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Yu Q, Ding J, Li S, Li Y. Autophagy in cancer immunotherapy: Perspective on immune evasion and cell death interactions. Cancer Lett 2024; 590:216856. [PMID: 38583651 DOI: 10.1016/j.canlet.2024.216856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
Both the innate and adaptive immune systems work together to produce immunity. Cancer immunotherapy is a novel approach to tumor suppression that has arisen in response to the ineffectiveness of traditional treatments like radiation and chemotherapy. On the other hand, immune evasion can diminish immunotherapy's efficacy. There has been a lot of focus in recent years on autophagy and other underlying mechanisms that impact the possibility of cancer immunotherapy. The primary feature of autophagy is the synthesis of autophagosomes, which engulf cytoplasmic components and destroy them by lysosomal degradation. The planned cell death mechanism known as autophagy can have opposite effects on carcinogenesis, either increasing or decreasing it. It is autophagy's job to maintain the balance and proper functioning of immune cells like B cells, T cells, and others. In addition, autophagy controls whether macrophages adopt the immunomodulatory M1 or M2 phenotype. The ability of autophagy to control the innate and adaptive immune systems is noteworthy. Interleukins and chemokines are immunological checkpoint chemicals that autophagy regulates. Reducing antigen presentation to induce immunological tolerance is another mechanism by which autophagy promotes cancer survival. Therefore, targeting autophagy is of importance for enhancing potential of cancer immunotherapy.
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Affiliation(s)
- Qiang Yu
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jiajun Ding
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Shisen Li
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Yunlong Li
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
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Ross LA, Lee J, Carlson AK, Conway DS, Cohen JA, Graves J, Zamvil SS, Newsome SD, Kunchok A. Progressive Encephalomyelopathy in an Older Man: A Case Report From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200210. [PMID: 38386951 PMCID: PMC10900913 DOI: 10.1212/nxi.0000000000200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Abstract
We present a case of subacute onset progressive encephalomyelopathy in a 77-year-old man with symmetric lateral column signal abnormalities on spinal MRI. We discuss the differential and presumptive final diagnosis along with a review of the postulated disease immunopathogenesis.
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Affiliation(s)
- Lindsay A Ross
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jonathan Lee
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Alise K Carlson
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Devon S Conway
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jeffrey A Cohen
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jennifer Graves
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Scott D Newsome
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Amy Kunchok
- From the Mellen Center for Multiple Sclerosis Treatment and Research (L.A.R., A.K.C., D.S.C., J.A.C., A.K.) and Diagnostic Radiology (J.L.), Cleveland Clinic, OH; Department of Neurosciences (J.G.), University of California San Diego, La Jolla, CA; UCSF Weill Institute of Neurosciences (S.S.Z.), University of California at San Francisco; and Department of Neurology (S.D.N.), Johns Hopkins School of Medicine, Baltimore, MD
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Faure F, Yshii L, Renno T, Coste I, Joubert B, Desestret V, Liblau R, Honnorat J. A Pilot Study to Develop Paraneoplastic Cerebellar Degeneration Mouse Model. CEREBELLUM (LONDON, ENGLAND) 2024; 23:181-196. [PMID: 36729270 DOI: 10.1007/s12311-023-01524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/03/2023]
Abstract
Modeling paraneoplastic neurological diseases to understand the immune mechanisms leading to neuronal death is a major challenge given the rarity and terminal access of patients' autopsies. Here, we present a pilot study aiming at modeling paraneoplastic cerebellar degeneration with Yo autoantibodies (Yo-PCD). Female mice were implanted with an ovarian carcinoma cell line expressing CDR2 and CDR2L, the known antigens recognized by anti-Yo antibodies. To boost the immune response, we also immunized the mice by injecting antigens with diverse adjuvants and immune checkpoint inhibitors. Ataxia and gait instability were assessed in treated mice as well as autoantibody levels, Purkinje cell density, and immune infiltration in the cerebellum. We observed the production of anti-Yo antibodies in the CSF and serum of all immunized mice. Brain immunoreaction varied depending on the site of implantation of the tumor, with subcutaneous administration leading to a massive infiltration of immune cells in the meningeal spaces, choroid plexus, and cerebellar parenchyma. However, we did not observe massive Purkinje cell death nor any motor impairments in any of the experimental groups. Self-sustained neuro-inflammation might require a longer time to build up in our model. Unusual tumor antigen presentation and/or intrinsic, species-specific factors required for pro-inflammatory engagement in the brain may also constitute strong limitations to achieve massive recruitment of antigen-specific T-cells and killing of antigen-expressing neurons in this mouse model.
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Affiliation(s)
- Fabrice Faure
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène (INMG)-MeLis, INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, 69373, Lyon, France
| | - Lidia Yshii
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, 31024, Toulouse, France
- Department of Immunology, Toulouse University Hospital, 31300, Toulouse, France
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000, Louvain, Belgium
- Department of Neurosciences, KU Leuven, 3000, Louvain, Belgium
| | - Toufic Renno
- Cancer Research Centre of Lyon, Université de Lyon, INSERM 1052, CNRS 5286, 69008, Lyon, France
| | - Isabelle Coste
- Cancer Research Centre of Lyon, Université de Lyon, INSERM 1052, CNRS 5286, 69008, Lyon, France
| | - Bastien Joubert
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène (INMG)-MeLis, INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, 69373, Lyon, France
- French Reference Centre On Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | - Virginie Desestret
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène (INMG)-MeLis, INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, 69373, Lyon, France
- French Reference Centre On Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677, Bron Cedex, France
| | - Roland Liblau
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, 31024, Toulouse, France
- Department of Immunology, Toulouse University Hospital, 31300, Toulouse, France
| | - Jérôme Honnorat
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène (INMG)-MeLis, INSERM U1314, CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, 69373, Lyon, France.
- French Reference Centre On Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69677, Bron Cedex, France.
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McKeon A, Tracy J. Paraneoplastic movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:211-227. [PMID: 38494279 DOI: 10.1016/b978-0-12-823912-4.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic movement disorders are diverse autoimmune neurological illnesses occurring in the context of systemic cancer, either in isolation or as part of a multifocal neurological disease. Movement phenomena may be ataxic, hypokinetic (parkinsonian), or hyperkinetic (myoclonus, chorea, or other dyskinetic disorders). Some disorders mimic neurodegenerative or hereditary illnesses. The subacute onset and coexisting nonclassic features of paraneoplastic disorders aid distinction. Paraneoplastic autoantibodies provide further information regarding differentiating cancer association, disease course, and treatment responses. A woman with cerebellar ataxia could have metabotropic glutamate receptor 1 autoimmunity, in the setting of Hodgkin lymphoma, a mild neurological phenotype and response to immunotherapy. A different woman, also with cerebellar ataxia, could have Purkinje cytoplasmic antibody type 1 (anti-Yo), accompanying ovarian adenocarcinoma, a rapidly progressive phenotype and persistent disabling deficits despite immune therapy. The list of antibody biomarkers is growing year-on-year, each with its own ideal specimen type for detection (serum or CSF), accompanying neurological manifestations, cancer association, treatment response, and prognosis. Therefore, a profile-based approach to screening both serum and CSF is recommended. Immune therapy trials are generally undertaken, and include one or more of corticosteroids, IVIg, plasma exchange, rituximab, or cyclophosphamide. Symptomatic therapies can also be employed for hyperkinetic disorders.
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Affiliation(s)
- Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Jennifer Tracy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Shelly S, Dubey D, Mills JR, Klein CJ. Paraneoplastic neuropathies and peripheral nerve hyperexcitability disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:239-273. [PMID: 38494281 DOI: 10.1016/b978-0-12-823912-4.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathy is a common referral for patients to the neurologic clinics. Paraneoplastic neuropathies account for a small but high morbidity and mortality subgroup. Symptoms include weakness, sensory loss, sweating irregularity, blood pressure instability, severe constipation, and neuropathic pain. Neuropathy is the first presenting symptom of malignancy among many patients. The molecular and cellular oncogenic immune targets reside within cell bodies, axons, cytoplasms, or surface membranes of neural tissues. A more favorable immune treatment outcome occurs in those where the targets reside on the cell surface. Patients with antibodies binding cell surface antigens commonly have neural hyperexcitability with pain, cramps, fasciculations, and hyperhidrotic attacks (CASPR2, LGI1, and others). The antigenic targets are also commonly expressed in the central nervous system, with presenting symptoms being myelopathy, encephalopathy, and seizures with neuropathy, often masked. Pain and autonomic components typically relate to small nerve fiber involvement (nociceptive, adrenergic, enteric, and sudomotor), sometimes without nerve fiber loss but rather hyperexcitability. The specific antibodies discovered help direct cancer investigations. Among the primary axonal paraneoplastic neuropathies, pathognomonic clinical features do not exist, and testing for multiple antibodies simultaneously provides the best sensitivity in testing (AGNA1-SOX1; amphiphysin; ANNA-1-HU; ANNA-3-DACH1; CASPR2; CRMP5; LGI1; PCA2-MAP1B, and others). Performing confirmatory antibody testing using adjunct methods improves specificity. Antibody-mediated demyelinating paraneoplastic neuropathies are limited to MAG-IgM (IgM-MGUS, Waldenström's, and myeloma), with the others associated with cytokine elevations (VEGF, IL6) caused by osteosclerotic myeloma, plasmacytoma (POEMS), and rarely angiofollicular lymphoma (Castleman's). Paraneoplastic disorders have clinical overlap with other idiopathic antibody disorders, including IgG4 demyelinating nodopathies (NF155 and Contactin-1). This review summarizes the paraneoplastic neuropathies, including those with peripheral nerve hyperexcitability.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Dalmau J. Changing landscape in the field of paraneoplastic neurology: Personal perspectives over a 35-year career. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:11-32. [PMID: 38494272 DOI: 10.1016/b978-0-12-823912-4.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes are a group of rare disorders that have fascinated neurologists for more than a century. The discovery in the 1980s that many of these disorders occurred in association with antibodies against neuronal proteins revived the interest for these diseases. This chapter first traces the history of the paraneoplastic neurologic syndromes during the era that preceded the discovery of immune mechanisms and then reviews the immunologic period during which many of these syndromes were found to be associated with antibodies against intracellular onconeuronal proteins and pathogenic cytotoxic T-cell mechanisms. Alongside these developments, investigations on the antibody-mediated disorders of the peripheral nervous system, such as the myasthenic syndromes or neuromyotonia, provided suggestions for the study of the central nervous system (CNS) syndromes. These converging areas of research culminated with the groundbreaking discovery of a new category of CNS disorders mediated by antibodies against neuronal surface proteins or receptors. These disorders are not always paraneoplastic, and the understanding of these syndromes and mechanisms has changed the landscape of neurology and neurosciences.
