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Menendez CM, Zuccolo J, Reim S, Swedo S, Kovoor A, Cunningham MW. Human monoclonal autoantibodies in autoimmune basal ganglia encephalitis target dopamine receptors and act as drug agonists. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.52.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Neuropsychiatric diseases in autoimmune basal ganglia encephalitis (BGE) are associated with anti-neuronal autoantibodies which target the basal ganglia. BGE includes the group A streptococcal sequelae Sydenham chorea (SC) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). In SC, autoantibodies against dopamine receptors 1 and 2 (D1R and D2R) are elevated, and IgG in SC sera and cerebrospinal fluid (CSF) induce excessive dopaminergic D2R signaling and dopamine release. D1R autoantibody reactivity targeting the basal ganglia is not defined. Here we demonstrate specific IgG targeting of D1R in multiple neuropsychiatric PANDAS cohorts by serum, CSF, and human-derived mAbs. Anti-D1R human mAbs and serum autoantibodies induced D1R second messenger signaling in a dose-dependent manner. The results suggest that D1R autoantibodies enhanced antibody-mediated IgG signaling activity in the presence of the neurotransmitter dopamine. D1R autoantibodies sensitized D1R and exacerbated endogenous dopamine signaling in disease. Agonistic D1R signaling was inhibited by synthetic D1R peptide epitopes derived from human D1R extracellular loops which identified the immunodominant epitopes and antibody specificity. Taken together, D2R autoantibodies in BGE lead to excessive dopamine release and chorea, while D1R autoantibodies act like dopamine on receptors leading to allosteric enhancement and neuropsychiatric disease. Collectively, our novel findings suggest dopamine receptor autoantibodies in basal ganglia disorders act like drugs and mediate hyperactive dopaminergic receptor signaling.
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Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, Stoner JA, Swedo SE, Cunningham MW. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry 2020; 11:564. [PMID: 32670106 PMCID: PMC7328706 DOI: 10.3389/fpsyt.2020.00564] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Movement, behavioral, and neuropsychiatric disorders in children have been linked to infections and a group of anti-neuronal autoantibodies, implying dopamine receptor-mediated encephalitis within the basal ganglia. The purpose of this study was to determine if anti-neuronal biomarkers, when used as a group, confirmed the acute disease in Sydenham chorea (SC) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). IgG autoantibodies against four neuronal autoantigens (tubulin, lysoganglioside GM1, and dopamine receptors D1 and D2) were detected in SC sera (N=8), sera and/or cerebrospinal fluid (CSF) from two groups of PANDAS cases (N=25 first group and N=35 second group), sera from Tourette's syndrome (N=18), obsessive-compulsive disorder (N=25), attention deficit hyperactivity disorder (N=18), and healthy controls (N=28) by direct enzyme-linked immunosorbent assay (ELISA). IgG specific for neuronal autoantigens was significantly elevated during the acute symptomatic phase, and the activity of calcium/calmodulin-dependent protein kinase II (CaMKII) pathway was significantly elevated in human neuronal cells. Five assays confirmed the disease in SC and in two groups of children with PANDAS. In 35 acute onset PANDAS patients, 32 sera (91.4%) were positive for one or more of the anti-neuronal autoantibodies compared with 9 of 28 healthy controls (32.1%, p<0.0001). Importantly, CSF of 32 (91.4%) PANDAS patients had one or more detectable anti-neuronal autoantibody titers and CaMKII activation. Among healthy control subjects with elevated serum autoantibody titers for individual antigens, none (0%) were positively associated with elevated positive CaMKII activation, which was a striking contrast to the sera of PANDAS subjects, who had 76-89% positive association with elevated individual autoantibody titers and positive CaMKII activity. At 6 months follow-up, symptoms improved for more than 80% of PANDAS subjects, and serum autoantibody titers also significantly decreased. Results reported herein and previously published studies in our laboratory suggest the antibody biomarkers may be a useful adjunct to clinical diagnosis of SC, PANDAS, and related disorders and are the first known group of autoantibodies detecting dopamine receptor-mediated encephalitis in children.
