
Anti-NMDAR encephalitis has been associated with multiple antigenic triggers (i.e., ovarian teratomas, prodromal viral infections) but whether geographic, climatic, and environmental factors might influence disease risk has not been explored yet. We performed a systematic review and a meta-analysis of all published papers reporting the incidence of anti-NMDAR encephalitis in a definite country or region. We performed several multivariate spatial autocorrelation analyses to analyze the spatial variations in the incidence of anti-NMDA encephalitis depending on its geographical localization and temperature. Finally, we performed seasonal analyses in two original datasets from France and Greece and assessed the impact of temperature using an exposure-lag-response model in the French dataset. The reported incidence of anti-NMDAR encephalitis varied considerably among studies and countries, being higher in Oceania and South America (0.2 and 0.16 per 100,000 persons-year, respectively) compared to Europe and North America (0.06 per 100,000 persons-year) (p < 0.01). Different regression models confirmed a strong negative correlation with latitude (Pearson's R = -0.88, p < 0.00001), with higher incidence in southern hemisphere countries far from the equator. Seasonal analyses showed a peak of cases during warm months. Exposure-lag-response models confirmed a positive correlation between extreme hot temperatures and the incidence of anti-NMDAR encephalitis in France (p = 0.03). Temperature analyses showed a significant association with higher mean temperatures and positive correlation with higher ultraviolet exposure worldwide. This study provides the first evidence that geographic and climatic factors including latitude, mean annual temperature, and ultraviolet exposure, might modify disease risk.
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Affiliation(s)
- Agustí Alentorn
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Giulia Berzero
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Harry Alexopoulos
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - John Tzartos
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, 72-74, Vas. Sofias Ave, 11528 Athens, Greece
| | - Germán Reyes Botero
- Department of Oncology, Neuro-Oncology Section, Hospital Pablo Tobón Uribe, Medellín 050010, Colombia
| | - Andrea Morales Martínez
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Departments of Neurology and Neurosurgery, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Francisco A García Jiménez
- Department of Neurology, Faculty of Medicine, University of Antioquia, Carrera 51d N° 62-29, Medellín 050010, Colombia
- Department of Neurology, Hospital Universitario San Vicente Fundación, Calle 64N° 51d-154, Medellín 050010, Colombia
| | - Dagoberto Cabrera
- Deparment of Neuropediatry, Hospital Universitario San Vicente Fundación, Calle 64N° 51d-154, Medellín 050010, Colombia
| | - José Vladimir Tobon
- Instituto Neurologico de Colombia, University of Antioquia, Medellin 050010, Colombia
| | - Carolina Delgado
- Departments of Neurology and Neurosurgery, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Patricio Sandoval
- Department of Neurology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Mónica Troncoso
- Department of Pediatric Neurology, Hospital Clínico San Borja Arriarán, Facultad de Medicina, Campus Centro, Universidad de Chile, Santiago 7800003, Chile
| | | | - Marine Giry
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Marion Benazra
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Isaias Hernández Verdin
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Maëlle Dade
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Géraldine Picard
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Véronique Rogemond
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Nicolas Weiss
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
- Department of Neurology, Neuro ICU, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
| | - Marinos C Dalakas
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Pierre-Yves Boëlle
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 75012 Paris, France
| | - Jean-Yves Delattre
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France
- Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Dimitri Psimaras
- Department of Neurology 2 Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, APHP, 75013 Paris, France
- Inserm U 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonnes Universités, 75005 Paris, France
- Centre de Compétence des Syndromes Neurologiques Paraneoplasiques et Encéphalites Autoimmunes, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
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11
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Pechlivanidou M, Ninou E, Karagiorgou K, Tsantila A, Mantegazza R, Francesca A, Furlan R, Dudeck L, Steiner J, Tzartos J, Tzartos S. Autoimmunity to Neuronal Nicotinic Acetylcholine Receptors. Pharmacol Res 2023; 192:106790. [PMID: 37164280 DOI: 10.1016/j.phrs.2023.106790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Abstract
Nicotinic acetylcholine receptors (nAChRs) are widely expressed in many and diverse cell types, participating in various functions of cells, tissues and systems. In this review, we focus on the autoimmunity against neuronal nAChRs, the specific autoantibodies and their mechanisms of pathological action in selected autoimmune diseases. We summarize the current relevant knowledge from human diseases as well as from experimental models of autoimmune neurological disorders related to antibodies against neuronal nAChR subunits. Despite the well-studied high immunogenicity of the muscle nAChRs where autoantibodies are the main pathogen of myasthenia gravis, autoimmunity to neuronal nAChRs seems infrequent, except for the autoantibodies to the ganglionic receptor, the α3 subunit containing nAChR (α3-nAChR), which are detected and are likely pathogenic in Autoimmune Autonomic Ganglionopathy (AAG). We describe the detection, presence and function of these antibodies and especially the recent development of a cell-based assay (CBA) which, contrary to until recently available assays, is highly specific for AAG. Rare reports of autoantibodies to the other neuronal nAChR subtypes include a few cases of antibodies to α7 and/or α4β2 nAChRs in Rasmussen encephalitis, schizophrenia, autoimmune meningoencephalomyelitis, and in some myasthenia gravis patients with concurrent CNS symptoms. Neuronal-type nAChRs are also present in several non-excitable tissues, however the presence and possible role of antibodies against them needs further verification. It is likely that the future development of more sensitive and disease-specific assays would reveal that neuronal nAChR autoantibodies are much more frequent and may explain the mechanisms of some seronegative autoimmune diseases.
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Affiliation(s)
| | | | - Katerina Karagiorgou
- Tzartos NeuroDiagnostics, Athens, Greece; Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | | | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andreetta Francesca
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy; Clinical and Research Center - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Leon Dudeck
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Johann Steiner
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany; Center for Health and Medical Prevention (CHaMP), Magdeburg, Germany; German Center for Mental Health DZPG, Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health C-I-R-C, Halle-Jena-Magdeburg, Germany
| | - John Tzartos
- 2(nd) Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece; Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece; Department of Pharmacy, University of Patras, Patras, Greece.
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12
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Giannopapas V, Stavrogianni K, Christouli N, Kitsos D, Sideri E, Bakalidou D, Voumvourakis K, Papagiannopoulou G, Tzartos J, Paraskevas G, Tsivgoulis G, Giannopoulos S. Do cardiovascular disease comorbidities affect the cognitive function of Multiple Sclerosis patients? J Clin Neurosci 2023; 112:20-24. [PMID: 37031630 DOI: 10.1016/j.jocn.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Cognitive impairment is a core symptom of multiple sclerosis, leading to disability in 40-70% of patients. The most common cognitive domains affected by MS are information processing speed, complex attention, executive functions and less frequently, episodic declarative memory. Cardiovascular disease comorbidities have been shown to increase the decline rate in many neurological conditions. Our study aims to examine the possible impact of CVD risk factors in the cognitive decline rate of PwMS. METHODS Over the course of a year, 248 PwMS with and without Cardiovascular comorbidity were cognitively evaluated using the written version of SDMT and the MoCA. RESULTS Compared to control, MS patients with comorbid CVD had greater general cognitive decline and decreased processing speed. Patients with comorbid diabetes and dyslipidemia had the highest impairment, followed by those with hypertension, compared to the control group and those patients with a high BMI. CONCLUSION The presence of cardiovascular comorbidities and especially dyslipidemia increases the rate of cognitive decline in MS patients. In such cases, patients should be evaluated every 6 months instead of a year and the use of the SDMT is advised since it's time efficient,it requires minimal training and correlates with MRI findings.
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Affiliation(s)
- Vasileios Giannopapas
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Physical Therapy, University of West Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Greece
| | - Konstantina Stavrogianni
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Niki Christouli
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Kitsos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleni Sideri
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Daphne Bakalidou
- Department of Physical Therapy, University of West Attica, Greece; Laboratory of Neuromuscular and Cardiovascular Study of Motion-LANECASM, University of West Attica, Greece
| | - Konstantinos Voumvourakis
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgia Papagiannopoulou
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - John Tzartos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgios Paraskevas
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Sotirios Giannopoulos
- Department of Neurology, Attikon University Hospital Greece, School of Medicine, National and Kapodistrian University of Athens, Greece.