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Affiliation(s)
- Josep Dalmau
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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Abbatemarco JR, Vedeler CA, Greenlee JE. Paraneoplastic cerebellar and brainstem disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:173-191. [PMID: 38494276 DOI: 10.1016/b978-0-12-823912-4.00030-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic cerebellar and brainstem disorders are a heterogeneous group that requires prompt recognition and treatment to help prevent irreversible neurologic injury. Paraneoplastic cerebellar degeneration is best characterized by Yo antibodies in patients with breast or ovarian cancer. Tr (DNER) antibodies in patients with Hodgkin lymphoma can also present with a pure cerebellar syndrome and is one of the few paraneoplastic syndromes found with hematological malignancy. Opsoclonus-myoclonus-ataxia syndrome presents in both pediatric and adult patients with characteristic clinical findings. Other paraneoplastic brainstem syndromes are associated with Ma2 and Hu antibodies, which can cause widespread neurologic dysfunction. The differential for these disorders is broad and also includes pharmacological side effects, infection or postinfectious processes, and neurodegenerative diseases. Although these immune-mediated disorders have been known for many years, mechanisms of pathogenesis are still unclear, and optimal treatment has not been established.
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Affiliation(s)
- Justin R Abbatemarco
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - Christian A Vedeler
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - John E Greenlee
- Neurology Service, George E. Wahlen Veterans Affairs Health Care System, Salt Lake City, UT, United States; Department of Neurology, University of Utah, Salt Lake City, UT, United States
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Pittock SJ, Giometto B. Introduction and overview of immunopathological mechanisms and future directions. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:3-10. [PMID: 38494284 DOI: 10.1016/b978-0-12-823912-4.00029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurological disorders represent a significant part of the field of autoimmune neurology. Most neural autoantibodies discovered to date are associated with underlying malignancy and in that context are considered paraneoplastic antibody biomarkers. These autoantibodies can be divided into two major categories: those that target intracellular proteins (not pathogenic) and those that target plasma membrane proteins (pathogenic). Disorders accompanied by the former are mediated primarily by neural peptide-specific cytotoxic T-cells, are commonly associated with cancer, and are poorly responsive to immunotherapy. Disorders accompanied by the latter represent antibody-mediated diseases and are generally more responsive to immunotherapy. Areas of significant unmet need in the context of paraneoplastic neurological disorders include novel therapeutic options, as FDA-approved therapies are lacking. This chapter provides a brief overview of immunopathological mechanisms and potential future therapeutic targets. Our contributing authors and their chapters are also introduced.
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Affiliation(s)
- Sean J Pittock
- Department of Neurology and Laboratory Medicine and Pathology and Center for MS and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, United States.
| | - Bruno Giometto
- Department of Neurology, Azienda Provinciale per I Servizi Sanitari (APSS) and University of Trento (Italy), Santa Chiara Hospital, Trento, Italy
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Rezk M, Pittock SJ, Kapadia RK, Knight AM, Guo Y, Gupta P, LaFrance-Corey RG, Zekeridou A, McKeon A, Dasari S, Mills JR, Dubey D. Identification of SKOR2 IgG as a novel biomarker of paraneoplastic neurologic syndrome. Front Immunol 2023; 14:1243946. [PMID: 37795104 PMCID: PMC10546397 DOI: 10.3389/fimmu.2023.1243946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction The development of new autoantigen discovery techniques, like programmable phage immunoprecipitation sequencing (PhIP-Seq), has accelerated the discovery of neural-specific autoantibodies. Herein, we report the identification of a novel biomarker for paraneoplastic neurologic syndrome (PNS), Sloan-Kettering-Virus-Family-Transcriptional-Corepressor-2 (SKOR2)-IgG, utilizing PhIP-Seq. We have also performed a thorough clinical validation using normal, healthy, and disease/cancer control samples. Methods Stored samples with unclassified staining at the junction of the Purkinje cell and the granule cell layers were analyzed by PhIP-Seq for putative autoantigen identification. The autoantigen was confirmed by recombinant antigen-expressing cell-based assay (CBA), Western blotting, and tissue immunofluorescence assay colocalization. Results PhIP-Seq data revealed SKOR2 as the candidate autoantigen. The target antigen was confirmed by a recombinant SKOR-2-expressing, and cell lysate Western blot. Furthermore, IgG from both patient samples colocalized with a commercial SKOR2-specific IgG on cryosections of the mouse brain. Both SKOR2 IgG-positive patients had central nervous system involvement, one presenting with encephalitis and seizures (Patient 1) and the other with cognitive dysfunction, spastic ataxia, dysarthria, dysphagia, and pseudobulbar affect (Patient 2). They had a refractory progressive course and were diagnosed with adenocarcinoma (Patient 1: lung, Patient 2: gallbladder). Sera from adenocarcinoma patients without PNS (n=30) tested for SKOR2-IgG were negative. Discussion SKOR2 IgG represents a novel biomarker for PNS associated with adenocarcinoma. Identification of additional SKOR2 IgG-positive cases will help categorize the associated neurological phenotype and the risk of underlying malignancy.
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Affiliation(s)
- Mohamed Rezk
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Ronak K. Kapadia
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew M. Knight
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Pranjal Gupta
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | | | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Surendra Dasari
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - John R. Mills
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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Gyongyosi B, Magyar-Stang R, Takacs T, Szekely E, Illes Z, Nilsson C, Gyorke T, Barsi P, Juhasz D, Banky B, Bereczki D, Honnorat J, Gunda B. Paraneoplastic Kelch-like protein 11 antibody-associated cerebellar and limbic encephalitis caused by metastatic “burned-out” seminoma – A scar(r)y phenomenon. J Neuroimmunol 2023; 378:578073. [PMID: 36989702 DOI: 10.1016/j.jneuroim.2023.578073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION The diagnosis of paraneoplastic neurologic syndromes is challenging when the primary tumor masquerades as scar tissue (i.e. "burned-out"). METHODS Case report. RESULTS A 45-year-old male patient presented with progressive cerebellar symptoms and hearing loss. Initial screening for malignancy and extensive testing of paraneoplastic and autoimmune neuronal antibodies gave negative results. Repeated whole-body FDG-PET CT revealed a single paraaortic lymphadenopathy, metastasis of a regressed testicular seminoma. Anti-Kelch-like protein-11 (KLHL11) encephalitis was finally diagnosed. CONCLUSION Our case highlights the importance of continued efforts to find an often burned-out testicular cancer in patients with a highly unique clinical presentation of KLHL11 encephalitis.
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Affiliation(s)
- Benedek Gyongyosi
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, Budapest, Hungary; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary.
| | - Timea Takacs
- Department of Neurology, Semmelweis University, Budapest, Hungary; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Eszter Szekely
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Christine Nilsson
- Laboratory of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Tamas Gyorke
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Peter Barsi
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Daniel Juhasz
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Balazs Banky
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Jerome Honnorat
- French Reference Center on Paraneoplastic Neurological Diseases and Autoimmune Encephalitis, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Bence Gunda
- Department of Neurology, Semmelweis University, Budapest, Hungary
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11
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Younger DS. Paraneoplastic motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:231-250. [PMID: 37620071 DOI: 10.1016/b978-0-323-98817-9.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Paraneoplastic neurological disorders (PNDs) are heterogeneous clinicopathologic syndromes that occur throughout the neuraxis resulting from damage to organs or tissues remote from the site of a malignant neoplasm or its metastases. The discordance between severe neurological disability and even an indolent malignancy suggests an underlying neuroimmunologic host immune response that inflicts nervous tissue damage while inhibiting malignant tumor growth. Motor system involvement, like other symptoms and signs, is associated with focal or diffuse involvement of the brain, spinal cord, peripheral nerve, neuromuscular junction or muscle, alone or in combination due to an underlying neuroimmune and neuroinflammatory process targeting neural-specific antigens. Unrecognized and therefore untreated, PNDs are often lethal making early detection and aggressive treatment of paramount importance. While the combination of clinical symptoms and signs, and analysis of detailed body and neuroimaging, clinical neurophysiology and electrodiagnostic studies, and tumor and nervous system tissue biopsies are all vitally important, the certain diagnosis of a PND rests with the discovery of a corresponding neural-specific paraneoplastic autoantibody in the blood and/or spinal cerebrospinal fluid.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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12
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Rapid-onset paraneoplastic cerebellar degeneration successfully treated by radiotherapy and tumorectomy. Int Cancer Conf J 2022; 12:19-23. [PMID: 36605832 PMCID: PMC9807696 DOI: 10.1007/s13691-022-00569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023] Open
Abstract
We report the first-ever documented case of successful treatment of paraneoplastic cerebellar degeneration (PCD) with radiotherapy. A 31-year-old female presented with rapidly progressing neurological symptoms, which were revealed to be due to PCD secondary to an undiagnosed breast cancer. The cancer responded well to chemotherapy, but her neurological status continued to deteriorate, eventually progressing to complete expressive aphasia and dyssynergia with paraparesis. Due to the extraordinarily rapid progression of the disorder, a treatment with tumorectomy and radiotherapy of the whole brain was performed. This proved to be very successful, with a complete stop of the deterioration of symptoms after treatment and with a significant neurologic improvement in the following months. This case indicates that there may be a place for radiotherapy in the treatment of PCD. Current treatment options have proven insufficient and no guidelines for treatment currently exist. As such, the disorder remains associated with a very poor prognosis and often entails permanent loss of function. Radiation, with its known immunosuppressive effect and non-stochastic effects on the nervous system at the proper doses, might therefore be a valid option. However, we should note that it was in this instance combined with a removal of the primary tumor and as such, its individual efficacy cannot be considered proven.