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Affiliation(s)
- Jennifer L. Chain
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathy Alvarez
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adita Mascaro-Blanco
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sean Reim
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Bentley
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Hommer
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Paul Grant
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - James F. Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Ivana Kawikova
- Section of Pediatric Neurology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Kyle Williams
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Susan E. Swedo
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Madeleine W. Cunningham
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Fallon BA, Strobino B, Reim S, Stoner J, Cunningham MW. Anti-lysoganglioside and other anti-neuronal autoantibodies in post-treatment Lyme Disease and Erythema Migrans after repeat infection. Brain Behav Immun Health 2020; 2:100015. [PMID: 34589824 PMCID: PMC8474536 DOI: 10.1016/j.bbih.2019.100015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 02/04/2023] Open
Abstract
Background Molecular mimicry targeting neural tissue has been reported after Borrelia burgdorferi(Bb) infection. Herein, we investigate whether antineuronal autoantibodies are increased and whether antibody-mediated signaling of neuronal cells is elevated in a cohort of symptomatic adults with a history of Lyme Disease (LD). Methods Participants (n = 179) included 24 with recent Erythema Migrans (EM) without prior LD, 8 with recent EM and prior LD (EM + prior LD), 119 with persistent post-treatment LD symptoms (PTLS), and 28 seronegative endemic controls with no prior LD history. Antineuronal immunoglobulin G (IgG) titers were measured by standard ELISA and compared with mean titers of normal age-matched sera against lysoganglioside, tubulin, and dopamine receptors (D1R and D2R). Antibody-mediated signaling of calcium calmodulin dependent protein kinase II (CaMKII) activity in a human neuronal cell line (SK-N-SH) was identified in serum. Results EM + prior LD cases had higher antibody titers than controls for anti-lysoganglioside GM1 (p = 0.002), anti-tubulin (p = 0.03), and anti-D1R (p = 0.02), as well as higher expression in the functional antibody-mediated CaMKII Assay (p = 0.03). The EM cases with no prior history showed no significant differences on any measures. The PTLS cases demonstrated significantly higher titers (p = 0.01) than controls on anti-lysoganglioside GM1, but not for the other measures. Conclusion The finding of elevated anti-neuronal autoantibodies in our small sample of those with a prior history of Lyme disease but not in those without prior Lyme disease, if replicated in a larger sample, suggests an immune priming effect of repeated infection; the CaMKII activation suggests that antineuronal antibodies have functional significance. The elevation of anti-lysoganglioside antibodies among those with PTLS is of particular interest given the established role of anti-ganglioside antibodies in peripheral and central neurologic diseases. Future prospective studies can determine whether these autoantibodies emerge after Bb infection and whether their emergence coincides with persistent neurologic or neuropsychiatric symptoms.
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Affiliation(s)
- Brian A. Fallon
- Columbia Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, USA
- Corresponding author. Columbia University, 1051 Riverside Drive, Unit 69, New York, NY, 10032, USA.