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13
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Stergiou C, Williams R, Fleming JR, Zouvelou V, Ninou E, Andreetta F, Rinaldi E, Simoncini O, Mantegazza R, Bogomolovas J, Tzartos J, Labeit S, Mayans O, Tzartos S. Immunological and Structural Characterization of Titin Main Immunogenic Region; I110 Domain Is the Target of Titin Antibodies in Myasthenia Gravis. Biomedicines 2023; 11:biomedicines11020449. [PMID: 36830985 PMCID: PMC9952892 DOI: 10.3390/biomedicines11020449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease caused by antibodies targeting the neuromuscular junction (NJ) of skeletal muscles. The major MG autoantigen is nicotinic acetylcholine receptor. Other autoantigens at the NJ include MuSK, LRP4 and agrin. Autoantibodies to the intra-sarcomeric striated muscle-specific gigantic protein titin, although not directed to the NJ, are invaluable biomarkers for thymoma and MG disease severity. Thymus and thymoma are critical in MG mechanisms and management. Titin autoantibodies bind to a 30 KDa titin segment, the main immunogenic region (MIR), consisting of an Ig-FnIII-FnIII 3-domain tandem, termed I109-I111. In this work, we further resolved the localization of titin epitope(s) to facilitate the development of more specific anti-titin diagnostics. For this, we expressed protein samples corresponding to 8 MIR and non-MIR titin fragments and tested 77 anti-titin sera for antibody binding using ELISA, competition experiments and Western blots. All anti-MIR antibodies were bound exclusively to the central MIR domain, I110, and to its containing titin segments. Most antibodies were bound also to SDS-denatured I110 on Western blots, suggesting that their epitope(s) are non-conformational. No significant difference was observed between thymoma and non-thymoma patients or between early- and late-onset MG. In addition, atomic 3D-structures of the MIR and its subcomponents were elucidated using X-ray crystallography. These immunological and structural data will allow further studies into the atomic determinants underlying titin-based autoimmunity, improved diagnostics and how to eventually treat titin autoimmunity associated co-morbidities.
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Affiliation(s)
| | - Rhys Williams
- Department of Biology, University of Konstanz, 78457 Konstanz, Germany
| | | | - Vasiliki Zouvelou
- 1st Neurology Department, Eginition Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | | | - Francesca Andreetta
- Fondazione I.R.C.C.S., Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Elena Rinaldi
- Fondazione I.R.C.C.S., Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Ornella Simoncini
- Fondazione I.R.C.C.S., Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Renato Mantegazza
- Fondazione I.R.C.C.S., Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Julius Bogomolovas
- School of Medicine, University of California, La Jolla, San Diego, CA 92093, USA
| | - John Tzartos
- School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Siegfried Labeit
- DZHK Partner Site Mannheim-Heidelberg, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Myomedix GmbH, 69151 Neckargemuend, Germany
| | - Olga Mayans
- Department of Biology, University of Konstanz, 78457 Konstanz, Germany
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, 115 23 Athens, Greece
- Hellenic Pasteur Institute, 115 21 Athens, Greece
- Department of Pharmacy, University of Patras, 265 00 Patras, Greece
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14
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Kitsos D, Tzartos J, Korres G, Giannopapas V, Riga M, Stergiou C, Tsoga A, Grigoropoulos C, Paraskevas G, Zompola C, Nikolopoulos T, Giannopoulos S. IL-6 Serum Levels in COVID-19 Patients With Vertigo. Cureus 2023; 15:e35042. [PMID: 36942191 PMCID: PMC10024114 DOI: 10.7759/cureus.35042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Dizziness and vertigo represent well-established symptoms of COVID-19. An overexpression of cytokines, a condition often described with the term "cytokine storm" or "hypercytokinemia", is a key characteristic of SARS-Cov-2 infection and plays a pivotal role in disease progression and prognosis. Among them, IL-6 is of major importance. Purpose The purpose of this study is to investigate any probable IL-6 serum titer difference in COVID-19 patients with vertigo (V+) or without vertigo (V-) admitted to the COVID-19 internal medicine departments of Attikon University Hospital, Athens, Greece, within 12 months. Methods The sample consisted of 52 COVID-19 patients who were diagnosed between January 1, 2020, and December 31, 2020. Of those, 31 reported vertigos during their admission (V+), while the remaining 21 COVID-19 patients did not complain of such symptoms (V-). Results Higher IL-6 serum levels post-COVID-19 infections lead to higher incidence rates of vertigo symptoms (p<.005), regardless of gender and age (p.005).
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Affiliation(s)
- Dimitrios Kitsos
- Department of Neurology, Attikon University Hospital, Athens, GRC
| | - John Tzartos
- Department of Neurology, Attikon University Hospital, Athens, GRC
| | - George Korres
- Department of Otolaryngology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Vasileios Giannopapas
- Physical Therapy, University of West Attica, Athens, GRC
- Department of Neurology, Attikon University Hospital, Athens, GRC
| | - Maria Riga
- Department of Otorhinolaryngology-Head and Neck Surgery, Dammam Medical Complex, Dammam, SAU
| | | | - Anthi Tsoga
- Department of Neurology, Attikon University Hospital, Athens, GRC
| | | | | | | | - Thomas Nikolopoulos
- Department of Otorhinolaryngology, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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15
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McKenzie N, Piconi G, Culeux A, Hammarin AL, Stergiou C, Tzartos S, Versleijen AAM, van de Geer J, Cras P, Cardone F, Ladogana A, Mammana A, Rossi M, Bongianni M, Perra D, Regelsberger G, Klotz S, Horneman S, Aguzzi A, Matthias S, Andrews M, Burns K, Haïk S, Ruiz-García R, Verner-Carlsson J, Tzartos J, Verbeek MM, De Vil B, Poleggi A, Parchi P, Zanusso G, Gelpi E, Frontzek K, Reiman R, Hermann P, Zerr I, Pal S, Green A. Concordance of CSF RT-QuIC across the European Creutzfeldt-Jakob Disease surveillance network. Eur J Neurol 2022; 29:2431-2438. [PMID: 35524506 PMCID: PMC9543645 DOI: 10.1111/ene.15387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
Background and purpose Cerebrospinal fluid (CSF) real‐time quaking‐induced conversion (RT‐QuIC) has a high degree of sensitivity and specificity for the diagnosis of sporadic Creutzfeldt–Jakob disease (sCJD) and this has led to its being included in revised European CJD Surveillance Network diagnostic criteria for sCJD. As CSF RT‐QuIC becomes more widely established, it is crucial that the analytical performance of individual laboratories is consistent. The aim of this ring‐trial was to ascertain the degree of concordance between European countries undertaking CSF RT‐QuIC. Methods Ten identical CSF samples, seven from probable or neuropathologically confirmed sCJD and three from non‐CJD cases, were sent to 13 laboratories from 11 countries for RT‐QuIC analysis. A range of instrumentation and different recombinant prion protein substrates were used. Each laboratory analysed the CSF samples blinded to the diagnosis and reported the results as positive or negative. Results All 13 laboratories correctly identified five of the seven sCJD cases and the remaining two sCJD cases were identified by 92% of laboratories. Of the two sCJD cases that were not identified by all laboratories, one had a disease duration >26 months with a negative 14‐3‐3, whilst the remaining case had a 4‐month disease duration and a positive 14‐3‐3. A single false positive CSF RT‐QuIC result was observed in this study. Conclusions This study shows that CSF RT‐QuIC demonstrates an excellent concordance between centres, even when using a variety of instrumentation, recombinant prion protein substrates and CSF volumes. The adoption of CSF RT‐QuIC by all CJD surveillance centres is recommended.