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13
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Muñiz-Castrillo S, Vogrig A, Ciano-Petersen NL, Villagrán-García M, Joubert B, Honnorat J. Novelties in Autoimmune and Paraneoplastic Cerebellar Ataxias: Twenty Years of Progresses. CEREBELLUM (LONDON, ENGLAND) 2022; 21:573-591. [PMID: 35020135 DOI: 10.1007/s12311-021-01363-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Major advances in our knowledge concerning autoimmune and paraneoplastic cerebellar ataxias have occurred in the last 20 years. The discovery of several neural antibodies represents an undeniable contribution to this field, especially those serving as good biomarkers of paraneoplastic neurological syndromes and those showing direct pathogenic effects. Yet, many patients still lack detectable or known antibodies, and also many antibodies have only been reported in few patients, which makes it difficult to define in detail their clinical value. Nevertheless, a notable progress has additionally been made in the clinical characterization of patients with the main neural antibodies, which, although typically present with a subacute pancerebellar syndrome, may also show either hyperacute or chronic onsets that complicate the differential diagnoses. However, prodromal and transient features could be useful clues for an early recognition, and extracerebellar involvement may also be highly indicative of the associated antibody. Moreover, important advances in our understanding of the pathogenesis of cerebellar ataxias include the description of antibody effects, especially those targeting cell-surface antigens, and first attempts to isolate antigen-specific T-cells. Furthermore, genetic predisposition seems relevant, although differently involved according to cancer association, with particular HLA observed in non-paraneoplastic cases and genetic abnormalities in the tumor cells in paraneoplastic ones. Finally, immune checkpoint inhibitors used as cancer immunotherapy may rarely induce cerebellar ataxias, but even this undesirable effect may in turn serve to shed some light on their physiopathology. Herein, we review the principal novelties of the last 20 years regarding autoimmune and paraneoplastic cerebellar ataxias.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Macarena Villagrán-García
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France.
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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14
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Winklehner M, Bauer J, Endmayr V, Schwaiger C, Ricken G, Motomura M, Yoshimura S, Shintaku H, Ishikawa K, Tsuura Y, Iizuka T, Yokota T, Irioka T, Höftberger R. Paraneoplastic Cerebellar Degeneration With P/Q-VGCC vs Yo Autoantibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e200006. [PMID: 36070310 PMCID: PMC9278121 DOI: 10.1212/nxi.0000000000200006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Paraneoplastic cerebellar degeneration (PCD) is characterized by a widespread loss of Purkinje cells (PCs) and may be associated with autoantibodies against intracellular antigens such as Yo or cell surface neuronal antigens such as the P/Q-type voltage-gated calcium channel (P/Q-VGCC). Although the intracellular location of the target antigen in anti-Yo-PCD supports a T cell-mediated pathology, the immune mechanisms in anti-P/Q-VGCC-PCD remain unclear. In this study, we compare neuropathologic characteristics of PCD with anti-P/Q-VGCC and anti-Yo autoantibodies in an archival autopsy cohort. METHODS We performed neuropathology, immunohistochemistry, and multiplex immunofluorescence on formalin-fixed and paraffin-embedded brain tissue of 1 anti-P/Q-VGCC, 2 anti-Yo-PCD autopsy cases and controls. RESULTS Anti-Yo-PCD revealed a diffuse and widespread PC loss together with microglial nodules with pSTAT1+ and CD8+granzymeB+ T cells and neuronal upregulation of major histocompatibility complex (MHC) Class I molecules. Some neurons showed a cytoplasmic immunoglobulin G (IgG) staining. In contrast, PC loss in anti-P/Q-VGCC-PCD was focal and predominantly affected the upper vermis, whereas caudal regions and lateral hemispheres were spared. Inflammation was characterized by scattered CD8+ T cells, single CD20+/CD79a+ B/plasma cells, and an IgG staining of the neuropil in the molecular layer of the cerebellar cortex and neuronal cytoplasms. No complement deposition or MHC-I upregulation was detected. Moreover, synaptophysin was reduced, and neuronal P/Q-VGCC was downregulated. In affected areas, axonal spheroids and the accumulation of amyloid precursor protein and glucose-regulated protein 78 in PCs indicate endoplasmatic reticulum stress and impairment of axonal transport. In both PCD types, calbindin expression was reduced or lost in the remaining PCs. DISCUSSION Anti-Yo-PCD showed characteristic features of a T cell-mediated pathology, whereas this was not observed in 1 case of anti-P/Q-VGCC-PCD. Our findings support a pathogenic role of anti-P/Q-VGCC autoantibodies in causing neuronal dysfunction, probably due to altered synaptic transmission resulting in calcium dysregulation and subsequent PC death. Because disease progression may lead to irreversible PC loss, anti-P/Q-VGCC-PCD patients could benefit from early oncologic and immunologic therapies.
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Affiliation(s)
- Michael Winklehner
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Jan Bauer
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Verena Endmayr
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Carmen Schwaiger
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Gerda Ricken
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Masakatsu Motomura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Shunsuke Yoshimura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Hiroshi Shintaku
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Kinya Ishikawa
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Yukio Tsuura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Takahiro Iizuka
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Takanori Yokota
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
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15
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Jia Y, Li M, Li D, Zhang M, Wang H, Jiao L, Huang Z, Ye J, Liu A, Wang Y. Immune-Mediated Cerebellar Ataxia Associated With Neuronal Surface Antibodies. Front Immunol 2022; 13:813926. [PMID: 35250990 PMCID: PMC8891139 DOI: 10.3389/fimmu.2022.813926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/01/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Immune-mediated cerebellar ataxias (IMCAs) are common in paraneoplastic cerebellar degeneration (PCD) but rarely occur in patients with neuronal surface antibodies (NSAbs). Although cerebellar ataxias (CAs) associated with anti-NMDAR and anti-CASPR2 have been reported in a few cases, they have never been studied systematically. This study aimed to analyze the characteristics of anti-NSAbs-associated CAs. METHODS A retrospective investigation was conducted to identify patients using the keywords IMCAs and NSAbs. We collected the clinical data of 14 patients diagnosed with anti-NSAbs-associated CAs. RESULTS The median age was 33 years (16-66), and the male-to-female ratio was 4:3. Nine were positive for NMDAR-Ab, two for LGI1-Ab, two for CASPR2-Ab, and one for AMPA2R-Ab. CAs were initial symptoms in three patients and presented during the first two months of the disease course (10 days on average) among the rest of the patients. After the immunotherapy, two cases were free from symptoms, and eight cases recovered satisfactorily (10/14, 71.4%). Compared with other causes of IMCAs, anti-NSAbs were more frequently associated with additional extra-cerebellar symptoms (85.7%), mostly seizures (78.6%) and mental abnormalities (64.3%). In the CSF analysis, pleocytosis was detected in ten patients (71.4%) and oligoclonal bands (OB) were observed in nine patients (64.3%). Moreover, compared with PCD and anti-GAD65-Ab-associated CAs, anti-NSAbs-associated CAs showed a better response to immunotherapy. CONCLUSION IMCAs are rare and atypical in autoimmune encephalitis with neuronal surface antibodies. Compared with other forms of IMCAs, more symptoms of encephalopathy, a higher rate of pleocytosis and positive OB in CSF, and positive therapeutic effect were the key features of anti-NSAbs-associated CAs.
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Affiliation(s)
- Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mingyu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dawei Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Mengyao Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huifang Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lidong Jiao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China.,Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China.,Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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16
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Paraneoplastic neurological syndromes associated with non-Hodgkin lymphoma: a case series. Neurol Sci 2022; 43:2077-2079. [DOI: 10.1007/s10072-021-05801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
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17
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Hampe CS, Mitoma H. A Breakdown of Immune Tolerance in the Cerebellum. Brain Sci 2022; 12:brainsci12030328. [PMID: 35326284 PMCID: PMC8946792 DOI: 10.3390/brainsci12030328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/21/2022] Open
Abstract
Cerebellar dysfunction can be associated with ataxia, dysarthria, dysmetria, nystagmus and cognitive deficits. While cerebellar dysfunction can be caused by vascular, traumatic, metabolic, genetic, inflammatory, infectious, and neoplastic events, the cerebellum is also a frequent target of autoimmune attacks. The underlying cause for this vulnerability is unclear, but it may be a result of region-specific differences in blood–brain barrier permeability, the high concentration of neurons in the cerebellum and the presence of autoantigens on Purkinje cells. An autoimmune response targeting the cerebellum—or any structure in the CNS—is typically accompanied by an influx of peripheral immune cells to the brain. Under healthy conditions, the brain is protected from the periphery by the blood–brain barrier, blood–CSF barrier, and blood–leptomeningeal barrier. Entry of immune cells to the brain for immune surveillance occurs only at the blood-CSF barrier and is strictly controlled. A breakdown in the barrier permeability allows peripheral immune cells uncontrolled access to the CNS. Often—particularly in infectious diseases—the autoimmune response develops because of molecular mimicry between the trigger and a host protein. In this review, we discuss the immune surveillance of the CNS in health and disease and also discuss specific examples of autoimmunity affecting the cerebellum.
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Affiliation(s)
- Christiane S. Hampe
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-554-9181
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo 160-0023, Japan;
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18
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Hwang EI, Sayour EJ, Flores CT, Grant G, Wechsler-Reya R, Hoang-Minh LB, Kieran MW, Salcido J, Prins RM, Figg JW, Platten M, Candelario KM, Hale PG, Blatt JE, Governale LS, Okada H, Mitchell DA, Pollack IF. The current landscape of immunotherapy for pediatric brain tumors. NATURE CANCER 2022; 3:11-24. [PMID: 35121998 DOI: 10.1038/s43018-021-00319-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/24/2021] [Indexed: 02/06/2023]
Abstract
Pediatric central nervous system tumors are the most common solid malignancies in childhood, and aggressive therapy often leads to long-term sequelae in survivors, making these tumors challenging to treat. Immunotherapy has revolutionized prospects for many cancer types in adults, but the intrinsic complexity of treating pediatric patients and the scarcity of clinical studies of children to inform effective approaches have hampered the development of effective immunotherapies in pediatric settings. Here, we review recent advances and ongoing challenges in pediatric brain cancer immunotherapy, as well as considerations for efficient clinical translation of efficacious immunotherapies into pediatric settings.
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Affiliation(s)
- Eugene I Hwang
- Division of Oncology, Brain Tumor Institute, Children's National Hospital, Washington, DC, USA.
| | - Elias J Sayour
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Catherine T Flores
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Gerald Grant
- Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Robert Wechsler-Reya
- Tumor Initiation & Maintenance Program, NCI-Designated Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Lan B Hoang-Minh
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | | | | | - Robert M Prins
- Departments of Neurosurgery and Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John W Figg
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University and CCU Brain Tumor Immunology, DKFZ, Heidelberg, Germany
| | - Kate M Candelario
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Paul G Hale
- Children's Brain Trust, Coral Springs, FL, USA
| | - Jason E Blatt
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Lance S Governale
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Hideho Okada
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Duane A Mitchell
- Department of Neurosurgery, Preston A. Wells, Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville, FL, USA
| | - Ian F Pollack
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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19
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Ismail FS, Meuth SG, Melzer N. The role of dendritic cells and their interactions in the pathogenesis of antibody-associated autoimmune encephalitis. J Neuroinflammation 2021; 18:260. [PMID: 34749759 PMCID: PMC8573920 DOI: 10.1186/s12974-021-02310-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/28/2021] [Indexed: 01/17/2023] Open
Abstract
Autoimmune encephalitis (AE) is an inflammatory brain disease which is frequently associated with antibodies (Abs) against cell-surface, synaptic or intracellular neuronal proteins. There is increasing evidence that dendritic cells (DCs) are implicated as key modulators in keeping the balance between immune response and tolerance in the CNS. Migratory features of DCs to and from the brain are linked to initiating and maintaining of neuroinflammation. Genetic polymorphisms together with other triggers such as systemic or cerebral viral infection, or systemic malignancies could contribute to the dysbalance of "regulatory" and "encephalitogenic" DCs with subsequent dysregulated T and B cell reactions in AE. Novel in vivo models with implantation of mature DCs containing neuronal antigens could help to study the pathogenesis and perhaps to understand the origin of AE. Investigations of DCs in human blood, lymphoid tissues, CSF, and brain parenchyma of patients with AE are necessary to deepen our knowledge about the complex interactions between DCs, T and B cells during neuroinflammation in AE. This can support developing new therapy strategies.