| | - Barbara Strobino
- Columbia Psychiatry, Columbia University Irving Medical Center, New York, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, USA
| | - Sean Reim
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Julie Stoner
- Department of Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Madeleine W. Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Shimasaki C, Frye RE, Trifiletti R, Cooperstock M, Kaplan G, Melamed I, Greenberg R, Katz A, Fier E, Kem D, Traver D, Dempsey T, Latimer ME, Cross A, Dunn JP, Bentley R, Alvarez K, Reim S, Appleman J. Evaluation of the Cunningham Panel™ in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms. J Neuroimmunol 2019; 339:577138. [PMID: 31884258 DOI: 10.1016/j.jneuroim.2019.577138] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/28/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This retrospective study examined whether changes in patient pre- and post-treatment symptoms correlated with changes in anti-neuronal autoantibody titers and the neuronal cell stimulation assay in the Cunningham Panel in patients with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS), and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). METHODS In an analysis of all tests consecutively performed in Moleculera Labs' clinical laboratory from April 22, 2013 to December 31, 2016, we identified 206 patients who were prescribed at least one panel prior to and following treatment, and who met the PANDAS/PANS diagnostic criteria. Patient follow-up was performed to collect symptoms and treatment or medical intervention. Of the 206 patients, 58 met the inclusion criteria of providing informed consent/assent and documented pre- and post-treatment symptoms. Clinician and parent-reported symptoms after treatment or medical intervention were categorized as "Improved/Resolved" (n = 34) or "Not-Improved/Worsened" (n = 24). These were analyzed for any association between changes in clinical status and changes in Cunningham panel test results. Clinical assay performance was also evaluated for reproducibility and reliability. RESULTS Comparison of pre- and post-treatment status revealed that the Cunningham Panel results correlated with changes in patient's neuropsychiatric symptoms. Based upon the change in the number of positive tests, the overall accuracy was 86%, the sensitivity and specificity were 88% and 83% respectively, and the Area Under the Curve (AUC) was 93.4%. When evaluated by changes in autoantibody levels, we observed an overall accuracy of 90%, a sensitivity of 88%, a specificity of 92% and an AUC of 95.7%. Assay reproducibility for the calcium/calmodulin-dependent protein kinase II (CaMKII) revealed a correlation coefficient of 0.90 (p < 1.67 × 10-6) and the ELISA assays demonstrated test-retest reproducibility comparable with other ELISA assays. CONCLUSION This study revealed a strong positive association between changes in neuropsychiatric symptoms and changes in the level of anti-neuronal antibodies and antibody-mediated CaMKII human neuronal cell activation. These results suggest there may be clinical utility in monitoring autoantibody levels and stimulatory activity against these five neuronal antigen targets as an aid in the diagnosis and treatment of infection-triggered autoimmune neuropsychiatric disorders. Future prospective studies should examine the feasibility of predicting antimicrobial and immunotherapy responses with the Cunningham Panel.
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Affiliation(s)
- Craig Shimasaki
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America.
| | - Richard E Frye
- Barrow Neurological Institute, Phoenix Children's Hospital, 1919 East Thomas Rd, Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States of America
| | - Rosario Trifiletti
- The PANS/PANDAS Institute, 545 Island Road, Suite 1D, Ramsey, NJ 07446, United States of America
| | - Michael Cooperstock
- Division of Infectious Diseases, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Gary Kaplan
- The Kaplan Center for Integrative Medicine, 6828 Elm Street, Suite 300, McLean, VA 22101, United States of America
| | - Isaac Melamed
- IMMUNOe Health and Research Centers, 6801 South Yosemite Street, Centennial, CO 80112, United States of America
| | - Rosalie Greenberg
- Medical Arts Psychotherapy Associates, P.A., 33 Overlook Road, Suite 406, Summit, NJ 07901, United States of America
| | - Amiram Katz
- Private Practice Neurology, 325 Boston Post Rd., Suite 1D, Orange, CT 06477, United States of America
| | - Eric Fier
- TherapyWorks ATL, 621 North Avenue NE, Atlanta, GA 30308, United States of America
| | - David Kem
- Section of Endocrinology and Diabetes, University of Oklahoma Department of Medicine, 1000 N Lincoln Blvd., Oklahoma City, OK 73104, United States of America
| | - David Traver
- 1261 E. Hillsdale Blvd., Foster City, CA 94404, United States of America
| | - Tania Dempsey
- Armonk Integrative Medicine, Private Practice, Pediatrics, 99 Business Park Drive, Armonk, NY 10504, United States of America
| | - M Elizabeth Latimer
- Latimer Neurology Center, 1101 30th Street NW Suite #320, Washington, DC 20007, United States of America
| | - Amy Cross
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America
| | - Joshua P Dunn
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America
| | - Rebecca Bentley
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America
| | - Kathy Alvarez
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America; The University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States of America
| | - Sean Reim
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States of America
| | - James Appleman
- Moleculera Labs, Inc., 755 Research Parkway, Suite 410, Oklahoma City, OK 73104, United States of America