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Affiliation(s)
- Neil McKenzie
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gabriele Piconi
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Audrey Culeux
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | | | | | - Alexandra A M Versleijen
- Neurochemistry Lab - Translational Metabolic Laboratory, Dept. of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacqueline van de Geer
- Neurochemistry Lab - Translational Metabolic Laboratory, Dept. of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Patrick Cras
- Laboratory of Neurology, University of Antwerp, Antwerp, Belgium
| | - Franco Cardone
- Dept of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Ladogana
- Dept of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Angela Mammana
- Laboratory of Neuropathology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Marcello Rossi
- Laboratory of Neuropathology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Daniela Perra
- Neuropathology Laboratory, University of Verona, Verona, Italy
| | - Guenther Regelsberger
- Austria: Guenther Regelsberger, Ellen Gelpi, Sigrid Klotz; Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sigrid Klotz
- Austria: Guenther Regelsberger, Ellen Gelpi, Sigrid Klotz; Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Simone Horneman
- Institute of Neuropathology, University Hospital of Zurich, Zürich, Switzerland
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital of Zurich, Zürich, Switzerland
| | - Schmitz Matthias
- National Reference Center for Transmissible Spongiform Encephalopathies, Göttingen, Germany
| | - Mary Andrews
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kimberley Burns
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stéphane Haïk
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Raquel Ruiz-García
- Immunology Department, Biomedical Diagnostic Centre. Hospital Clinic de Barcelona, Spain / Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona,, Barcelona, Spain
| | | | | | - Marcel M Verbeek
- Neurochemistry Lab - Translational Metabolic Laboratory, Dept. of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bart De Vil
- Laboratory of Neurology, University of Antwerp, Antwerp, Belgium
| | - Anna Poleggi
- Dept of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Piero Parchi
- Laboratory of Neuropathology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), University of Bologna, Italy
| | | | - Ellen Gelpi
- Austria: Guenther Regelsberger, Ellen Gelpi, Sigrid Klotz; Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karl Frontzek
- Institute of Neuropathology, University Hospital of Zurich, Zürich, Switzerland
| | - Regina Reiman
- Institute of Neuropathology, University Hospital of Zurich, Zürich, Switzerland
| | - Peter Hermann
- National Reference Center for Transmissible Spongiform Encephalopathies, Göttingen, Germany
| | - Inga Zerr
- National Reference Center for Transmissible Spongiform Encephalopathies, Göttingen, Germany
| | - Suvankar Pal
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alison Green
- The National CJD Research & Surveillance Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Karagiorgou K, Dandoulaki M, Mantegazza R, Andreetta F, Furlan R, Lindstrom J, Zisimopoulou P, Chroni E, Kokotis P, Anagnostou E, Tzanetakos D, Breza M, Katsarou Z, Amoiridis G, Mastorodemos V, Bregianni M, Bonakis A, Tsivgoulis G, Voumvourakis K, Tzartos S, Tzartos J. Novel Cell-Based Assay for Alpha-3 Nicotinic Receptor Antibodies Detects Antibodies Exclusively in Autoimmune Autonomic Ganglionopathy. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/3/e1162. [PMID: 35351814 PMCID: PMC8969289 DOI: 10.1212/nxi.0000000000001162] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives Autoantibodies against α3-subunit–containing nicotinic acetylcholine receptors (α3-nAChRs), usually measured by radioimmunoprecipitation assay (RIPA), are detected in patients with autoimmune autonomic ganglionopathy (AAG). However, low α3-nAChR antibody levels are frequently detected in other neurologic diseases with questionable significance. Our objective was to develop a method for the selective detection of the potentially pathogenic α3-nAChR antibodies, seemingly present only in patients with AAG. Methods The study involved sera from 55 patients from Greece, suspected for autonomic failure, and 13 patients from Italy diagnosed with autonomic failure, positive for α3-nAChR antibodies by RIPA. In addition, sera from 52 patients with Ca2+ channel or Hu antibodies and from 2,628 controls with various neuroimmune diseases were included. A sensitive live cell-based assay (CBA) with α3-nAChR–transfected cells was developed to detect antibodies against the cell-exposed α3-nAChR domain. Results Twenty-five patients were found α3-nAChR antibody positive by RIPA. Fifteen of 25 patients were also CBA positive. Of interest, all 15 CBA-positive patients had AAG, whereas all 10 CBA-negative patients had other neurologic diseases. RIPA antibody levels of the CBA-negative sera were low, although our CBA could detect dilutions of AAG sera corresponding to equally low RIPA antibody levels. No serum bound to control-transfected cells, and none of the 2,628 controls was α3-CBA positive. Discussion This study showed that in contrast to the established RIPA for α3-nAChR antibodies, which at low levels is of moderate disease specificity, our CBA seems AAG specific, while at least equally sensitive with the RIPA. This study provides Class II evidence that α3-nAChR CBA is a specific assay for AAG. Classification of Evidence This study provides Class II evidence that an α3-nAChR cell-based assay is a more specific assay for AAG than the standard RIPA.
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Affiliation(s)
- Katerina Karagiorgou
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Maria Dandoulaki
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Renato Mantegazza
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Francesca Andreetta
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Raffaello Furlan
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Jon Lindstrom
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Paraskevi Zisimopoulou
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Elisabeth Chroni
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Panagiotis Kokotis
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Evangelos Anagnostou
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Dimitrios Tzanetakos
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Marianthi Breza
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Zoe Katsarou
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Georgios Amoiridis
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Vasileios Mastorodemos
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Marianna Bregianni
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Anastasios Bonakis
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Georgios Tsivgoulis
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Konstantinos Voumvourakis
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - Socrates Tzartos
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
| | - John Tzartos
- From the Tzartos NeuroDiagnostics (K.K., M.D., S.T., J.T.), Athens; Department of Biochemistry and Biotechnology (K.K.), University of Thessaly, Larissa, Greece; Neuroimmunology and Neuromuscular Diseases Unit (R.M., F.A.), Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences Humanitas University (R.F.), Milan, Italy; Department of Neuroscience (J.L.), Medical School, University of Pennsylvania, Philadelphia, PA; Department of Neurobiology (P.Z., S.T.), Hellenic Pasteur Institute, Athens, Greece; Department of Neurology (E.C.), School of Medicine, University of Patras; 1st Department of Neurology (P.K., E.A., D.T., M. Breza), School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens (NKUA), Athens; Department of Neurology (Z.K.), Hippokration Hospital, Thessaloniki; Neurology Department (G.A., V.M.), University Hospital of Crete, Heraklion, Crete; and 2nd Department of Neurology (M. Bregianni, A.B., G.T., K.V., J.T.), Attikon University Hospital, School of Medicine, NKUA, Athens, Greece
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17
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Koneczny I, Tzartos J, Mané-Damas M, Yilmaz V, Huijbers MG, Lazaridis K, Höftberger R, Tüzün E, Martinez-Martinez P, Tzartos S, Leypoldt F. IgG4 Autoantibodies in Organ-Specific Autoimmunopathies: Reviewing Class Switching, Antibody-Producing Cells, and Specific Immunotherapies. Front Immunol 2022; 13:834342. [PMID: 35401530 PMCID: PMC8986991 DOI: 10.3389/fimmu.2022.834342] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
Organ-specific autoimmunity is often characterized by autoantibodies targeting proteins expressed in the affected tissue. A subgroup of autoimmunopathies has recently emerged that is characterized by predominant autoantibodies of the IgG4 subclass (IgG4-autoimmune diseases; IgG4-AID). This group includes pemphigus vulgaris, thrombotic thrombocytopenic purpura, subtypes of autoimmune encephalitis, inflammatory neuropathies, myasthenia gravis and membranous nephropathy. Although the associated autoantibodies target specific antigens in different organs and thus cause diverse syndromes and diseases, they share surprising similarities in genetic predisposition, disease mechanisms, clinical course and response to therapies. IgG4-AID appear to be distinct from another group of rare immune diseases associated with IgG4, which are the IgG4-related diseases (IgG4-RLD), such as IgG4-related which have distinct clinical and serological properties and are not characterized by antigen-specific IgG4. Importantly, IgG4-AID differ significantly from diseases associated with IgG1 autoantibodies targeting the same organ. This may be due to the unique functional characteristics of IgG4 autoantibodies (e.g. anti-inflammatory and functionally monovalent) that affect how the antibodies cause disease, and the differential response to immunotherapies of the IgG4 producing B cells/plasmablasts. These clinical and pathophysiological clues give important insight in the immunopathogenesis of IgG4-AID. Understanding IgG4 immunobiology is a key step towards the development of novel, IgG4 specific treatments. In this review we therefore summarize current knowledge on IgG4 regulation, the relevance of class switching in the context of health and disease, describe the cellular mechanisms involved in IgG4 production and provide an overview of treatment responses in IgG4-AID.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Inga Koneczny,
| | - John Tzartos
- Neuroimmunology, Tzartos NeuroDiagnostics, Athens, Greece
- 2nd Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Mané-Damas
- Research Group Neuroinflammation and Autoimmunity, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Maartje G. Huijbers
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Konstantinos Lazaridis
- Department of Immunology, Laboratory of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Pilar Martinez-Martinez
- Research Group Neuroinflammation and Autoimmunity, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Socrates Tzartos
- Neuroimmunology, Tzartos NeuroDiagnostics, Athens, Greece
- Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry and Department of Neurology, UKSH Kiel/Lübeck, Kiel University, Kiel, Germany
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18
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Veltsista D, Kefalopoulou Z, Tzartos J, Chroni E. Autoantibody profile in myasthenia gravis patients with a refractory phase. Muscle Nerve 2022; 65:607-611. [PMID: 35195920 DOI: 10.1002/mus.27521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A subgroup of myasthenia gravis (MG) patients fails to respond adequately to recommended treatments, a condition referred to as refractory MG. During the refractory phase patients experience persistent debilitating symptoms with potential life-threatening events or inability to reduce immunosuppressant dosages and minimize long-term toxicities. METHODS We conducted a retrospective single-centre study of 113 MG patients to investigate the autoantibody profile and clinical characteristics of refractory MG patients, compared to non-refractory patients, based on predefined criteria. RESULTS Fifteen patients (13.3%) were classified as refractory. Double seronegative MG (DSNMG), without detectable nicotinic acetylcholine receptor (AChR) or muscle-specific tyrosine kinase (MuSK) antibodies, was identified in 6 refractory patients, significantly higher than those with non-refractory MG (40% vs 16.3%, p=0.031). None of the refractory patients had MuSK antibodies. Patients in the refractory group more frequently had an earlier disease onset, thymic pathology and thymectomy (all p-values ≤0.03). DISCUSSION In this study, patients with refractory MG were more likely than those with non-refractory MG to be DSN; and refractory DSNMG patients had worse MGFA classes in their recent visit compared to anti-AChR positive refractory patients. Refractory DSNMG patients may represent a distinct group that requires more individualized and targeted treatment approaches. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dimitra Veltsista
- Neuromuscular Center, Department of Neurology, University of Patras, Rio, Patras, Greece
| | - Zinovia Kefalopoulou
- Neuromuscular Center, Department of Neurology, University of Patras, Rio, Patras, Greece
| | - John Tzartos
- 2nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Rimini 1, Chaidari, Athens, Greece.,Tzartos NeuroDiagnostics, Eslin street 3, 115 23, Athens, Greece
| | - Elisabeth Chroni
- Neuromuscular Center, Department of Neurology, University of Patras, Rio, Patras, Greece
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19
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Topaloudi A, Zagoriti Z, Flint AC, Martinez MB, Yang Z, Tsetsos F, Christou YP, Lagoumintzis G, Yannaki E, Zamba-Papanicolaou E, Tzartos J, Tsekmekidou X, Kotsa K, Maltezos E, Papanas N, Papazoglou D, Passadakis P, Roumeliotis A, Roumeliotis S, Theodoridis M, Thodis E, Panagoutsos S, Yovos J, Stamatoyannopoulos J, Poulas K, Kleopa K, Tzartos S, Georgitsi M, Paschou P. Myasthenia gravis genome-wide association study implicates AGRN as a risk locus. J Med Genet 2021; 59:801-809. [PMID: 34400559 DOI: 10.1136/jmedgenet-2021-107953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Myasthenia gravis (MG) is a rare autoimmune disorder affecting the neuromuscular junction (NMJ). Here, we investigate the genetic architecture of MG via a genome-wide association study (GWAS) of the largest MG data set analysed to date. METHODS We performed GWAS meta-analysis integrating three different data sets (total of 1401 cases and 3508 controls). We carried out human leucocyte antigen (HLA) fine-mapping, gene-based and tissue enrichment analyses and investigated genetic correlation with 13 other autoimmune disorders as well as pleiotropy across MG and correlated disorders. RESULTS We confirmed the previously reported MG association with TNFRSF11A (rs4369774; p=1.09×10-13, OR=1.4). Furthermore, gene-based analysis revealed AGRN as a novel MG susceptibility gene. HLA fine-mapping pointed to two independent MG loci: HLA-DRB1 and HLA-B. MG onset-specific analysis reveals differences in the genetic architecture of early-onset MG (EOMG) versus late-onset MG (LOMG). Furthermore, we find MG to be genetically correlated with type 1 diabetes (T1D), rheumatoid arthritis (RA), late-onset vitiligo and autoimmune thyroid disease (ATD). Cross-disorder meta-analysis reveals multiple risk loci that appear pleiotropic across MG and correlated disorders. DISCUSSION Our gene-based analysis identifies AGRN as a novel MG susceptibility gene, implicating for the first time a locus encoding a protein (agrin) that is directly relevant to NMJ activation. Mutations in AGRN have been found to underlie congenital myasthenic syndrome. Our results are also consistent with previous studies highlighting the role of HLA and TNFRSF11A in MG aetiology and the different risk genes in EOMG versus LOMG. Finally, we uncover the genetic correlation of MG with T1D, RA, ATD and late-onset vitiligo, pointing to shared underlying genetic mechanisms.