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Affiliation(s)
- Fatme Seval Ismail
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
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20
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Zitvogel L, Perreault C, Finn OJ, Kroemer G. Beneficial autoimmunity improves cancer prognosis. Nat Rev Clin Oncol 2021; 18:591-602. [PMID: 33976418 DOI: 10.1038/s41571-021-00508-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 02/06/2023]
Abstract
Many tumour antigens that do not arise from cancer cell-specific mutations are targets of humoral and cellular immunity despite their expression on non-malignant cells. Thus, in addition to the expected ability to detect mutations and stress-associated shifts in the immunoproteome and immunopeptidome (the sum of MHC class I-bound peptides) unique to malignant cells, the immune system also recognizes antigens expressed in non-malignant cells, which can result in autoimmune reactions against non-malignant cells from the tissue of origin. These autoimmune manifestations include, among others, vitiligo, thyroiditis and paraneoplastic syndromes, concurrent with melanoma, thyroid cancer and non-small-cell lung cancer, respectively. Importantly, despite the undesirable effects of these symptoms, such events can have prognostic value and correlate with favourable disease outcomes, suggesting 'beneficial autoimmunity'. Similarly, the occurrence of dermal and endocrine autoimmune adverse events in patients receiving immune-checkpoint inhibitors can have a positive predictive value for therapeutic outcomes. Neoplasias derived from stem cells deemed 'not essential' for survival (such as melanocytes, thyroid cells and most cells in sex-specific organs) have a particularly good prognosis, perhaps because the host can tolerate autoimmune reactions that destroy tumour cells at some cost to non-malignant tissues. In this Perspective, we discuss examples of spontaneous as well as therapy-induced autoimmunity that correlate with favourable disease outcomes and make a strong case in favour of this 'beneficial autoimmunity' being important not only in patients with advanced-stage disease but also in cancer immunosurveillance.
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Affiliation(s)
- Laurence Zitvogel
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France. .,Université Paris Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France. .,INSERM U1015, Gustave Roussy, Villejuif, France. .,Equipe labellisée par la Ligue contre le cancer, Villejuif, France. .,Center of Clinical Investigations in Biotherapies of Cancer (CICBT) BIOTHERIS, Villejuif, France. .,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China.
| | - Claude Perreault
- Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, QC, Canada
| | - Olivera J Finn
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Guido Kroemer
- Gustave Roussy Comprehensive Cancer Institute, Villejuif, France. .,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China. .,Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, Institut Universitaire de France, Paris, France. .,Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France. .,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. .,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.
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21
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Liontos M, Fiste O, Drakopoulou D, Thomakos N, Goula K, Zagouri F, Anagnostouli M, Dimopoulos MA. Paraneoplastic cerebellar degeneration in platinum-responsive endometrial cancer: A case report and review of literature. Gynecol Oncol Rep 2021; 37:100826. [PMID: 34258363 PMCID: PMC8260878 DOI: 10.1016/j.gore.2021.100826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 12/17/2022] Open
Abstract
Paraneoplastic cerebellar ataxia (PCA) represents an uncommon autoimmnue neurological disorder. It usually precedes the occurrence or relapse of gynecological cancer; especially ovarian cancer. We present the case of platinum-responsive endometrial cancer who developed PCA.
Paraneoplastic cerebellar ataxia is a rare immune-induced, non-metastatic neurologic syndrome, most frequently associated with gynecological cancers, which carries an abysmal prognosis. We report the case of a patient with advanced-stage uterine cancer, who developed severe pancerebellar ataxia, while in partial remission, after the completion of 3 cycles of neoadjuvant platinum-based chemotherapy. Swift initiation of immunosuppressive therapy with corticosteroids combined with plasmapheresis did not result in significant clinical benefit. Early recognition of this debilitating condition and standardization of its treatment strategy are prerequisites for both improved survival outcomes and quality of life in these patients. Further studies are warranted to clarify the immune-stimulating impact of effective cytotoxic chemotherapy and the occurence of autoimmune paraneoplastic neurological syndromes.
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Affiliation(s)
- Michalis Liontos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Oraianthi Fiste
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Danai Drakopoulou
- 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
| | - Nikolaos Thomakos
- Division of Gynecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliroi Goula
- Department of Pathology, Alexandra Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Multiple Sclerosis & Demyelinating Diseases Unit and Immunogenetics Laboratory, 1st Department of Neurology, Medical School, National and Kapodistrian University of Athens, NKUA, Aeginition Hospital, Athens, Greece
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22
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Abstract
Introduction: Paraneoplastic neurological syndromes (PNS) are a rare heterogeneous group of neurological diseases associated with tumors. These syndromes are the result of a cross-reactive immune response against antigens shared by the tumor and the nervous system. The discovery of an increasing number of autoantigens and the identification of tumoral factors leading to a substantial antitumoral immune response makes this topic highly innovative.Areas covered: This review covers the clinical, oncological, pathophysiological aspects of both immunological PNS groups. One is associated with autoantibodies against intracellular onconeural antibodies, which are highly specific for an underlying tumor, although the disease is mainly T-cell mediated. In contrast, PNS associated with pathogenic surface-binding/receptor autoantibodies, which are often responsive to immunosuppressive treatment, may manifest as paraneoplastic and non-paraneoplastic diseases. The most frequent tumors associated with PNS are (small cell) lung cancer, gynecological tumors, thymoma, lymphoma, and, in children, neuroblastoma. A special interest is given to PNS, induced by immune checkpoint-inhibitors (ICIs).Expert opinion: Research in PNS, including the group of ICI-induced PNS provide new insights in both the pathophysiology of PNS and tumor immune interactions and offers new treatment options for this group of severe neurological diseases.
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Affiliation(s)
- Franz Blaes
- Department of Neurology, KKH Gummersbach, Gummersbach, Germany
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23
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Feldheim J, Deuschl C, Glas M, Kleinschnitz C, Hagenacker T. Simultaneous paraneoplastic cerebellar degeneration, Lambert-Eaton syndrome and neuropathy associated with AGNA/anti-SOX1 and VGCC antibodies. Neurol Res Pract 2021; 3:30. [PMID: 34030742 PMCID: PMC8142469 DOI: 10.1186/s42466-021-00129-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Anti-glial nuclear antibody (AGNA) is an onconeuroal antibody targeting the nuclei of Bergmann glia in the cerebellum and Anti-SRY-related HMG-box 1 (SOX1). It is highly specific for small cell lung cancer (SCLC) and correlates to the appearance of paraneoplastic neurological syndromes such as Lambert-Eaton myasthenic syndrome (pLEMS) and paraneoplastic cerebellar degeneration (PCD) amongst others. Herein, we present a SCLC patient with rapidly progressive PCD, LEMS and axonal polyneuropathy associated with AGNA/SOX1-antibodies, successfully treated with plasma-exchange (PLEX).
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Affiliation(s)
- Jonas Feldheim
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany.,Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany. .,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.
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24
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Miske R, Scharf M, Stark P, Dietzel H, Bien CI, Borchers C, Kermer P, Ott A, Denno Y, Rochow N, Borowski K, Finke C, Teegen B, Probst C, Komorowski L. Autoantibodies Against the Purkinje Cell Protein RGS8 in Paraneoplastic Cerebellar Syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e987. [PMID: 33782191 PMCID: PMC8009278 DOI: 10.1212/nxi.0000000000000987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
Objective To describe the identification of regulator of G-protein signaling 8 (RGS8) as an autoantibody target in patients with cerebellar syndrome associated with lymphoma. Methods Sera of 4 patients with a very similar unclassified reactivity against cerebellar Purkinje cells were used in antigen identification experiments. Immunoprecipitations with cerebellar lysates followed by mass spectrometry identified the autoantigen, which was verified by recombinant immunofluorescence assay, immunoblot, and ELISA with the recombinant protein. Results The sera and CSF of 4 patients stained the Purkinje cells and molecular layer of the cerebellum. RGS8 was identified as the target antigen in all 4 sera. In a neutralization experiment, recombinant human RGS8 was able to neutralize the autoantibodies' tissue reaction. Patient sera and CSF showed a specific reactivity against recombinant RGS8 in ELISA and immunoblot, whereas no such reactivity was detectable in the controls. Clinical data were available for 2 of the 4 patients, remarkably both presented with cerebellar syndrome accompanied by B-cell lymphoma of the stomach (patient 1, 53 years) or Hodgkin lymphoma (patient 2, 74 years). Conclusion Our results indicate that autoantibodies against the intracellular Purkinje cell protein RGS8 represent new markers for paraneoplastic cerebellar syndrome associated with lymphoma. Classification of Evidence This study provided Class IV evidence that autoantibodies against the intracellular Purkinje cell protein RGS8 are associated with paraneoplastic cerebellar syndrome in lymphoma.