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Lacy M, Gerdes N, Ahmadsei M, Karshovska E, Kuipers M, Heemskerk J, Bürger C, Reim S, Weber C, Atzler D, Lutgens E. Platelet Cd40l Does Not Affect Atherogenesis, But Is A Key Player In Atherothrombosis. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lacy M, Gerdes N, Bürger C, Winkels H, Nitz K, Reim S, Weber C, Atzler D, Lutgens E. Deficiency Of Cd40-Cd40l Signaling In Dcs And T Cells Attenuates Atherosclerosis Through Reductions In Th1 Populations. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lacy M, Gerdes N, Buerger C, Winkels H, Reim S, Weber C, Atzler D, Lutgens E. P4417Deficiency of CD40-CD40L signaling in DCs and T cells attenuates atherosclerosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Lacy
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - N Gerdes
- University Hospital Dusseldorf, Dusseldorf, Germany
| | - C Buerger
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - H Winkels
- La Jolla Institute for Allergy & Immunology, San Diego, United States of America
| | - S Reim
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - C Weber
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - D Atzler
- Institute for Cardiovascular Prevention (IPEK), Munich, Germany
| | - E Lutgens
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
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Myers JM, Alvarez KM, Reim S, Bentley R, Garman L, Chen A, Wiley G, Bebak M, Montgomery CG, Gaffney P, Simpson KE, Stavrakis S, Cooper LT, Cunningham MW. Molecular mimicry and signaling by human monoclonal autoantibody derived from human myocarditis and heart failure may contribute to fibrosis and remodeling in cardiomyopathy. The Journal of Immunology 2018. [DOI: 10.4049/jimmunol.200.supp.166.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Previous studies in animal models of myocarditis suggest that immune responses against cardiac myosin may lead to remodeling in the heart and dilated cardiomyopathy. In human myocarditis and dilated cardiomyopathy, anti-cardiac myosin autoantibodies significantly associated with myocarditis in cohorts of adults and children and reacted significantly with both human cardiac myosin (HCM) and the β-adrenergic receptors (βAR). We produced a human monoclonal antibody (mAb) derived from human myocarditis which reacted with HCM and specific peptides from pathogenic regions of HCM. Autoantibodies against HCM and βAR from myocarditis and dilated cardiomyopathy including the human myocarditis-derived mAb targeted heart cells by signaling protein kinase A (PKA) in a primary heart cell line. To further define potential pathogenic mechanisms of the human mAb and serum autoantibodies from myocarditis and cardiomyopathy and to test our hypothesis that autoantibodies may alter gene expression related to extracellular matrix, remodeling and fibrosis, we investigated genes differentially expressed by RNA sequence analysis of a primary heart cell line after treatment with the human mAb and sera from both children and adults with myocarditis. The overall heatmap of differentially expressed genes in heart cells demonstrated a significant difference between the control sera group and both human mAb and myocarditis sera treatment groups. We identified upregulated genes related to fibrosis, apoptosis, inflammation and cardiomyopathy, suggesting that the myocarditis- and cardiomyopathy-derived autoantibodies may induce signaling in primary heart cells and potentially contribute to fibrosis and remodeling in the heart.
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Bürger C, Winkels H, Spitz C, Meiler S, Reim S, Weber C, Lutgens E, Gerdes N. T cell-specific CD40L contributes to atherosclerosis. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Li H, Yu X, Liles C, Khan M, Vanderlinde-Wood M, Galloway A, Zillner C, Benbrook A, Reim S, Collier D, Hill MA, Raj SR, Okamoto LE, Cunningham MW, Aston CE, Kem DC. Autoimmune basis for postural tachycardia syndrome. J Am Heart Assoc 2014; 3:e000755. [PMID: 24572257 PMCID: PMC3959717 DOI: 10.1161/jaha.113.000755] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with postural tachycardia syndrome (POTS) have exaggerated orthostatic tachycardia often following a viral illness, suggesting autoimmunity may play a pathophysiological role in POTS. We tested the hypothesis that they harbor functional autoantibodies to adrenergic receptors (AR). METHODS AND RESULTS Fourteen POTS patients (7 each from 2 institutions) and 10 healthy subjects were examined for α1AR autoantibody-mediated contractility using a perfused rat cremaster arteriole assay. A receptor-transfected cell-based assay was used to detect the presence of β1AR and β2AR autoantibodies. Data were normalized and expressed as a percentage of baseline. The sera of all 14 POTS patients demonstrated significant arteriolar contractile activity (69±3% compared to 91±1% of baseline for healthy controls, P<0.001) when coexisting β2AR dilative activity was blocked; and this was suppressed by α1AR blockade with prazosin. POTS sera acted as a partial α1AR antagonist significantly shifting phenylephrine contractility curves to the right. All POTS sera increased β1AR activation (130±3% of baseline, P<0.01) and a subset had increased β2AR activity versus healthy subjects. POTS sera shifted isoproterenol cAMP response curves to the left, consistent with enhanced β1AR and β2AR agonist activity. Autoantibody-positive POTS sera demonstrated specific binding to β1AR, β2AR, and α1AR in transfected cells. CONCLUSIONS POTS patients have elevated α1AR autoantibodies exerting a partial peripheral antagonist effect resulting in a compensatory sympathoneural activation of α1AR for vasoconstriction and concurrent βAR-mediated tachycardia. Coexisting β1AR and β2AR agonistic autoantibodies facilitate this tachycardia. These findings may explain the increased standing plasma norepinephrine and excessive tachycardia observed in many POTS patients.