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Affiliation(s)
- Apostolia Topaloudi
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Zoi Zagoriti
- Department of Pharmacy, University of Patras, Rio, Greece
| | - Alyssa Camille Flint
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
| | | | - Zhiyu Yang
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupoli, Greece
| | | | | | - Evangelia Yannaki
- Department of Hematology, George Papanicolaou Hospital, Thessaloniki, Greece
| | - Eleni Zamba-Papanicolaou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Department of Neuroepidemiology and Centre for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics and Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | | | - Xanthippi Tsekmekidou
- Division of Endocrinology and Metabolism-Diabetes Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism-Diabetes Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Maltezos
- Diabetes Center, 2nd Department of Internal Medicine, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Nikolaos Papanas
- Diabetes Center, 2nd Department of Internal Medicine, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Dimitrios Papazoglou
- Diabetes Center, 2nd Department of Internal Medicine, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Ploumis Passadakis
- Department of Nephrology, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marios Theodoridis
- Department of Nephrology, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Elias Thodis
- Department of Nephrology, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - Stylianos Panagoutsos
- Department of Nephrology, Alexandroupolis University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece
| | - John Yovos
- Division of Endocrinology and Metabolism-Diabetes Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - John Stamatoyannopoulos
- Departments of Medicine and Genome Sciences, University of Washington, Seattle, Washington, USA
| | | | - Kleopas Kleopa
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Department of Neuroscience and Centre for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics and Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Socrates Tzartos
- Department of Pharmacy, University of Patras, Rio, Greece.,Hellenic Pasteur Institute, Athens, Greece
| | - Marianthi Georgitsi
- 1st Laboratory of Medical Biology-Genetics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
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20
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Muñoz U, Sebal C, Escudero E, Esiri M, Tzartos J, Sloan C, Sadaba MC. Main Role of Antibodies in Demyelination and Axonal Damage in Multiple Sclerosis. Cell Mol Neurobiol 2021; 42:1809-1827. [PMID: 33625628 DOI: 10.1007/s10571-021-01059-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
Antibodies and oxidative stress are hallmarks of multiple sclerosis (MS) lesions. We aimed to clarify the relation between them, their role in MS patients and to investigate their specificity, comparing MS with classical neurodegenerative diseases (ND). Brain samples from 14 MS cases, 6 with ND and 9 controls (without neurological diseases). Immunohistochemistry assays were used to detect oxidized lipids (EO6), IgG and IgM, oligodendrocytes (Olig2), axons (NF, neurofilament) and cellular (TUNEL) and axonal damage (APP, amyloid precursor protein). We did not observe EO6 in controls. All samples from MS patients showed EO6 in oligodendrocytes and axons within lesions. We did not detect co-localization between EO6 and antibodies. Neither did we between EO6 and TUNEL or APP. 94.4% of TUNEL-positive cells in normal appearing white matter were also stained for IgG and 75.5% for IgM. IgM, but not IgG, co-localized with APP. EO6 was associated with axonal damage in amyotrophic lateral sclerosis (ALS). We did not observe association between antibodies and cellular or axonal damage in ND patients. MS patients showed a higher number of B cells and plasma cells in the lesions and meninges than controls. The number of B cells and plasma cells was associated with the presence of antibodies and with the activity of the lesions. We observed a main role of B lymphocytes in the development of MS lesions. Antibodies contribute to the oligodendrocyte and axonal damage in MS. Oxidative stress was associated with axonal damage in ALS.
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Affiliation(s)
- Ursula Muñoz
- Facultad de Medicina Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
| | - Cristina Sebal
- Facultad de Medicina Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Esther Escudero
- Facultad de Medicina Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Margaret Esiri
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | | | - Carolyn Sloan
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | - Mari Cruz Sadaba
- Facultad de Medicina Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain.
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21
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Breza M, Hirst J, Chelban V, Banneau G, Tissier L, Kol B, Bourinaris T, Said SA, Péréon Y, Heinzmann A, Debs R, Juntas-Morales R, Martinez VG, Camdessanche JP, Scherer-Gagou C, Zola JM, Athanasiou-Fragkouli A, Efthymiou S, Vavougios G, Velonakis G, Stamelou M, Tzartos J, Potagas C, Zambelis T, Mariotti C, Blackstone C, Vandrovcova J, Mavridis T, Kartanou C, Stefanis L, Wood N, Karadima G, LeGuern E, Koutsis G, Houlden H, Stevanin G. Expanding the Spectrum of AP5Z1-Related Hereditary Spastic Paraplegia (HSP-SPG48): A Multicenter Study on a Rare Disease. Mov Disord 2021; 36:1034-1038. [PMID: 33543803 DOI: 10.1002/mds.28487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jennifer Hirst
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Viorica Chelban
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Guillaume Banneau
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Département de Génétique Médicale, Institut Fédératif de Biologie, Toulouse, France
| | - Laurène Tissier
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Bophara Kol
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Thomas Bourinaris
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Samia A Said
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Yann Péréon
- Department of Clinical Neurophysiology, Reference centre for NMD, CHU Nantes, Place Alexis-Ricordeau, Nantes, France
| | - Anna Heinzmann
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rabab Debs
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Raul Juntas-Morales
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Victoria G Martinez
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean P Camdessanche
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Clarisse Scherer-Gagou
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean-Médard Zola
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Stephanie Efthymiou
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | | | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - Maria Stamelou
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Parkinson's Disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece.,School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - John Tzartos
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Zambelis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milan, Italy
| | - Craig Blackstone
- Cell Biology Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana Vandrovcova
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Theodoros Mavridis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrisoula Kartanou
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Wood
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Georgia Karadima
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric LeGuern
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Sorbonne Université, Institut du Cerveau, INSERM, CNRS, CHU Pitié-Salpêtrière, Paris, France
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Henry Houlden
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Giovanni Stevanin
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Sorbonne Université, Institut du Cerveau, INSERM, CNRS, CHU Pitié-Salpêtrière, Paris, France.,PSL Research University, EPHE, Neurogenetics Team, Paris, France
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22
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Koneczny I, Yilmaz V, Lazaridis K, Tzartos J, Lenz TL, Tzartos S, Tüzün E, Leypoldt F. Common Denominators in the Immunobiology of IgG4 Autoimmune Diseases: What Do Glomerulonephritis, Pemphigus Vulgaris, Myasthenia Gravis, Thrombotic Thrombocytopenic Purpura and Autoimmune Encephalitis Have in Common? Front Immunol 2021; 11:605214. [PMID: 33584677 PMCID: PMC7878376 DOI: 10.3389/fimmu.2020.605214] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
IgG4 autoimmune diseases (IgG4-AID) are an emerging group of autoimmune diseases that are caused by pathogenic autoantibodies of the IgG4 subclass. It has only recently been appreciated, that members of this group share relevant immunobiological and therapeutic aspects even though different antigens, tissues and organs are affected: glomerulonephritis (kidney), pemphigus vulgaris (skin), thrombotic thrombocytopenic purpura (hematologic system) muscle-specific kinase (MuSK) in myasthenia gravis (peripheral nervous system) and autoimmune encephalitis (central nervous system) to give some examples. In all these diseases, patients’ IgG4 subclass autoantibodies block protein-protein interactions instead of causing complement mediated tissue injury, patients respond favorably to rituximab and share a genetic predisposition: at least five HLA class II genes have been reported in individual studies to be associated with several different IgG4-AID. This suggests a role for the HLA class II region and specifically the DRβ1 chain for aberrant priming of autoreactive T-cells toward a chronic immune response skewed toward the production of IgG4 subclass autoantibodies. The aim of this review is to provide an update on findings arguing for a common pathogenic mechanism in IgG4-AID in general and to provide hypotheses about the role of distinct HLA haplotypes, T-cells and cytokines in IgG4-AID.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Konstantinos Lazaridis