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Affiliation(s)
- Ramona Miske
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Madeleine Scharf
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Stark
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heiko Dietzel
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna I Bien
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Borchers
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pawel Kermer
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anthonina Ott
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yvonne Denno
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nadine Rochow
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kathrin Borowski
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Teegen
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Probst
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Komorowski
- From the Institute for Experimental Immunology (R.M., M.S., A.O., Y.D., N.R., C.P., L.K.), Affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Luebeck; Department of Neurology (P.S., H.D.), Krankenhaus St. Elisabeth, Damme; Laboratory Krone (C.I.B.), Bad Salzuflen; Department of Neurology (C.B., P.K.), Nordwest-Krankenhaus Sanderbusch, Sande; Clinical Immunological Laboratory Prof. Dr. Med. Winfried Stöcker (K.B., B.T.), Luebeck; and Department of Neurology (C.F.), Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Neurological complications of immune checkpoint inhibitor cancer immunotherapy. J Neurol Sci 2021; 424:117424. [PMID: 33812689 DOI: 10.1016/j.jns.2021.117424] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/26/2021] [Accepted: 03/24/2021] [Indexed: 01/21/2023]
Abstract
Neurological autoimmunity is increasingly recognized as a complication of immune checkpoint inhibitor (ICI) cancer immunotherapy. ICIs act by enhancing endogenous anti-tumor immune responses and can also lead to autoimmunity affecting all organs. ICI-related neurological autoimmunity is rare, most often manifests with neuromuscular involvement and more rarely affects the central nervous system. Neurological complications often often present in the first three months of ICI treatment but can also appear after ICI discontinuation. These can occur in patients with tumors not traditionally associated with paraneoplastic neurological autoimmunity, such as melanoma and renal-cell carcinoma and should be suspected when a new neurological symptoms present while on ICI and cannot be explained by disease progression or as a consequence of metabolic dysfunction. Treatment consists of ICI discontinuation or withdrawal depending on the severity with or without immunosuppression. Generally, improvement is observed depending on the patient's baseline characteristics and neurological presentation.
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26
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Jitprapaikulsan J, Paul P, Thakolwiboon S, Mittal SO, Pittock SJ, Dubey D. Paraneoplastic neurological syndrome: an evolving story. Neurooncol Pract 2021; 8:362-374. [PMID: 34277016 DOI: 10.1093/nop/npab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Paraneoplastic neurological syndrome (PNS) comprises a group of neurological disorders that result from a misguided immune response to the nervous system triggered by a distant tumor. These disorders frequently manifest before the diagnosis of the underlying neoplasm. Since the first reported case in 1888 by Oppenheim, the knowledge in this area has evolved rapidly. Several classic PNS have been described, such as limbic encephalitis, paraneoplastic cerebellar degeneration, encephalomyelitis, opsoclonus-myoclonus, sensory neuronopathy, Lambert-Eaton Myasthenic syndrome, and chronic gastrointestinal dysmotility. It is now recognized that PNS can have varied nonclassical manifestations that extend beyond the traditional syndromic descriptions. Multiple onconeural antibodies with high specificity for certain tumor types and neurological phenotypes have been discovered over the past 3 decades. Increasing use of immune checkpoint inhibitors (ICIs) has led to increased recognition of neurologic ICI-related adverse events. Some of these resemble PNS. In this article, we review the clinical, oncologic, and immunopathogenic associations of PNS.
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Affiliation(s)
- Jiraporn Jitprapaikulsan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pritikanta Paul
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
| | - Smathorn Thakolwiboon
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Shivam Om Mittal
- Department of Neurology, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota
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27
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Devine MF, Kothapalli N, Elkhooly M, Dubey D. Paraneoplastic neurological syndromes: clinical presentations and management. Ther Adv Neurol Disord 2021; 14:1756286420985323. [PMID: 33796141 PMCID: PMC7970694 DOI: 10.1177/1756286420985323] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022] Open
Abstract
We provide an overview of the varied presentations of paraneoplastic neurological syndromes. We also review the onconeural antibodies and their particular oncological and neurological associations. Recognition of these syndromes and their oncological associations is crucial, as early diagnosis and management has been associated with better patient outcomes. Specific management strategies and prognosis vary widely depending on the underlying etiology. An understanding of the relevant clinical details, imaging findings, and other diagnostic information can help tailor treatment approaches. We provide an outline of the diagnostic evaluation and treatment of various paraneoplastic neurological disorders, presenting with central and/or peripheral nervous system involvement. We briefly discuss neurologic immune checkpoint inhibitor-related adverse events, which can occasionally present with paraneoplastic neurological syndrome phenotypes.
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Affiliation(s)
- Michelle F Devine
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naga Kothapalli
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburg, PA, USA
| | | | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905-0002, USA
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28
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Mitoma H, Manto M, Hadjivassiliou M. Immune-Mediated Cerebellar Ataxias: Clinical Diagnosis and Treatment Based on Immunological and Physiological Mechanisms. J Mov Disord 2021; 14:10-28. [PMID: 33423437 PMCID: PMC7840241 DOI: 10.14802/jmd.20040] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022] Open
Abstract
Since the first description of immune-mediated cerebellar ataxias (IMCAs) by Charcot in 1868, several milestones have been reached in our understanding of this group of neurological disorders. IMCAs have diverse etiologies, such as gluten ataxia, postinfectious cerebellitis, paraneoplastic cerebellar degeneration, opsoclonus myoclonus syndrome, anti-GAD ataxia, and primary autoimmune cerebellar ataxia. The cerebellum, a vulnerable autoimmune target of the nervous system, has remarkable capacities (collectively known as the cerebellar reserve, closely linked to plasticity) to compensate and restore function following various pathological insults. Therefore, good prognosis is expected when immune-mediated therapeutic interventions are delivered during early stages when the cerebellar reserve can be preserved. However, some types of IMCAs show poor responses to immunotherapies, even if such therapies are introduced at an early stage. Thus, further research is needed to enhance our understanding of the autoimmune mechanisms underlying IMCAs, as such research could potentially lead to the development of more effective immunotherapies. We underscore the need to pursue the identification of robust biomarkers.
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Affiliation(s)
- Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, Charleroi, Belgium.,Service des Neurosciences, University of Mons, Mons, Belgium
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29
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Gerhard GM, Bill R, Messemaker M, Klein AM, Pittet MJ. Tumor-infiltrating dendritic cell states are conserved across solid human cancers. J Exp Med 2021; 218:e20200264. [PMID: 33601412 PMCID: PMC7754678 DOI: 10.1084/jem.20200264] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/23/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Dendritic cells (DCs) contribute a small fraction of the tumor microenvironment but are emerging as an essential antitumor component based on their ability to foster T cell immunity and immunotherapy responses. Here, we discuss our expanding view of DC heterogeneity in human tumors, as revealed with meta-analysis of single-cell transcriptome profiling studies. We further examine tumor-infiltrating DC states that are conserved across patients, cancer types, and species and consider the fundamental and clinical relevance of these findings. Finally, we provide an outlook on research opportunities to further explore mechanisms governing tumor-infiltrating DC behavior and functions.
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Affiliation(s)
- Genevieve M. Gerhard
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ruben Bill
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Marius Messemaker
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Allon M. Klein
- Department of Systems Biology, Harvard Medical School, Boston, MA
| | - Mikael J. Pittet
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
- Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
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30
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Averchenkov D, Volik A, Fominykh V, Nazarov V, Moshnikova A, Lapin S, Brylev L, Guekht A. Acute disseminated encephalomyelitis. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:119-128. [DOI: 10.17116/jnevro2021121111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Zhu M, Ma Y, Zekeridou A, Lennon VA. Case Report: Innate Immune System Challenge Unleashes Paraneoplastic Neurological Autoimmunity. Front Neurol 2020; 11:598894. [PMID: 33362700 PMCID: PMC7759151 DOI: 10.3389/fneur.2020.598894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023] Open
Abstract
Paraneoplastic autoimmune neurological disorders reflect tumor-initiated immune responses against onconeural antigens. Symptoms and signs can affect the central and/or peripheral nervous systems, neuromuscular junction or muscle, and typically evolve subacutely before an underlying neoplasm is discovered. We describe four patients whose neurological symptoms were precipitated by potent innate immune system challenges: bladder instillation of BCG, tick bite and an "alternative cancer therapy" with bacterial extracts and TNF-α. We hypothesize that a tumor-initiated autoimmune response (evidenced by autoantibody profiles), pre-dating the immune system challenge, was unmasked or amplified in these patients by cytokines released systemically from innate immune cells activated by microbial pathogen-associated molecular patterns (PAMPs). The resultant upregulation of cognate onconeural peptides as MHC1 protein complexes on neural cell surfaces would render those cells susceptible to killing by CD8+ T cells, thus precipitating the patient's neurological symptoms.
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Affiliation(s)
- Mingqin Zhu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Yuetao Ma
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.,Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Department of Immunology, Mayo Clinic, Rochester, MN, United States
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32
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Ryder PV, Fang J, Lerit DA. centrocortin RNA localization to centrosomes is regulated by FMRP and facilitates error-free mitosis. J Cell Biol 2020; 219:211538. [PMID: 33196763 PMCID: PMC7716377 DOI: 10.1083/jcb.202004101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/12/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023] Open
Abstract
Centrosomes are microtubule-organizing centers required for error-free mitosis and embryonic development. The microtubule-nucleating activity of centrosomes is conferred by the pericentriolar material (PCM), a composite of numerous proteins subject to cell cycle-dependent oscillations in levels and organization. In diverse cell types, mRNAs localize to centrosomes and may contribute to changes in PCM abundance. Here, we investigate the regulation of mRNA localization to centrosomes in the rapidly cycling Drosophila melanogaster embryo. We find that RNA localization to centrosomes is regulated during the cell cycle and developmentally. We identify a novel role for the fragile-X mental retardation protein in the posttranscriptional regulation of a model centrosomal mRNA, centrocortin (cen). Further, mistargeting cen mRNA is sufficient to alter cognate protein localization to centrosomes and impair spindle morphogenesis and genome stability.
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33
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Herdlevær I, Kråkenes T, Schubert M, Vedeler CA. Localization of CDR2L and CDR2 in paraneoplastic cerebellar degeneration. Ann Clin Transl Neurol 2020; 7:2231-2242. [PMID: 33009713 PMCID: PMC7664253 DOI: 10.1002/acn3.51212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 09/11/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Identify the subcellular location and potential binding partners of two cerebellar degeneration-related proteins, CDR2L and CDR2, associated with anti-Yo-mediated paraneoplastic cerebellar degeneration. METHODS Cancer cells, rat Purkinje neuron cultures, and human cerebellar sections were exposed to cerebrospinal fluid and serum from patients with paraneoplastic cerebellar degeneration with Yo antibodies and with several antibodies against CDR2L and CDR2. We used mass spectrometry-based proteomics, super-resolution microscopy, proximity ligation assay, and co-immunoprecipitation to verify the antibodies and to identify potential binding partners. RESULTS We confirmed the CDR2L specificity of Yo antibodies by mass spectrometry-based proteomics and found that CDR2L localized to the cytoplasm and CDR2 to the nucleus. CDR2L co-localized with the 40S ribosomal protein S6, while CDR2 co-localized with the nuclear speckle proteins SON, eukaryotic initiation factor 4A-III, and serine/arginine-rich splicing factor 2. INTERPRETATION We showed that Yo antibodies specifically bind to CDR2L in Purkinje neurons of PCD patients where they potentially interfere with the function of the ribosomal machinery resulting in disrupted mRNA translation and/or protein synthesis. Our findings demonstrating that CDR2L interacts with ribosomal proteins and CDR2 with nuclear speckle proteins is an important step toward understanding PCD pathogenesis.