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Affiliation(s)
- Hongliang Li
- Endocrinology and Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center & Veterans Affairs Medical Center, Oklahoma City, OK
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Hong K, Nourian Z, Reim S, Yu X, Li H, Yang Y, Jackson WF, Benbrook A, Kem DC, Hill MA. Angiotensin II‐independent Activation of AT1 Receptors in Skeletal Muscle Arterioles. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.678.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kwangseok Hong
- Dalton Cardiovascular Res CtrUniversity of MissouriColumbiaMO
- Medical Pharmacology & PhysiologyUniversity of MissouriColumbiaMO
| | - Zahra Nourian
- Dalton Cardiovascular Res CtrUniversity of MissouriColumbiaMO
| | - Sean Reim
- Heart Rhythm InstituteUniversity of Oklahoma Health Sciences & VAM CenterOklahoma CityOK
| | - Xichun Yu
- Heart Rhythm InstituteUniversity of Oklahoma Health Sciences & VAM CenterOklahoma CityOK
| | - Hongliang Li
- Heart Rhythm InstituteUniversity of Oklahoma Health Sciences & VAM CenterOklahoma CityOK
| | - Yan Yang
- Dalton Cardiovascular Res CtrUniversity of MissouriColumbiaMO
| | | | - Alexandra Benbrook
- Heart Rhythm InstituteUniversity of Oklahoma Health Sciences & VAM CenterOklahoma CityOK
| | - David C Kem
- Heart Rhythm InstituteUniversity of Oklahoma Health Sciences & VAM CenterOklahoma CityOK
| | - Michael A Hill
- Dalton Cardiovascular Res CtrUniversity of MissouriColumbiaMO
- Medical Pharmacology & PhysiologyUniversity of MissouriColumbiaMO
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Li H, Kem DC, Reim S, Khan M, Vanderlinde-Wood M, Zillner C, Collier D, Liles C, Hill MA, Cunningham MW, Aston CE, Yu X. Agonistic autoantibodies as vasodilators in orthostatic hypotension: a new mechanism. Hypertension 2012; 59:402-8. [PMID: 22215709 DOI: 10.1161/hypertensionaha.111.184937] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Agonistic autoantibodies to the β-adrenergic and muscarinic receptors are a novel investigative and therapeutic target for certain orthostatic disorders. We have identified the presence of autoantibodies to β2-adrenergic and/or M3 muscarinic receptors by ELISA in 75% (15 of 20) of patients with significant orthostatic hypotension. Purified serum IgG from all 20 of the patients and 10 healthy control subjects were examined in a receptor-transfected cell-based cAMP assay for β2 receptor activation and β-arrestin assay for M3 receptor activation. There was a significant increase in IgG-induced activation of β2 and M3 receptors in the patient group compared with controls. A dose response was observed for both IgG activation of β2 and M3 receptors and inhibition of their activation with the nonselective β blocker propranolol and muscarinic blocker atropine. The antibody effects on β2 and/or M3 (via production of NO) receptor-mediated vasodilation were studied in a rat cremaster resistance arteriole assay. Infusion of IgG from patients with documented β2 and/or M3 receptor agonistic activity produced a dose-dependent vasodilation. Sequential addition of the β-blocker propranolol and the NO synthase inhibitor N(G)-nitro-L-arginine methyl ester partially inhibited IgG-induced vasodilation (percentage of maximal dilatory response: from 57.7±10.4 to 35.3±4.6 and 24.3±5.8, respectively; P<0.01; n=3), indicating that antibody activation of vascular β2 and/or M3 receptors may contribute to systemic vasodilation. These data support the concept that circulating agonistic autoantibodies serve as vasodilators and may cause or exacerbate orthostatic hypotension.