- Department of Immunology, Laboratory of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - John Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tobias L Lenz
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry and Department of Neurology, Medical Faculty, Christian-Albrechts-University Kiel, Kiel, Germany
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23
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Breza M, Bourinaris T, Efthymiou S, Maroofian R, Athanasiou-Fragkouli A, Tzartos J, Velonakis G, Karavasilis E, Angelopoulou G, Kasselimis D, Potagas C, Stefanis L, Karadima G, Koutsis G, Houlden H. A homozygous GDAP2 loss-of-function variant in a patient with adult-onset cerebellar ataxia. Brain 2020; 143:e49. [PMID: 32428220 DOI: 10.1093/brain/awaa120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Bourinaris
- Department of Neuromuscular Disorders, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Reza Maroofian
- Department of Neuromuscular Disorders, Institute of Neurology, University College London, London WC1N 3BG, UK
| | | | - John Tzartos
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Tzartos Neurodiagnostics, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Angelopoulou
- Neuropsychology and Speech Pathology Unit, 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Speech Pathology Unit, 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Crete, Greece
| | - Constantin Potagas
- Neuropsychology and Speech Pathology Unit, 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Karadima
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Henry Houlden
- Department of Neuromuscular Disorders, Institute of Neurology, University College London, London WC1N 3BG, UK
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24
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Yilmaz V, Ulusoy C, Hajtovic S, Turkoglu R, Kurtuncu M, Tzartos J, Lazaridis K, Tuzun E. Effects of Teriflunomide on B Cell Subsets in MuSK-Induced Experimental Autoimmune Myasthenia Gravis and Multiple Sclerosis. Immunol Invest 2020; 50:671-684. [PMID: 32597289 DOI: 10.1080/08820139.2020.1785491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antigen-specific immune responses are crucially involved in both multiple sclerosis (MS) and myasthenia gravis (MG). Teriflunomide is an immunomodulatory agent approved for treatment of MS through inhibition of lymphocyte proliferation. MG associated with muscle-specific tyrosine kinase (MuSK) antibodies often manifests with a severe disease course, prompting development of effective treatment methods. To evaluate whether teriflunomide treatment may ameliorate MuSK-autoimmunity, experimental autoimmune MG (EAMG) was induced by immunizing C57BL/6 (B6) mice three times with MuSK in complete Freund's adjuvant (CFA) (n = 17). MuSK-immunized mice were treated daily with teriflunomide (n = 8) or PBS (n = 9) starting from the third immunization (week 8) to termination (week 14). Clinical severity of EAMG was monitored. Immunological alterations were evaluated by measurement of anti-MuSK IgG, neuromuscular junction deposits, and flow cytometric analysis of lymph node cells. In MS patients under teriflunomide treatment, the peripheral blood B cell subset profile was analyzed. B6 mice treated with teriflunomide displayed relatively preserved body weight, lower EAMG prevalence, reduced average clinical grades, higher inverted screen scores, diminished anti-MuSK antibody and NMJ deposit levels. Amelioration of EAMG findings was associated with reduced memory B cell ratios in the lymph nodes. Similarly, MS patients under teriflunomide treatment showed reduced memory B cell, plasma cell, and plasmablast ratios. Teriflunomide treatment has effectively ameliorated MuSK-autoimmunity and thus may putatively be used in long-term management of MuSK-MG as an auxiliary treatment method. Teriflunomide appears to exert beneficial effects through inhibition of effector B cells.
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Affiliation(s)
- Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Canan Ulusoy
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Sabastian Hajtovic
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY, USA
| | - Recai Turkoglu
- Department of Neurology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Murat Kurtuncu
- Department of Neurology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - John Tzartos
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Tzartos NeuroDiagnostics, Athens, Greece
| | | | - Erdem Tuzun
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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25
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Yetimler B, Tzartos J, Şengül B, Dursun E, Ulukan Ç, Karagiorgou K, Gezen-Ak D, Sezgin M, Papaconstantinou A, Tzartos S, Orhan EK, Ekizoğlu E, Küçükali Cİ, Baykan B, Tüzün E. Serum glial fibrillary acidic protein (GFAP)-antibody in idiopathic intracranial hypertension. Int J Neurosci 2020; 131:775-779. [PMID: 32303142 DOI: 10.1080/00207454.2020.1758084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM Idiopathic intracranial hypertension (IIH), a disease of obscure origin, is characterized by headache and visual disturbances due to increased intracranial pressure. Recent line of evidence has suggested involvement of inflammation in IIH pathogenesis thus bringing forward anti-glial autoimmunity as a potential contributor of IIH. Glial fibrillary acidic protein (GFAP) is a major astrocytic autoantigen associated with a specific form of meningoencephalitis. MATERIALS AND METHODS In this study, we investigated the presence of GFAP-antibody in 65 sera (49 obtained during active disease and 16 during remission) and in 15 cerebrospinal fluid (CSF) samples of 58 consecutively recruited IIH patients using cell based assay and indirect immunohistochemistry. RESULTS GFAP-antibody was found in active period sera of 2 IIH patients with classical symptoms and good treatment response. Two remission period sera obtained at different time points from one of these cases showed lower titers of GFAP-antibody positivity. IgG from positive samples yielded an astrocytic immunoreactivity pattern. None of the CSF samples showed GFAP-antibodies. CONCLUSIONS These results suggest that anti-astrocyte autoimmunity might be present in a fraction of IIH patients. Exact pathogenic significance of this association needs to be further studied.
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Affiliation(s)
- Berrak Yetimler
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - John Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,1st Department of Neurology, Eginition Hospital, Medical School, University of Athens, Athens, Greece
| | - Büşra Şengül
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Erdinç Dursun
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.,Department of Neuroscience, Institute of Neurological Sciences, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Çağrı Ulukan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Duygu Gezen-Ak
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Mine Sezgin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,Hellenic Pasteur Institute, Athens, Greece
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
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26
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Koutsouraki E, Michmizos D, Patsi O, Tzartos J, Spilioti M, Arnaoutoglou M, Tsolaki M. A probable role of copper in the comorbidity in Wilson's and Creutzfeldt-Jakob's Diseases: a case report. Virol J 2020; 17:35. [PMID: 32169096 PMCID: PMC7071643 DOI: 10.1186/s12985-020-01309-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/27/2020] [Indexed: 11/27/2022] Open
Abstract
Background To the best of our knowledgedd, there is currently no case in the literature reporting the comorbidity of Wilson’s and Creutzfeldt-Jakob disease (CJD), linked through copper. Case presentation A 44-year-old male with a history of inherited Wilson’s disease (hepatolenticular degeneration), which manifested as mild liver injury and psychiatric symptoms, was admitted to our department due to speech and cognitive disturbances. Upon his admission, he had motor aphasia as well as psychomotor retardation with an otherwise normal neurological examination. Laboratory tests, including liver enzymes, copper and serum ammonia were all within normal range. The brain MRI showed increased T2 signal in the caudate nuclei, attributed to copper deposition in the context of Wilson’s disease. In the electroencephalogram, periodic sharp discharges were eminent, initially unilateral and then generalized. The positive 14–3-3 protein in the cerebrospinal fluid (CSF) and the new brain MRI, that demonstrated elevated DWI signal not only in the basal ganglia but also in parts of the cerebral cortex (cortical ribbon sign), all supportive of a possible CJD diagnosis. The detection of PrPSc in the patient’s CSF, using the RT-QuIC method, which has a 99.4–100% specificity for CJD, made the diagnosis of CJD highly probable. Conclusion This is the first report of Wilson’s and Creutzfeldt-Jakob diseases co-morbidity in the literature, which could evoke a possible role of copper in the pathogenesis of CJD.