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Affiliation(s)
- Ida Herdlevær
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of NeurologyHaukeland University HospitalBergenNorway
| | | | - Manja Schubert
- Department of NeurologyHaukeland University HospitalBergenNorway
| | - Christian A. Vedeler
- Department of Clinical MedicineUniversity of BergenBergenNorway
- Department of NeurologyHaukeland University HospitalBergenNorway
- Departments of Neurology and Clinical MedicineNeuro‐SysMed ‐ Centre of Excellence for Experimental Therapy in NeurologyBergenNorway
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34
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Kuehn JC, Meschede C, Helmstaedter C, Surges R, von Wrede R, Hattingen E, Vatter H, Elger CE, Schoch S, Becker AJ, Pitsch J. Adult-onset temporal lobe epilepsy suspicious for autoimmune pathogenesis: Autoantibody prevalence and clinical correlates. PLoS One 2020; 15:e0241289. [PMID: 33119692 PMCID: PMC7595292 DOI: 10.1371/journal.pone.0241289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023] Open
Abstract
Temporal lobe adult-onset seizures (TAOS) related to autoimmunity represent an increasingly recognized disease syndrome within the spectrum of epilepsies. In this context, certain autoantibodies (autoABs) were often associated with limbic encephalitis (LE). Here, we aimed to gain insights into (a) the distribution of ‘neurological’ autoABs (neuroABs, defined as autoABs targeting neuronal surface structures or ‘onconeuronal’ ABs or anti-glutamate acid decarboxylase 65 (GAD65) autoABs) in a large consecutive TAOS patient cohort, to characterize (b) clinical profiles of seropositive versus seronegative individuals and to find (c) potential evidence for other autoABs. Blood sera/cerebrospinal fluid (CSF) of TAOS patients (n = 800) and healthy donors (n = 27) were analyzed for neuroABs and screened for other autoABs by indirect immunofluorescence on hippocampal/cerebellar sections and immunoblots of whole brain and synaptosome lysates. Serological results were correlated with clinico-neuropsychological features. 13% of TAOS patients (n = 105) were neuroAB+, with anti-GAD65 and anti-N-methyl-D-aspartate receptors (NMDAR) as most frequent autoABs in this group. In our screening tests 25% of neuroAB- patients (n = 199) were positive (screening+), whereas all control samples were negative (n = 27). Intriguingly, key clinico-neuropsychological characteristics including magnetic resonance imaging (MRI) findings, epileptiform electroencephalographic (EEG) activity, and inflammatory cellular infiltrates in CSF were shared to a greater extent by neuroAB+ with neuroAB-/screening+ patients than with neuroAB-/screening- patients. Serological testing in a large consecutive TAOS patient series revealed seropositivity for anti-GAD65 autoABs as the most frequent neuroAB. Intriguingly, neuroAB+ individuals were virtually indistinguishable from neuroAB-/screening+ patients in several major clinical features. In contrast, neuroAB-/screening- TAOS patients differed in many parameters. These data support the potential presence of so far unrecognized autoABs in patients with TAOS.
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Affiliation(s)
- Julia C. Kuehn
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | - Christoph Helmstaedter
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Dept. of Neuroradiology, University Clinic of Frankfurt, Frankfurt, Germany
| | - Hartmut Vatter
- Clinic for Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christian E. Elger
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Susanne Schoch
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Bonn, Germany
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Albert J. Becker
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Julika Pitsch
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Bonn, Germany
- Dept. of Epileptology, University Hospital Bonn, Bonn, Germany
- * E-mail:
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35
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Ascierto PA, Bifulco C, Galon J, Garbe C, Khleif SN, McQuade J, Odunsi K, Okada H, Paulos CM, Quezada SA, Tawbi HA, Timmerman J, Trinchieri G, Butterfield LH, Puzanov I. The Great Debate at 'Immunotherapy Bridge', Naples, December 5, 2019. J Immunother Cancer 2020; 8:e000921. [PMID: 32843491 PMCID: PMC7449295 DOI: 10.1136/jitc-2020-000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 12/25/2022] Open
Abstract
As part of the 2019 Immunotherapy Bridge congress (December 4-5, Naples, Italy), the Great Debate session featured counterpoint views from leading experts on six topical issues in immunotherapy today. These were the use of chimeric antigen receptor T cell therapy in solid tumors, whether the Immunoscore should be more widely used in clinical practice, whether antibody-dependent cellular cytotoxicity is important in the mode of action of anticytotoxic T-lymphocyte-associated protein 4 antibodies, whether the brain is immunologically unique or just another organ, the role of microbiome versus nutrition in affecting responses to immunotherapy, and whether chemotherapy is immunostimulatory or immunosuppressive. Discussion of these important topics are summarized in this report.
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Affiliation(s)
- Paolo A Ascierto
- Cancer Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Carlo Bifulco
- Earle A. Chiles Research Institute, Robert W. Franz Cancer Research Center, Providence Portland Medical Center, Portland, Oregon, USA
| | - Jerome Galon
- Laboratory of Integrative Cancer Immunology, Equipe Labellisée Ligue Contre le Cancer, Centre de Recherche des Cordeliers, INSERM, Paris, Île-de-France, France
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Samir N Khleif
- The Loop Immuno-Oncology Research Laboratory, Lombardi Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Jennifer McQuade
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kunle Odunsi
- Center for Immunotherapy and Department of Gynaecologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hideho Okada
- Department of Neurological Surgery, Parker Institute for Cancer Immunotherapy, UCSF, San Francisco, California, USA
| | - Chrystal M Paulos
- Department of Microbiology and Immunology Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
| | - Sergio A Quezada
- Cancer Immunology Unit, Research Department of Haematology, University College London Cancer Institute, London, UK
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John Timmerman
- Santa Monica UCLA Medical Center, University of California Los Angeles, Los Angeles, California, USA
| | - Giorgio Trinchieri
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa H Butterfield
- PICI Research and Development, Parker Institute for Cancer Immunotherapy, UCSF, San Francisco, California, USA
| | - Igor Puzanov
- Early Phase Clinical Trials Program, Developmental Therapeutics Program, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Tanaka K, Kawamura M, Sakimura K, Kato N. Significance of Autoantibodies in Autoimmune Encephalitis in Relation to Antigen Localization: An Outline of Frequently Reported Autoantibodies with a Non-Systematic Review. Int J Mol Sci 2020; 21:ijms21144941. [PMID: 32668637 PMCID: PMC7404295 DOI: 10.3390/ijms21144941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
Autoantibodies related to central nervous system (CNS) diseases propel research on paraneoplastic neurological syndrome (PNS). This syndrome develops autoantibodies in combination with certain neurological syndromes and cancers, such as anti-HuD antibodies in encephalomyelitis with small cell lung cancer and anti-Yo antibodies in cerebellar degeneration with gynecological cancer. These autoantibodies have roles in the diagnosis of neurological diseases and early detection of cancers that are usually occult. Most of these autoantibodies have no pathogenic roles in neuronal dysfunction directly. Instead, antigen-specific cytotoxic T lymphocytes are thought to have direct roles in neuronal damage. The recent discoveries of autoantibodies against neuronal synaptic receptors/channels produced in patients with autoimmune encephalomyelitis have highlighted insights into our understanding of the variable neurological symptoms in this disease. It has also improved our understanding of intractable epilepsy, atypical psychosis, and some demyelinating diseases that are ameliorated with immune therapies. The production and motility of these antibodies through the blood-brain barrier into the CNS remains unknown. Most of these recently identified autoantibodies bind to neuronal and glial cell surface synaptic receptors, potentially altering the synaptic signaling process. The clinical features differ among pathologies based on antibody targets. The investigation of these antibodies provides a deeper understanding of the background of neurological symptoms in addition to novel insights into their basic neuroscience.
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Affiliation(s)
- Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima 960-1247, Japan
- Correspondence: ; Tel.: +81-25-227-0624; Fax: +81-25-227-0816
| | - Meiko Kawamura
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
| | - Kenji Sakimura
- Department of Animal Model Development, Brain Research Institute, Niigata University, 1-757 Asahimachi-dori, Chuoku, Niigata 951-8585, Japan; (M.K.); (K.S.)
| | - Nobuo Kato
- Department of Physiology, Kanazawa Medical University, Ishikawa 920-0293, Japan;
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37
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Vogrig A, Muñiz-Castrillo S, Desestret V, Joubert B, Honnorat J. Pathophysiology of paraneoplastic and autoimmune encephalitis: genes, infections, and checkpoint inhibitors. Ther Adv Neurol Disord 2020; 13:1756286420932797. [PMID: 32636932 PMCID: PMC7318829 DOI: 10.1177/1756286420932797] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/17/2020] [Indexed: 12/14/2022] Open
Abstract
Paraneoplastic neurological syndromes (PNSs) are rare complications of systemic cancers that can affect all parts of the central and/or peripheral nervous system. A body of experimental and clinical data has demonstrated that the pathogenesis of PNSs is immune-mediated. Nevertheless, the mechanisms leading to immune tolerance breakdown in these conditions remain to be elucidated. Despite their rarity, PNSs offer a unique perspective to understand the complex interplay between cancer immunity, effect of immune checkpoint inhibitors (ICIs), and mechanisms underlying the attack of neurons in antibody-mediated neurological disorders, with potentially relevant therapeutic implications. In particular, it is reported that ICI treatment can unleash PNSs and that the immunopathological features of PNS-related tumors are distinctive, showing prominent tumor-infiltrating lymphocytes and germinal center reactions. Intriguingly, similar pathological substrates have gained further attention as potential biomarkers of ICI-sensitivity and oncological prognosis. Moreover, the genetic analysis of PNS-associated tumors has revealed specific molecular signatures and mutations in genes encoding onconeural proteins, leading to the production of highly immunogenic neoantigens. Other than PNSs, autoimmune encephalitides (AEs) comprise a recently described group of disorders characterized by prominent neuropsychiatric symptoms, diverse antibody spectrum, and less tight association with cancer. Other triggering factors seem to be involved in AEs. Recent data have shed light on the importance of preceding infections (in particular, herpes simplex virus encephalitis) in inducing neurological autoimmune disorders in susceptible individuals (those with a selective deficiency in the innate immune system). In addition, in some AEs (e.g. LGI1-antibody encephalitis) an association with specific host-related factors [e.g., human leukocyte antigen (HLA)] was clearly demonstrated. We provide herein a comprehensive review of the most recent findings in the field of PNSs and AEs, with particular focus on their triggering factors and immunopathogenesis.