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Affiliation(s)
- Hongliang Li
- Oklahoma City Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Yu X, Stavrakis S, Hill MA, Huang S, Reim S, Li H, Khan M, Hamlett S, Cunningham MW, Kem DC. Autoantibody activation of beta-adrenergic and muscarinic receptors contributes to an "autoimmune" orthostatic hypotension. J Am Soc Hypertens 2012; 6:40-7. [PMID: 22130180 PMCID: PMC3259269 DOI: 10.1016/j.jash.2011.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/04/2011] [Accepted: 10/07/2011] [Indexed: 01/25/2023]
Abstract
BACKGROUND Orthostatic hypotension (OH) is characterized by an abnormal autonomic response to upright posture. Activating autoantibodies to β1/2-adrenergic (AAβ1/2AR) and M2/3 muscarinic receptors (AAM2/3R) produce vasodilative changes in the vasculature that may contribute to OH. METHODS Immunoglobulin (Ig)G from 6 patients with idiopathic OH harboring autoantibodies and from 10 healthy control subjects were examined for: 1) β1AR and M2R activity with a perfused Purkinje fiber assay and PKA assay in H9c2 cells and 2) vasodilator β2AR and M3R activity using a pressurized cremaster resistance arteriole assay. Changes in IgG activity with and without propranolol, atropine, and L-NAME were used to estimate AAβAR, AAM2R, and AAM3R activation of their respective functions. RESULTS All six patients had elevated enzyme-linked immunosorbent assay titers to at least one of the receptors compared with controls. βAR-mediated contractility activity and M2R activity were increased in five of the six patients. IgG from all six patients produced a direct vasodilator effect on cremaster arterioles. βAR and nitric oxide synthase blockade led to near normalization of IgG-induced vasodilation. CONCLUSION AAβ1/2AR and AAM2/3R are present in some patients with idiopathic OH compatible with an in vivo effect. These autoantibodies and their cardiovascular effects provide new mechanistic insights into the pathophysiology of OH.
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Affiliation(s)
- Xichun Yu
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Michael A. Hill
- Department of Medical Pharmacology and Physiology, Dalton Cardiovascular Research Center, University of Missouri, Columbia, Missouri, USA
| | - Shijun Huang
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Sean Reim
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Hongliang Li
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Muneer Khan
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Sean Hamlett
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
| | - Madeleine W. Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David C. Kem
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
- Endocrinology and the Harold Hamm Oklahoma Diabetes Center, Department of Medicine, University of Oklahoma Health Sciences Center and VA Medical Center, Oklahoma City, Oklahoma, USA
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Meissner OA, Rieber J, Babaryka G, Oswald M, Reim S, Siebert U, Redel T, Eibel R, Mueller-Lisse U, Reiser M, Mueller-Lisse UG. Intravaskuläre optische Kohärenztomographie: Unterscheidung verschiedener Plaquetypen und Vermessung von Gefäßdimensionen in atherosklerotischen Unterschenkelarterienex vivo. ROFO-FORTSCHR RONTG 2006; 178:214-20. [PMID: 16435253 DOI: 10.1055/s-2005-858922] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Intravascular optical coherence tomography (OCT) is a new technique based on infrared light that visualizes the arteries with a resolution of 10-20 microm. Intravascular ultrasound (IVUS) is the current in vivo reference standard and provides a resolution of 100-150 microm. This study compared OCT to IVUS and histopathology with respect to the ability to