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Affiliation(s)
| | | | - Olga Patsi
- Aristotle University, 1st Neurology clinic, AHEPA Hospital, Thessaloniki, Greece
| | | | - Martha Spilioti
- Aristotle University, 1st Neurology clinic, AHEPA Hospital, Thessaloniki, Greece
| | | | - Magda Tsolaki
- Aristotle University, 1st Neurology clinic, AHEPA Hospital, Thessaloniki, Greece
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27
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Vakrakou AG, Evangelopoulos ME, Boutzios G, Tzanetakos D, Tzartos J, Velonakis G, Toulas P, Anagnostouli M, Andreadou E, Koutsis G, Stefanis L, Fragoulis GE, Kilidireas C. Recurrent myelitis and asymptomatic hypophysitis in IgG4-related disease: case-based review. Rheumatol Int 2020; 40:337-343. [PMID: 31898763 DOI: 10.1007/s00296-019-04502-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/11/2019] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a disorder with various clinical manifestations. Central nervous system (CNS) involvement is well recognized, with hypertrophic pachymeningitis and hypophysitis being the most common manifestations. Spinal cord involvement is an extremely rare manifestation. We present the first case of an IgG4-RD patient with spinal cord parenchymal disease and concurrent hypophysitis. We review also the current literature about CNS parenchymal involvement in the context of IgG4-RD. A young female presented with clinical symptoms of myelitis. Cervical spinal cord magnetic resonance imaging (MRI) displayed features of longitudinally extensive transverse myelitis (LETM). Brain MRI showed a small number of high-intensity lesions in the deep white matter and enlargement of hypophysis with homogeneous gadolinium enhancement (asymptomatic hypophysitis). Diagnostic workup revealed elevated IgG4 serum levels (146 mg/dL). Our patient fulfilled the organ-specific diagnostic criteria of IgG4-hypophysitis. Treatment with intravenous glucocorticoids led to rapid clinical response, and to the substantial resolution of imaging findings. Azathioprine was used as a maintenance treatment. One relapse occurred 2 years after the initial diagnosis and patient was re-treated with glucocorticoids. Three years after relapse, patient is in remission with azathioprine. We present the first case of myelitis with radiological features of LETM associated with increased IgG4 serum levels and the simultaneous presence of asymptomatic IgG4-related hypophysitis.
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Affiliation(s)
- Aigli G Vakrakou
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece.
| | - Maria-Eleptheria Evangelopoulos
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, Laikon General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitrios Tzanetakos
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - John Tzartos
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Georgios Velonakis
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Panagiotis Toulas
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Maria Anagnostouli
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Elissavet Andreadou
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Georgios Koutsis
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - George E Fragoulis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Constantinos Kilidireas
- 1st Department of Neurology, Medical School of Athens, National and Kapodistrian University, Aeginition Hospital, Athens, Greece
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28
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Koutsis G, Breza M, Velonakis G, Tzartos J, Kasselimis D, Kartanou C, Karavasilis E, Tzanetakos D, Anagnostouli M, Andreadou E, Evangelopoulos ME, Kilidireas C, Potagas C, Panas M, Karadima G. X linked Charcot-Marie-Tooth disease and multiple sclerosis: emerging evidence for an association. J Neurol Neurosurg Psychiatry 2019; 90:187-194. [PMID: 30196252 DOI: 10.1136/jnnp-2018-319014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/31/2018] [Accepted: 08/11/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE X linked Charcot-Marie-Tooth disease (CMTX) is a hereditary neuropathy caused by mutations in GJB1 coding for connexin-32, a gap junction protein expressed in Schwann cells, but also found in oligodendrocytes. Four patients with CMTX developing central nervous system (CNS) demyelination compatible with multiple sclerosis (MS) have been individually published. We presently sought to systematically investigate the relationship between CMTX and MS. METHODS Over 20 years, 70 consecutive patients (36 men) with GJB1 mutations were identified at our Neurogenetics Unit, Athens, Greece, and assessed for clinical features suggestive of MS. Additionally, 18 patients with CMTX without CNS symptoms and 18 matched controls underwent brain MRI to investigate incidental findings. Serum from patients with CMTX and MS was tested for CNS immunoreactivity. RESULTS We identified three patients with CMTX who developed clinical features suggestive of inflammatory CNS demyelination fulfilling MS diagnostic criteria. The resulting 20-year MS incidence (4.3%) differed significantly from the highest background 20-year MS incidence ever reported from Greece (p=0.00039). The search for incidental brain MRI findings identified two CMTX cases (11%) with lesions suggestive of focal demyelination compared with 0 control. Moreover, 10 cases in the CMTX cohort had hyperintensity in the splenium of the corpus callosum compared with 0 control (p=0.0002). No specific CNS-reactive humoral factors were identified in patients with CMTX and MS. CONCLUSIONS We have demonstrated a higher than expected frequency of MS in patients with CMTX and identified incidental focal demyelinating lesions on brain MRI in patients with CMTX without CNS symptoms. This provides circumstantial evidence for GJB1 mutations acting as a possible MS risk factor.
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Affiliation(s)
- Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- Neurogenetics Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Tzartos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Speech Pathology Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Division of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Crete, Greece
| | - Chrisoula Kartanou
- Neurogenetics Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tzanetakos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisavet Andreadou
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eleftheria Evangelopoulos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Kilidireas
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Speech Pathology Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Panas
- Neurogenetics Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Karadima
- Neurogenetics Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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29
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Koneczny I, Rennspiess D, Marcuse F, Dankerlui N, Abdul Hamid M, Mané-Damas M, Maessen J, Van Schil P, Saxena A, Zisimopoulou P, Lazaridis K, Woodhall M, Karagiorgou K, Tzartos J, Tzartos S, De Baets MH, Molenaar PC, Marx A, Zur Hausen A, Losen M, Martinez-Martinez P. Characterization of the thymus in Lrp4 myasthenia gravis: Four cases. Autoimmun Rev 2018; 18:50-55. [PMID: 30414949 DOI: 10.1016/j.autrev.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/20/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction. Most patients have pathogenic autoantibodies against the acetylcholine receptor (AChR). In the last years a novel subpopulation of MG patients has been described that harbors antibodies against low-density lipoprotein receptor-related protein 4 (Lrp4), another postsynaptic neuromuscular antigen. In early-onset AChR MG (EOMG), the thymus plays an important role in immunopathogenesis, and early thymectomy is beneficial. It is still unknown if the thymus plays any role in Lrp4-MG. In this pilot study, we compared thymus samples from four patients with Lrp4-MG (one pre-treated with immunosuppressive drugs), four non-MG controls and five EOMG patients (not pretreated with immunosuppressive drugs). Immunohistochemistry of the Lrp4-MG thymi revealed normal architecture, with normal numbers and distribution of B-cells, lymphoid follicles and Hassall's corpuscles. Primary CD23+ lymphoid follicles were similarly infrequent in Lrp4-MG and control thymic sections. In none of the control or Lrp4-MG thymi did we find secondary follicles with CD10+ germinal centers. These were evident in 2 of the 5 EOMG thymi, where primary lymphoid follicles were also more frequent on average, thus showing considerable heterogeneity between patients. Even if characteristic pathological thymic changes were not observed in the Lrp4 subgroup, we cannot exclude a role for the thymus in Lrp4-MG pathogenesis, since one Lrp4-MG patient went into clinical remission after thymectomy alone (at one year follow-up) and one more improved after thymectomy in combination with immunosuppressive therapy.
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Affiliation(s)
- Inga Koneczny
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Dorit Rennspiess
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Florit Marcuse
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Nathalie Dankerlui
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Myurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Marina Mané-Damas
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Jos Maessen
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Paul Van Schil
- Dept. of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, Edegem (Antwerp), B- 2650, Belgium
| | - Abhishek Saxena
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Paraskevi Zisimopoulou
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Konstantinos Lazaridis
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Mark Woodhall
- Neurosciences Group, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, University of Oxford, Oxford OX3 9DU, UK
| | | | - John Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece; Tzartos Neuro Diagnostics, 3 Eslin Street, 11523 Athens, Greece
| | - Socrates Tzartos
- Department of Neurobiology, Hellenic Pasteur Institute, 127 Vas. Sofias Avenue, 11521 Athens, Greece
| | - Marc H De Baets
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Peter C Molenaar
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Axel Zur Hausen
- Department of Pathology, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands; GROW: School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6200 MD Maastricht, the Netherlands
| | - Mario Losen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
| | - Pilar Martinez-Martinez
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.
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30
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Breza M, Smyrni N, Koutsis G, Anagnostou E, Tzartos J, Velonakis G, Kokkinis C, Kilindireas C, Papavasiliou A, Kotsalis C. Ocular flutter as presenting manifestation of pediatric MOG antibody–associated demyelination: A case report. Mult Scler 2018; 25:122-125. [DOI: 10.1177/1352458518771872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 13-year-old girl presented with a 5-day history of oscillopsia. On examination, ocular flutter and mild cerebellar signs were found. Brain magnetic resonance imaging (MRI) revealed four periventricular and subcortical non-enhancing lesions. Cerebrospinal fluid (CSF) oligoclonal bands were negative. Neuroblastoma or other malignancies were not found. She responded well to a corticosteroid–intravenous immunoglobulin (IVIG) combination and remained symptom-free for 3 years until presenting again with isolated ocular flutter. Brain MRI at this time remained atypical for classic multiple sclerosis (MS) with a predominance of juxtacortical demyelinating lesions. CSF was positive for oligoclonal bands. Serum myelin oligodendrocyte glycoprotein (MOG) antibodies were present. Ocular flutter can be the presenting feature of MOG antibody–associated pediatric demyelination.