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Affiliation(s)
- Alberto Vogrig
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Virginie Desestret
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Bastien Joubert
- French Reference Center for Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Jérôme Honnorat
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasiques, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, France
- SynatAc Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Lyon, France
- University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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Yshii L, Bost C, Liblau R. Immunological Bases of Paraneoplastic Cerebellar Degeneration and Therapeutic Implications. Front Immunol 2020; 11:991. [PMID: 32655545 PMCID: PMC7326021 DOI: 10.3389/fimmu.2020.00991] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a rare immune-mediated disease that develops mostly in the setting of neoplasia and offers a unique prospect to explore the interplay between tumor immunity and autoimmunity. In PCD, the deleterious adaptive immune response targets self-antigens aberrantly expressed by tumor cells, mostly gynecological cancers, and physiologically expressed by the Purkinje neurons of the cerebellum. Highly specific anti-neuronal antibodies in the serum and cerebrospinal fluid represent key diagnostic biomarkers of PCD. Some anti-neuronal antibodies such as anti-Yo autoantibodies (recognizing the CDR2/CDR2L proteins) are only associated with PCD. Other anti-neuronal antibodies, such as anti-Hu, anti-Ri, and anti-Ma2, are detected in patients with PCD or other types of paraneoplastic neurological manifestations. Importantly, these autoantibodies cannot transfer disease and evidence for a pathogenic role of autoreactive T cells is accumulating. However, the precise mechanisms responsible for disruption of self-tolerance to neuronal self-antigens in the cancer setting and the pathways involved in pathogenesis within the cerebellum remain to be fully deciphered. Although the occurrence of PCD is rare, the risk for such severe complication may increase with wider use of cancer immunotherapy, notably immune checkpoint blockade. Here, we review recent literature pertaining to the pathophysiology of PCD and propose an immune scheme underlying this disabling disease. Additionally, based on observations from patients' samples and on the pre-clinical model we recently developed, we discuss potential therapeutic strategies that could blunt this cerebellum-specific autoimmune disease.
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Affiliation(s)
- Lidia Yshii
- INSERM U1043, CNRS UMR 5282, Université Toulouse III, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Chloé Bost
- INSERM U1043, CNRS UMR 5282, Université Toulouse III, Center for Pathophysiology Toulouse Purpan, Toulouse, France.,Department of Immunology, Purpan University Hospital Toulouse, Toulouse, France
| | - Roland Liblau
- INSERM U1043, CNRS UMR 5282, Université Toulouse III, Center for Pathophysiology Toulouse Purpan, Toulouse, France.,Department of Immunology, Purpan University Hospital Toulouse, Toulouse, France
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Bracher A, Alcalá C, Ferrer J, Melzer N, Hohlfeld R, Casanova B, Beltrán E, Dornmair K. An expanded parenchymal CD8+ T cell clone in GABA A receptor encephalitis. Ann Clin Transl Neurol 2020; 7:239-244. [PMID: 31943946 PMCID: PMC7034500 DOI: 10.1002/acn3.50974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/12/2019] [Accepted: 12/05/2019] [Indexed: 12/28/2022] Open
Abstract
The role of T cells in autoimmune encephalitis syndromes with autoantibodies against cell surface antigens is still enigmatic. Here we analyzed the T cell receptor repertoires of CD8+ and CD4+ T cells in a patient with "idiopathic" gamma-aminobutyric-acid-A receptor (GABAA -R) encephalitis by next-generation sequencing and single-cell analyses. We identified a CD8+ T cell clone that was strongly expanded in the cerebrospinal fluid and in the hippocampus but not in the operculo-insular cortex. By contrast, CD4+ T cells were polyclonal in these tissues. Such a strong clonal expansion suggests that CD8+ T cells may play a significant role in the pathogenesis.
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Affiliation(s)
- Aline Bracher
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians Universität München, Munich, Germany
| | - Carmen Alcalá
- Department of Neurology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - Jaime Ferrer
- Department of Pathology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - Nico Melzer
- Clinic of Neurology and Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bonaventura Casanova
- Department of Neurology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - Eduardo Beltrán
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians Universität München, Munich, Germany
| | - Klaus Dornmair
- Institute of Clinical Neuroimmunology, Biomedical Center and Hospital of the Ludwig-Maximilians Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Shelly S, Kryzer TJ, Komorowski L, Miske R, Anderson MD, Flanagan EP, Hinson SR, Lennon VA, Pittock SJ, McKeon A. Neurochondrin neurological autoimmunity. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:6/6/e612. [PMID: 31511329 PMCID: PMC6745726 DOI: 10.1212/nxi.0000000000000612] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022]
Abstract
Objectives To describe the neurologic spectrum and treatment outcomes for neurochondrin-IgG positive cases identified serologically in the Mayo Clinic Neuroimmunology Laboratory. Methods Archived serum and CSF specimens previously scored positive for IgGs that stained mouse hippocampal tissue in a nonuniform synaptic pattern by immunofluorescence assay (89 among 616,025 screened, 1993–2019) were reevaluated. Antibody characterization experiments revealed specificity for neurochondrin, confirmed by recombinant protein assays. Results IgG in serum (9) or CSF (4) from 8 patients yielded identical neuron-restricted CNS patterns, most pronounced in hippocampus (stratum lucidum in particular), cerebellum (Purkinje cells and molecular layer), and amygdala. All were neurochondrin-IgG positive. Five were women; median symptom onset age was 43 years (range, 30–69). Of 7 with clinical data, 6 presented with rapidly progressive cerebellar ataxia, brainstem signs, or both; 1 had isolated unexplained psychosis 1 year prior. Five of 6 had cerebellar signs, 4 with additional brainstem symptoms or signs (eye movement abnormalities, 3; dysphagia, 2; nausea and vomiting, 1). One patient with brainstem signs (vocal cord paralysis and VII nerve palsy) had accompanying myelopathy (longitudinally extensive abnormality on MRI; aquaporin-4-IgG and myelin oligodendrocyte glycoprotein-IgG negative). The 7th patient had small fiber neuropathy only. Just 1 of 7 had contemporaneous cancer (uterine). Six patients with ataxia or brainstem signs received immunotherapy, but just 1 remained ambulatory. At last follow-up, 5 had MRI evidence of severe cerebellar atrophy. Conclusion In our series, neurochondrin autoimmunity was usually accompanied by a nonparaneoplastic rapidly progressive rhombencephalitis with poor neurologic outcomes. Other phenotypes and occasional paraneoplastic causes may occur.
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Affiliation(s)
- Shahar Shelly
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Thomas J Kryzer
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Lars Komorowski
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Ramona Miske
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Mark D Anderson
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Shannon R Hinson
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology (S.S., T.J.K., E.P.F., S.R.H., V.A.L., S.J.P., A.M.), Department of Neurology (E.P.F., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), College of Medicine, Mayo Clinic; Euroimmun AG (L.K., R.M.), Lubeck, Germany; and Department of Neurology (M.D.A.), University of Mississippi Medical Center, Jackson, MS.
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Zekeridou A, Lennon VA. Neurologic Autoimmunity in the Era of Checkpoint Inhibitor Cancer Immunotherapy. Mayo Clin Proc 2019; 94:1865-1878. [PMID: 31358366 DOI: 10.1016/j.mayocp.2019.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 01/21/2023]
Abstract
Neurologic autoimmune disorders in the context of systemic cancer reflect antitumor immune responses against onconeural proteins that are autoantigens in the nervous system. These responses observe basic principles of cancer immunity and are highly pertinent to oncological practice since the introduction of immune checkpoint inhibitor cancer therapy. The patient's autoantibody profile is consistent with the antigenic composition of the underlying malignancy. A major determinant of the pathogenic outcome is the anatomic and subcellular location of the autoantigen. IgGs targeting plasma membrane proteins (eg, muscle acetylcholine receptor -IgG in patients with paraneoplastic myasthenia gravis) have pathogenic potential. However, IgGs specific for intracellular antigens (eg, antineuronal nuclear antibody 1 [anti-Hu] associated with sensory neuronopathy and small cell lung cancer) are surrogate markers for CD8+ T lymphocytes targeting peptides derived from nuclear or cytoplasmic proteins. In an inflammatory milieu, those peptides translocate to neural plasma membranes as major histocompatibility complex class I protein complexes. Paraneoplastic neurologic autoimmunity can affect any level of the neuraxis and may be mistaken for cancer progression. Importantly, these disorders generally respond favorably to early-initiated immunotherapy and cancer treatment. Small cell lung cancer and thymoma are commonly associated with neurologic autoimmunity, but in the context of checkpoint inhibitor therapy, other malignancy associations are increasingly recognized.
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Affiliation(s)
- Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Department of Immunology, Mayo Clinic, Rochester, MN
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42
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Abstract
The paraneoplastic and autoimmune encephalitides are now well-established entities. Detection of neural autoantibodies enables specific diagnoses, provides information on the underlying disease pathophysiology, immunological treatability and the likelihood of a tumor being the underlying cause. This is true for the "high ranking" neural antibodies that have been established in the context of circumscribed clinical images and in consideration of large control groups, have been found in the same way by other laboratories and they respond to immunotherapy. The immune reaction can be triggered by tumors and virus encephalitides, e.g. N‑methyl-D-aspartate (NMDA) receptor antibodies. In some cases a genetic predisposition has been shown. Some antibodies are formed peripherally, others intrathecally. The route of the antibodies into the brain can be via the blood-brain barrier or cerebrospinal fluid (CSF). In the brain itself, the antibodies lead to an internalization of antigenic receptors, such as NMDA and α‑amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, or to nerve-destroying activation of the classical complement cascade. In other conditions, cytotoxic T cells are at the core of the pathophysiology. For diagnostic purposes, the testing of CSF-serum pairs with broad spectrum antigen panels is recommended. Therapeutically, the aim is to suppress the production of pathogenic antibodies or even to eliminate them directly. A sequence of first-line treatment (steroids, intravenous immunoglobulins and/or apheresis) and second-line treatment (rituximab and/or cyclophosphamide) has been established.