differentiate atherosclerotic plaques and quantify vascular dimensions in peripheral crural arteries ex vivo. MATERIALS AND METHODS 50 segments of atherosclerotic arteries derived from five amputated human lower extremities were examined. The different plaque types (fibrous, high-lipid content, calcified) were assigned by two independent examiners, and the sensitivity and specificity of OCT in comparison with histopathology as well as intra- and interobserver consensus were calculated. A comparison of OCT with IVUS addressed the parameters: luminal area (LA), vascular wall area (VA) and plaque area (PA). RESULTS When comparing OCT and histopathology with respect to the differentiation of various plaque types, sensitivities of 81 % and specificities of 89 % for fibrous plaques, of 100 % and 93 % for lipid-rich plaques and of 80 % and 89 % for calcified plaques were achieved (overall correlation 83 %). Intra- and interobserver consensus was very high (kappa = 0.86 and kappa = 0.89, p < 0.001, respectively). There was also a high correlation between quantitative measurements (Bland-Altman plot [LA]: mean bias, 0.1 mm(2) accuracy +/- 1.8 mm(2), r = 0.95 [p < 0.001] Bland-Altman plot [VA]: mean bias, 0.3 mm(2) accuracy +/- 2.3 mm(2), r = 0.94 [p < 0.001] Bland-Altman plot [PA]: mean bias, 0.4 mm(2) accuracy +/- 2.3 mm(2), r = 0.80 [p < 0.01]. CONCLUSION OCT allows the differentiation of atherosclerotic plaque types in crural arteries with high accuracy compared to histopathology. Quantitative measurements show a high correlation with IVUS, the current reference standard.
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Affiliation(s)
- O A Meissner
- Institut für Klinische Radiologie, Ludwig-Maximilians-Universität München.
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Meissner OA, Rieber J, Babaryka G, Reim S, Oswald M, Redel T, Kleen M, Reiser M. Intravaskuläre optische Kohärenztomographie: Validierung einer neuen mikrostrukturellen Bildgebung an Koronararterien in vitro. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Meissner OA, Rieber J, Babaryka G, Kleen M, Redel T, Oswald M, Reim S, Reiser M. Optische Kohärenztomographie: In-Vitro Untersuchungen der Koronararterien im Vergleich mit dem Intravaskulären Ultraschall und der Histologie – Erste Ergebnisse. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-864021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Reim S, Hanke V. INVESTIGATION ON STABILITY OF TRANSGENES AND THEIR EXPRESSION IN TRANSGENIC APPLE PLANTS (MALUS X DOMESTICA BORKH.). ACTA ACUST UNITED AC 2004. [DOI: 10.17660/actahortic.2004.663.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Frenzen G, Reim S, Sippel H, Frauenrath H. Crystal structure of dichloro[(+)-1,2-bis((2S,5S)-2,5-dimethylphospholano) benzene-P,P'] nickel, C18H28Cl2NiP2. Z KRIST-NEW CRYST ST 1999. [DOI: 10.1515/ncrs-1999-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Frenzen
- 1Universität Gh Kassel, Fachbereich 19 - Biologie/Chemie, Heinrich-Plett-Str. 40, D-34109 Kassel, Germany
| | - S. Reim
- 1Universität Gh Kassel, Fachbereich 19 - Biologie/Chemie, Heinrich-Plett-Str. 40, D-34109 Kassel, Germany
| | - H. Sippel
- 1Universität Gh Kassel, Fachbereich 19 - Biologie/Chemie, Heinrich-Plett-Str. 40, D-34109 Kassel, Germany
| | - H. Frauenrath
- 1Universität Gh Kassel, Fachbereich 19 - Biologie/Chemie, Heinrich-Plett-Str. 40, D-34109 Kassel, Germany
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Frenzen G, Rabe S, Frauenrath H, Reim S. Crystal structure of diiodo[(–)-2,2-dimethyl-4,5-bis(diphenylphoshinomethyl)-1,3-dioxolane-P,P'] nickel, C31H32I2NiO2P2. Z KRIST-NEW CRYST ST 1998. [DOI: 10.1524/ncrs.1998.213.14.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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