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Affiliation(s)
- Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Smyrni
- Neurology Department, Penteli Children’s Hospital, Attica, Greece
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Anagnostou
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Tzartos
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece/Tzartos Neurodiagnostics, Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Constantinos Kilindireas
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Vakrakou AG, Tzanetakos D, Valsami S, Grigoriou E, Psarra K, Tzartos J, Anagnostouli M, Andreadou E, Evangelopoulos ME, Koutsis G, Chrysovitsanou C, Gialafos E, Dimitrakopoulos A, Stefanis L, Kilidireas C. A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes. BMC Neurol 2018; 18:178. [PMID: 30373566 PMCID: PMC6206708 DOI: 10.1186/s12883-018-1183-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in Multiple Sclerosis (MS) patients compared to β-interferon. It acts against CD52, leading primarily to lymphopenia. Recent data have shown that mild neutropenia is observed in 16% of treated MS-patients whereas severe neutropenia occurred in 0.6%. CASE PRESENTATION Herein, we present the case of a 34-year-old woman with relapsing-remitting MS, with a history of treatment with glatiramer acetate and natalizumab, who subsequently received Alemtuzumab (12 mg / 24 h × 5 days). 70-days after the last Alemtuzumab administration, the patient displayed neutropenia (500 neutrophils/μL) with virtual absence of B-cells (0.6% of total lymphocytes), low values of CD4-T-cells (6.6%) and predominance of CD8-T-cells (48%) and NK-cells (47%); while large granular lymphocytes (LGL) predominated in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission. CONCLUSION This is the first case of a patient with relapsing-remitting MS with neutropenia two months post-Alemtuzumab, with simultaneous presence of LGL cells in the blood and a robust therapeutic response to prednisolone. We recommend testing with a complete blood count every 15 days in the first 3 months after the 1st Alemtuzumab administration and searching for large granular lymphocytes cell expansion on microscopic examination of the peripheral blood if neutropenia develops.
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Affiliation(s)
- A. G. Vakrakou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - D. Tzanetakos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - S. Valsami
- Department of Blood Transfusion, Medical School of Athens, National & Kapodistrian University, Aretaieion Hospital, Athens, Greece
| | - E. Grigoriou
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - K. Psarra
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - J. Tzartos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - M. Anagnostouli
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - E. Andreadou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - M. E. Evangelopoulos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - G. Koutsis
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - C. Chrysovitsanou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - E. Gialafos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - A. Dimitrakopoulos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - L. Stefanis
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - C. Kilidireas
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
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Tüzün E, Gezen-Ak D, Tzartos J, Dursun E, Giriş M, Zisimopoulou P, Karagiorgou K, Yetimler B, Küçükali Cİ, İdrisoğlu HA. LRP4 antibody positive amyotrophic lateral sclerosis patients display neuropil-reactive IgG and enhanced serum complement levels. Immunol Lett 2018; 203:54-56. [PMID: 30227179 DOI: 10.1016/j.imlet.2018.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/08/2018] [Accepted: 09/14/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey.
| | - Duygu Gezen-Ak
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - John Tzartos
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece
| | - Erdinç Dursun
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Giriş
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | | | | | - Berrak Yetimler
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Halil Atilla İdrisoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Altıokka-Uzun G, Erdağ E, Baykan B, Tzartos J, Gezen-Ak D, Samancı B, Dursun E, Zisimopoulou P, Karagiorgou K, Stergiou C, Şahin E, Ekizoğlu E, Kürtüncü M, Tüzün E. Glial and neuronal antibodies in patients with idiopathic intracranial hypertension. Neurol Sci 2017; 38:1817-1822. [PMID: 28733756 DOI: 10.1007/s10072-017-3066-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/10/2017] [Indexed: 02/08/2023]
Abstract
Headache and visual disturbances are the main presenting symptoms of idiopathic intracranial hypertension (IIH) characterized by increased intracranial pressure (ICP) with an unknown cause. We aimed to investigate the antibodies against optic neuritis-associated glial antigens, aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) and uncharacterized neuronal membrane antigens in IIH patients. Consecutive patients diagnosed according to Friedman revised diagnostic criteria and control subjects were included after their consent. All serum samples were analyzed for antibodies against AQP4 and MOG using cell-based immunofluorescent assays and for uncharacterized neuronal membrane antigens by indirect immunocytochemistry utilizing live neurons. Sera of 34 patients with IIH and 40 control subjects were investigated but none of the patients showed AQP4 and MOG antibodies. However, serum IgG of five IIH patients showed reactivity against membrane antigens of rat hippocampal and cortical neurons. Interestingly, three out of these five patients had nonspecific white matter lesions on MRI, whereas only four of all other patients had these lesions (p = 0.048). AQP4 and MOG antibodies do not seem to have a role in the pathophysiology of IIH. However, association of immunocytochemistry findings with the presence of white matter lesions may suggest that immunological factors contribute to the pathogenesis of IIH in at least some of the patients.
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Affiliation(s)
- Güneş Altıokka-Uzun
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey.
| | - Ece Erdağ
- Department of Neuroscience, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey
| | - John Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,Hellenic Pasteur Institute, Athens, Greece
| | - Duygu Gezen-Ak
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bedia Samancı
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey
| | - Erdinç Dursun
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | | | | | - Erdi Şahin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey
| | - Esme Ekizoğlu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34104, Istanbul, Turkey
| | - Erdem Tüzün
- Department of Neuroscience, Institute for Experimental Medical Research, Istanbul University, Istanbul, Turkey
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34
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Stergiou C, Lazaridis K, Zouvelou V, Tzartos J, Mantegazza R, Antozzi C, Andreetta F, Evoli A, Deymeer F, Saruhan-Direskeneli G, Durmus H, Brenner T, Vaknin A, Berrih-Aknin S, Behin A, Sharshar T, De Baets M, Losen M, Martinez-Martinez P, Kleopa KA, Zamba-Papanicolaou E, Kyriakides T, Kostera-Pruszczyk A, Szczudlik P, Szyluk B, Lavrnic D, Basta I, Peric S, Tallaksen C, Maniaol A, Gilhus NE, Casasnovas Pons C, Pitha J, Jakubíkova M, Hanisch F, Bogomolovas J, Labeit D, Labeit S, Tzartos SJ. Titin antibodies in "seronegative" myasthenia gravis--A new role for an old antigen. J Neuroimmunol 2016; 292:108-15. [PMID: 26943968 DOI: 10.1016/j.jneuroim.2016.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
Myasthenia gravis (MG) is an autoimmune disease caused by antibodies targeting the neuromuscular junction of skeletal muscles. Triple-seronegative MG (tSN-MG, without detectable AChR, MuSK and LRP4 antibodies), which accounts for ~10% of MG patients, presents a serious gap in MG diagnosis and complicates differential diagnosis of similar disorders. Several AChR antibody positive patients (AChR-MG) also have antibodies against titin, usually detected by ELISA. We have developed a very sensitive radioimmunoprecipitation assay (RIPA) for titin antibodies, by which many previously negative samples were found positive, including several from tSN-MG patients. The validity of the RIPA results was confirmed by western blots. Using this RIPA we screened 667 MG sera from 13 countries; as expected, AChR-MG patients had the highest frequency of titin antibodies (40.9%), while MuSK-MG and LRP4-MG patients were positive in 14.6% and 16.4% respectively. Most importantly, 13.4% (50/372) of the tSN-MG patients were also titin antibody positive. None of the 121 healthy controls or the 90 myopathy patients, and only 3.6% (7/193) of other neurological disease patients were positive. We thus propose that the present titin antibody RIPA is a useful tool for serological MG diagnosis of tSN patients.
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Affiliation(s)
- C Stergiou
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece
| | | | - V Zouvelou
- Neurology Department, Aeginition Hospital, Athens, Greece
| | - J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece
| | - R Mantegazza
- Neurological Institute "C. Besta", Milano, Italy
| | - C Antozzi
- Neurological Institute "C. Besta", Milano, Italy
| | - F Andreetta
- Neurological Institute "C. Besta", Milano, Italy
| | - A Evoli
- Institute of Neurology, Catholic University, Rome, Italy
| | - F Deymeer
- Istanbul University, Istanbul, Turkey
| | | | - H Durmus
- Istanbul University, Istanbul, Turkey
| | - T Brenner
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Vaknin
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - A Behin
- UPMC and INSERM, Paris, France
| | - T Sharshar
- Raymond Poincaré Hospital, Garches, France
| | - M De Baets
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - M Losen
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - P Martinez-Martinez
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - K A Kleopa
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - T Kyriakides
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - P Szczudlik
- Department of Neurology, Medical University of Warsaw, Poland
| | - B Szyluk
- Department of Neurology, Medical University of Warsaw, Poland
| | - D Lavrnic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Basta
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - S Peric
- Neurology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - C Tallaksen
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway; Faculty of Medicine, Olso University, Norway
| | - A Maniaol
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - N E Gilhus
- Department of Clinical Medicine, University of Bergen, Norway
| | | | - J Pitha
- Department of Neurology and Clinical Neuroscience Center, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic
| | - M Jakubíkova
- Department of Neurology and Clinical Neuroscience Center, 1st Faculty of Medicine, Charles University and General Teaching Hospital, Prague, Czech Republic
| | - F Hanisch
- Universitätsklinikum Halle, Halle, Germany
| | - J Bogomolovas
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany
| | - D Labeit
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany; Myomedix GmbH, 69151 Neckargemuend, Germany
| | - S Labeit
- Faculty of Clinical Medicine Manheim, University of Heidelberg, Germany
| | - S J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; Tzartos NeuroDiagnostics, Athens, Greece.
