3
|
Honorat JA, Komorowski L, Josephs KA, Fechner K, St Louis EK, Hinson SR, Lederer S, Kumar N, Gadoth A, Lennon VA, Pittock SJ, McKeon A. IgLON5 antibody: Neurological accompaniments and outcomes in 20 patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e385. [PMID: 28761904 PMCID: PMC5515599 DOI: 10.1212/nxi.0000000000000385] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/08/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the phenotypes, treatment response, and outcome of IgLON5 autoimmunity. METHODS Archived serum and CSF specimens from 367 patients known to harbor unclassified antibodies which stained neural synapses diffusely (mimicking amphiphysin-IgG) were reevaluated by indirect immunofluorescence assay (IFA) using a composite of mouse tissues and recombinant IgLON5-transfected cell-based assay (CBA, Euroimmun). RESULTS Available specimens (serum, 25; CSF, 9) from 26/367 patients (7%) had identical IFA appearance and robust IgLON5 CBA positivity. Clinical information was available for 20/26 patients; 13 were women. Median disease-onset age was 62 years (range, 46-75 years). Most patients had insidious onset and progression of neurological symptoms affecting movement and sleep predominantly. Sleep disorders were sleep-disordered breathing (11) and parasomnias (3). Brainstem disorders were gait instability (14), dysphagia (10), abnormal eye movements (7), respiratory dysfunction (6), ataxia (5), craniocervical dystonia (3), and dysarthria (3). Findings compatible with hyperexcitability included myoclonus (3), cramps (3), fasciculations (2), and exaggerated startle (2). Neuropsychiatric disorders included cognitive dysfunction (6), psychiatric symptoms (5), and seizures (1). Dysautonomia, in 9, affected bladder function (7), gastrointestinal motility (3), thermoregulation (3), and orthostatic tolerance (1). Just 2 patients had coexisting autoimmune disease. Brain MRI findings were nonspecific and CSF was noninflammatory in all tested. Seven of 9 immunotherapy-treated patients improved: 6 of those 7 were stable at last follow-up. Three untreated patients died. Each IgLON5-IgG subclass (1-4) was readily detectable in ≥80% of specimens using CBA. CONCLUSIONS IgLON5-IgG is diagnostic of a potentially treatable neurological disorder, where autoimmune clues are otherwise lacking.
Collapse
Affiliation(s)
- Josephe A Honorat
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Lars Komorowski
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Keith A Josephs
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Kai Fechner
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Erik K St Louis
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Shannon R Hinson
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Sabine Lederer
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Neeraj Kumar
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Avi Gadoth
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology (J.A.H., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (K.A.J., E.K.S.L., N.K., A.G., V.A.L., S.J.P., A.M.), Department of Medicine (E.K.S.L.), Department of Immunology (V.A.L.), and Center for Sleep Medicine (E.K.S.L.), College of Medicine, Mayo Clinic, Rochester, MN; and Institute of Experimental Immunology (L.K., K.F., S.L.), Euroimmun AG, Lubeck, Germany
| |
Collapse
|
4
|
Hasan MM, DeFaveri J, Kuure S, Dash SN, Lehtonen S, Merilä J, McCairns RJS. Kidney morphology and candidate gene expression shows plasticity in sticklebacks adapted to divergent osmotic environments. J Exp Biol 2017; 220:2175-2186. [DOI: 10.1242/jeb.146027] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 03/27/2017] [Indexed: 01/09/2023]
Abstract
Novel physiological challenges in different environments can promote the evolution of divergent phenotypes, either through plastic or genetic changes. Environmental salinity serves as a key barrier to the distribution of nearly all aquatic organisms, and species diversification is likely to be enabled by adaptation to alternative osmotic environments. The threespine stickleback (Gasterosteus aculeatus) is a euryhaline species with populations found both in marine and freshwater environments. It has evolved both highly plastic and locally adapted phenotypes due to salinity-derived selection, but the physiological and genetic basis of adaptation to salinity is not fully understood. We integrated comparative cellular morphology of the kidney, a key organ for osmoregulation, and candidate gene expression to explore the underpinnings of evolved variation in osmotic plasticity within two populations of sticklebacks from distinct salinity zones in the Baltic Sea: the high salinity Kattegat, representative of the ancestral marine habitat, and the low salinity Bay of Bothnia. A common-garden experiment revealed that kidney morphology in the ancestral high salinity population had a highly plastic response to salinity conditions, whereas this plastic response was reduced in the low salinity population. Candidate gene expression in kidney tissue revealed a similar pattern of population-specific differences, with a higher degree of plasticity in the native high salinity population. Together these results suggest that renal cellular morphology has become canalized to low salinity, and that these structural differences may have functional implications for osmoregulation.
Collapse
Affiliation(s)
- M. Mehedi Hasan
- Fisheries and Marine Resource Technology Discipline, Khulna University, Khulna, Bangladesh
- Ecological Genetics Research Unit, Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Jacquelin DeFaveri
- Ecological Genetics Research Unit, Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Satu Kuure
- Institute of Biotechnology & Laboratory Animal Centre, University of Helsinki, Helsinki, Finland
| | - Surjya N. Dash
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Sanna Lehtonen
- Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Juha Merilä
- Ecological Genetics Research Unit, Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - R. J. Scott McCairns
- Ecological Genetics Research Unit, Department of Biosciences, University of Helsinki, Helsinki, Finland
- ESE, Ecology and Ecosystem Health, INRA, Agrocampus Ouest, 35042 Rennes, France
| |
Collapse
|