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Mandel-Brehm C, Dubey D, Kryzer TJ, O'Donovan BD, Tran B, Vazquez SE, Sample HA, Zorn KC, Khan LM, Bledsoe IO, McKeon A, Pleasure SJ, Lennon VA, DeRisi JL, Wilson MR, Pittock SJ. Kelch-like Protein 11 Antibodies in Seminoma-Associated Paraneoplastic Encephalitis. N Engl J Med 2019; 381:47-54. [PMID: 31269365 PMCID: PMC6800027 DOI: 10.1056/nejmoa1816721] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 37-year-old man with a history of seminoma presented with vertigo, ataxia, and diplopia. An autoantibody specific for kelch-like protein 11 (KLHL11) was identified with the use of programmable phage display. Immunoassays were used to identify KLHL11 IgG in 12 other men with similar neurologic features and testicular disease. Immunostaining of the patient's IgG on mouse brain tissue showed sparse but distinctive points of staining in multiple brain regions, with enrichment in perivascular and perimeningeal tissues. The onset of the neurologic syndrome preceded the diagnosis of seminoma in 9 of the 13 patients. An age-adjusted estimate of the prevalence of autoimmune KLHL11 encephalitis in Olmsted County, Minnesota, was 2.79 cases per 100,000 men. (Funded by the Rochester Epidemiology Project and others.).
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Affiliation(s)
- Caleigh Mandel-Brehm
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Divyanshu Dubey
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Thomas J Kryzer
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Brian D O'Donovan
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Baouyen Tran
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sara E Vazquez
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Hannah A Sample
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Kelsey C Zorn
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Lillian M Khan
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Ian O Bledsoe
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Samuel J Pleasure
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Joseph L DeRisi
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Michael R Wilson
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Biochemistry and Biophysics (C.M.-B., B.D.O., S.E.V., H.A.S., K.C.Z., L.M.K., J.L.D.), the Weill Institute for Neurosciences (B.T., I.O.B., S.J. Pleasure, M.R.W.), the Department of Neurology (B.T., I.O.B., S.J. Pleasure, M.R.W.), and the Chan Zuckerberg Biohub (J.L.D.), University of California, San Francisco, San Francisco; and the Departments of Laboratory Medicine and Pathology (D.D., T.J.K., A.M., V.A.L., S.J. Pittock), Neurology (D.D., A.M., V.A.L., S.J. Pittock), and Immunology (V.A.L.), Mayo Clinic, Rochester, MN
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Abstract
The field of autoimmune epilepsy has evolved substantially in the last few decades with discovery of several neural autoantibodies and improved mechanistic understanding of these immune-mediated syndromes. A considerable proportion of patients with epilepsy of unknown etiology have been demonstrated to have an autoimmune cause. The majority of the patients with autoimmune epilepsy usually present with new-onset refractory seizures along with subacute progressive cognitive decline and behavioral or psychiatric dysfunction. Neural specific antibodies commonly associated with autoimmune epilepsy include leucine-rich glioma-inactivated protein 1 (LGI1), N-methyl-D-aspartate receptor (NMDA-R), and glutamic acid decarboxylase 65 (GAD65) IgG. Diagnosis of these cases depends on the identification of the clinical syndrome and ancillary studies including autoantibody evaluation. Predictive models (Antibody Prevalence in Epilepsy and Encephalopathy [APE2] and Response to Immunotherapy in Epilepsy and Encephalopathy [RITE2] scores) based on clinical features and initial neurological assessment may be utilized for selection of cases for autoimmune epilepsy evaluation and management. In this article, we will review the recent advances in autoimmune epilepsy and provide diagnostic and therapeutic algorithms for epilepsies with suspected autoimmune etiology.
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Affiliation(s)
- Khalil S Husari
- Comprehensive Epilepsy Center, Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Divyanshu Dubey
- Department of Neurology and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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45
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Kråkenes T, Herdlevaer I, Raspotnig M, Haugen M, Schubert M, Vedeler CA. CDR2L Is the Major Yo Antibody Target in Paraneoplastic Cerebellar Degeneration. Ann Neurol 2019; 86:316-321. [PMID: 31148214 DOI: 10.1002/ana.25511] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/09/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022]
Abstract
The pathogenesis of Yo-mediated paraneoplastic cerebellar degeneration (PCD) is unclear. We applied cerebrospinal fluid and serum from PCD patients as well as CDR2 and CDR2L antibodies to neuronal tissue, cancer cell lines, and cells transfected with recombinant CDR2 and CDR2L to elucidate which is the major antigen of Yo antibodies. We found that Yo antibodies bound endogenous CDR2L, but not endogenous CDR2. However, Yo antibodies can bind the recombinant CDR2 protein used in routine clinical testing for these antibodies. Because Yo antibodies only bind endogenous CDR2L, we conclude that CDR2L is the major antigen of Yo antibodies in PCD. ANN NEUROL 2019;86:316-321.
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Affiliation(s)
- Torbjørn Kråkenes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ida Herdlevaer
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Mette Haugen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Manja Schubert
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Christian A Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Neuro-SysMed - Centre of Excellence for Experimental Therapy in Neurology, Departments of Neurology and Clinical Medicine, Bergen, Norway
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46
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Liu Z, Jiao L, Qiu Z, Da Y, Tang Y, Lin Y, Li D, Huang J, Kang X, Dong H. Clinical characteristics of patients with paraneoplastic myelopathy. J Neuroimmunol 2019; 330:136-142. [DOI: 10.1016/j.jneuroim.2019.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/24/2023]
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47
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Yshii L, Pignolet B, Mauré E, Pierau M, Brunner-Weinzierl M, Hartley O, Bauer J, Liblau R. IFN-γ is a therapeutic target in paraneoplastic cerebellar degeneration. JCI Insight 2019; 4:127001. [PMID: 30944244 DOI: 10.1172/jci.insight.127001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
Paraneoplastic neurological disorders result from an autoimmune response against neural self-antigens that are ectopically expressed in neoplastic cells. In paraneoplastic disorders associated to autoantibodies against intracellular proteins, such as paraneoplastic cerebellar degeneration (PCD), current data point to a major role of cell-mediated immunity. In an animal model, in which a neo-self-antigen was expressed in both Purkinje neurons and implanted breast tumor cells, immune checkpoint blockade led to complete tumor control at the expense of cerebellum infiltration by T cells and Purkinje neuron loss, thereby mimicking PCD. Here, we identify 2 potential therapeutic targets expressed by cerebellum-infiltrating T cells in this model, namely α4 integrin and IFN-γ. Mice with PCD were treated with anti-α4 integrin antibodies or neutralizing anti-IFN-γ antibodies at the onset of neurological signs. Although blocking α4 integrin had little or no impact on disease development, treatment using the anti-IFN-γ antibody led to almost complete protection from PCD. These findings strongly suggest that the production of IFN-γ by cerebellum-invading T cells plays a major role in Purkinje neuron death. Our successful preclinical use of neutralizing anti-IFN-γ antibody for the treatment of PCD offers a potentially new therapeutic opportunity for cancer patients at the onset of paraneoplastic neurological disorders.
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Affiliation(s)
- Lidia Yshii
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France
| | - Béatrice Pignolet
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France.,Department of Clinical Neurosciences, Toulouse University Hospital, Toulouse, France
| | - Emilie Mauré
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France
| | - Mandy Pierau
- Department of Experimental Pediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Monika Brunner-Weinzierl
- Department of Experimental Pediatrics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Oliver Hartley
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Liblau
- Centre de Physiopathologie Toulouse-Purpan (CPTP), Université de Toulouse, CNRS, Inserm, UPS, Toulouse, France
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48
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Interplay between dendritic cells and cancer cells. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2019; 348:179-215. [DOI: 10.1016/bs.ircmb.2019.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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49
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Chatterjee M, Hurley LC, Levin NK, Stack M, Tainsky MA. Utility of paraneoplastic antigens as biomarkers for surveillance and prediction of recurrence in ovarian cancer. Cancer Biomark 2018; 20:369-387. [PMID: 29125478 DOI: 10.3233/cbm-170652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ovarian cancer is frequently diagnosed at an advanced stage and 70% of patients experience recurrence months to years from initial diagnosis. The expression of paraneoplastic antigens can result in the occurrence of onconeural autoantibodies in ovarian cancer that may be associated with neurological disorders that are clinically manifested in patients before diagnosis of ovarian cancer. These paraneoplastic antigens can serve as excellent biomarkers not only for early detection but also for monitoring ovarian cancer recurrence. OBJECTIVE To assess the immunoreactivity of our previous 3 biomarkers along with 3 paraneoplastic antigens, HARS, Ro52 and CDR2 for the evaluation of their sensitivity in predicting recurrence before the clinical relapse of the ovarian cancer. METHODS Western blot immunoassays were performed to assess the immunoreactivity of 6 antigens with 21 recurrent ovarian cancer patients. RESULTS The results indicated that antibodies to HARS, Ro52, CDR2 and 5H6 antigens predicted ovarian cancer recurrence 5.03 months before the clinical or symptomatic relapse in 21 ovarian cancer patients with a sensitivity of 90.5% when CA125 levels were below the standard cutoff (35 U/ml). CONCLUSION Our study suggests that appearance of onconeural antibodies prior to the rise in CA125 during post treatment surveillance can be a useful diagnostic to predict ovarian cancer recurrence.
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Affiliation(s)
- Madhumita Chatterjee
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Laura C Hurley
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Nancy K Levin
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Matthew Stack
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Michael A Tainsky
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Cancer Biology Graduate Program, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Molecular Therapeutics Program, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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50
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Jain A, Vats M, Neogi S, Khwaja GA. Paraneoplastic cerebellar degeneration with bilateral facial palsy: a rare primary presentation of breast cancer. BMJ Case Rep 2018; 2018:bcr-2018-224996. [PMID: 29930189 DOI: 10.1136/bcr-2018-224996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Paraneoplastic cerebellar degeneration is a rare dysfunction of the cerebellum associated with malignancy. Nevertheless, it is the most common paraneoplastic syndrome affecting the brain. A 50-year-old woman presented to the neurology outpatient department (OPD) with symptoms of cerebellar dysfunction since 4 months and complaints of a painless lump in the right breast and drooling from mouth since 1 month. Examination revealed classical signs of cerebellar dysfunction and a 5×5 cm lump in the right breast with a single right axillary lymph node. Serum anti-Yo antibody titre was strongly positive. The patient was referred to General Surgery OPD for opinion. After establishing the diagnosis of right breast carcinoma; she underwent a right modified radical mastectomy. She was referred to the oncologist for chemo/radiotherapy but because of poor performance status, only symptomatic treatment was pursued. Follow-up till now shows no improvement in the neurological dysfunction.
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Affiliation(s)
- Arihant Jain
- Department of General Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Manu Vats
- Department of General Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Sushanto Neogi
- Department of General Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Delhi, India
| | - Geeta Anjum Khwaja
- Department of Neurology, G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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