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35
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Tzartos J, Zisimopoulou P, Rentzos M, Karandreas N, Zouvelou V, Evangelakou P, Tsonis A, Thomaidis T, Lauria G, Andreetta F, Mantegazza R, Tzartos S. Antibodies to LRP4 in serum and CSF from amyotrophic lateral sclerosis patients. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Tüzün E, Tzartos J, Ekizoğlu E, Stergiou C, Zisimopoulou P, Coban A, Shugaiv E, Türkoğlu R, Kürtüncü M, Baykan B, Tzartos S. Aquaporin-1 antibody in neuromyelitis optical patients. Eur Neurol 2014; 72:271-2. [PMID: 25277962 DOI: 10.1159/000364904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/25/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/METHODS To find out the prevalence of aquaporin-antibody (Aqp-Ab) and characterize Aqp-Ab associated clinical features in NMO, Aqp-1 and Aqp-4-Abs were examined using radioimmunoprecipitation and cell-based assays, respectively. RESULTS Aqp-4 and Aqp-1-Abs were detected in 20/30 and 8/30 NMO patients, respectively. One patient was Aqp-1-Ab single-positive, 13 patients were Aqp-4-Ab single-positive, 7 patients were Aqp-4/Aqp-1-Ab double-positive and 9 patients were seronegative. All double-positive patients had optic neuritis during the first attack. Only 2/29 MS patients and none of the control idiopathic intracranial hypertension patients were Aqp-1-Ab positive. CONCLUSION Aqp-1-Ab is usually detected in Aqp-4-Ab positive NMO patients and might be involved in optic neuritis pathogenesis.
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Affiliation(s)
- Erdem Tüzün
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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37
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Zisimopoulou P, Evangelakou P, Tzartos J, Lazaridis K, Zouvelou V, Mantegazza R, Antozzi C, Andreetta F, Evoli A, Deymeer F, Saruhan-Direskeneli G, Durmus H, Brenner T, Vaknin A, Berrih-Aknin S, Frenkian Cuvelier M, Stojkovic T, DeBaets M, Losen M, Martinez-Martinez P, Kleopa KA, Zamba-Papanicolaou E, Kyriakides T, Kostera-Pruszczyk A, Szczudlik P, Szyluk B, Lavrnic D, Basta I, Peric S, Tallaksen C, Maniaol A, Tzartos SJ. A comprehensive analysis of the epidemiology and clinical characteristics of anti-LRP4 in myasthenia gravis. J Autoimmun 2013; 52:139-45. [PMID: 24373505 DOI: 10.1016/j.jaut.2013.12.004] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 12/08/2013] [Indexed: 11/29/2022]
Abstract
Double-seronegative myasthenia gravis (dSN-MG, without detectable AChR and MuSK antibodies) presents a serious gap in MG diagnosis and understanding. Recently, autoantibodies against the low-density lipoprotein receptor-related protein 4 (LRP4) have been identified in several dSN-MG sera, but with dramatic frequency variation (∼2-50%). We have developed a cell based assay (CBA) based on human LRP4 expressing HEK293 cells, for the reliable and efficient detection of LRP4 antibodies. We have screened about 800 MG patient sera from 10 countries for LRP4 antibodies. The overall frequency of LRP4-MG in the dSN-MG group (635 patients) was 18.7% but with variations among different populations (range 7-32.7%). Interestingly, we also identified double positive sera: 8/107 anti-AChR positive and 10/67 anti-MuSK positive sera also had detectable LRP4 antibodies, predominantly originating from only two of the participating groups. No LRP4 antibodies were identified in sera from 56 healthy controls tested, while 4/110 from patients with other neuroimmune diseases were positive. The clinical data, when available, for the LRP4-MG patients were then studied. At disease onset symptoms were mild (81% had MGFA grade I or II), with some identified thymic changes (32% hyperplasia, none with thymoma). On the other hand, double positive patients (AChR/LRP4-MG and MuSK/LRP4-MG) had more severe symptoms at onset compared with any single positive MG subgroup. Contrary to MuSK-MG, 27% of ocular dSN-MG patients were LRP4 antibody positive. Similarly, contrary to MuSK antibodies, which are predominantly of the IgG4 subtype, LRP4 antibodies were predominantly of the IgG1 and IgG2 subtypes. The prevalence was higher in women than in men (female/male ratio 2.5/1), with an average disease onset at ages 33.4 for females and 41.9 for males. Overall, the response of LRP4-MG patients to treatment was similar to published responses of AChR-MG rather than to MuSK-MG patients.
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Affiliation(s)
| | - P Evangelakou
- Hellenic Pasteur Institute, Athens, Greece; University of Patras, Patras, Greece
| | - J Tzartos
- Hellenic Pasteur Institute, Athens, Greece
| | | | - V Zouvelou
- Neurology Department, Aeginition Hospital, Athens, Greece
| | - R Mantegazza
- Neurological Institute "C. Besta", Milano, Italy
| | - C Antozzi
- Neurological Institute "C. Besta", Milano, Italy
| | - F Andreetta
- Neurological Institute "C. Besta", Milano, Italy
| | - A Evoli
- Institute of Neurology, Catholic University, Rome, Italy
| | - F Deymeer
- Istanbul University, Istanbul, Turkey
| | | | - H Durmus
- Istanbul University, Istanbul, Turkey
| | - T Brenner
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A Vaknin
- Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - M DeBaets
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - M Losen
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - P Martinez-Martinez
- School for Mental Health and Neuroscience, Maastricht University, The Netherlands
| | - K A Kleopa
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - T Kyriakides
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - P Szczudlik
- Department of Neurology, Medical University of Warsaw, Poland
| | - B Szyluk
- Department of Neurology, Medical University of Warsaw, Poland
| | - D Lavrnic
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - I Basta
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - S Peric
- Serbia, Clinic of Neurology, Clinical Center of Serbia, Serbia
| | - C Tallaksen
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - A Maniaol
- Norway Department of Neurology, Ullevaal University Hospital, Oslo, Norway
| | - S J Tzartos
- Hellenic Pasteur Institute, Athens, Greece; University of Patras, Patras, Greece.
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Tzartos J, Stergiou C, Alexopoulos H, Zisimopoulou P, Karageorgiou C, Kilintireas K, Dalakas M, Tzartos S. Highly Sensitive Radioimmunoassay Identifies Anti-Aquaporin-4 Autoantibodies in Several "Seronegative" Patients Suspected for Neuromyelitis Optica-Spectrum Disorders (NMO) (P02.133). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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German AC, Myint KSA, Mai NTH, Pomeroy I, Phu NH, Tzartos J, Winter P, Collett J, Farrar J, Barrett A, Kipar A, Esiri MM, Solomon T. A preliminary neuropathological study of Japanese encephalitis in humans and a mouse model. Trans R Soc Trop Med Hyg 2006; 100:1135-45. [PMID: 16814333 DOI: 10.1016/j.trstmh.2006.02.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 11/30/2022] Open
Abstract
Japanese encephalitis virus is a mosquito-borne flavivirus that causes approximately 10000 deaths annually in Asia. After a brief viraemia, the virus enters the central nervous system, but the means of crossing the blood-brain barrier is uncertain. We used routine histological staining, immunohistology and electron microscopy to examine brain material from four fatal human cases, and made comparisons with material from a mouse model. In human material there was oedema, perivascular inflammation, haemorrhage, microglial nodules and acellular necrotic foci, as has been described previously. In addition, there was new evidence suggestive of viral replication in the vascular endothelium, with endothelial cell damage; this included occasional viral antigen staining, uneven binding of the vascular endothelial cells to Ulex europaeus agglutinin I and ultrastructural changes. Viral antigen was also found in neurons. There was an active astrocytic response, as shown by glial fibrillary acidic protein staining, and activation of microglial cells was demonstrated by an increase in major histocompatibility complex class II expression. Similar inflammatory infiltrates and a microglial reaction were observed in mouse brain tissue. In addition, beta-amyloid precursor protein staining indicated impaired axonal transport. Whether these findings are caused by viral replication in the vascular endothelium or the immune response merits further investigation.
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Affiliation(s)
- Allison C German
- Division of Medical Microbiology, University of Liverpool, Liverpool, UK
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