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Krejcova V, David J, Svepes A, Buksakowska I, Kantorova E, Liba Z, Paulas L, Indrakova J, Zieg J. Persistent Flaccid Paralysis in a Patient with Bartter Syndrome. Klin Padiatr 2023; 235:299-301. [PMID: 36848940 DOI: 10.1055/a-1829-6365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Vlasta Krejcova
- Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
| | - Jan David
- Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
| | - Adam Svepes
- Department of Pediatrics, Regional hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Irena Buksakowska
- Department of Radiology, Motol University Hospital, Praha, Czech Republic
| | - Eva Kantorova
- Department of Medical Genetics, Regional hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Zuzana Liba
- Department of Pediatric Neurology, Motol University Hospital, Praha, Czech Republic
| | - Lukas Paulas
- Department of Pediatric Neurology, Motol University Hospital, Praha, Czech Republic
| | - Jana Indrakova
- Department of Medical Genetics, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jakub Zieg
- Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
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Fejtkova M, Sukova M, Hlozkova K, Skvarova Kramarzova K, Rackova M, Jakubec D, Bakardjieva M, Bloomfield M, Klocperk A, Parackova Z, Sediva A, Aluri J, Novakova M, Kalina T, Fronkova E, Hrusak O, Malcova H, Sedlacek P, Liba Z, Kudr M, Stary J, Cooper MA, Svaton M, Kanderova V. TLR8/TLR7 dysregulation due to a novel TLR8 mutation causes severe autoimmune hemolytic anemia and autoinflammation in identical twins. Am J Hematol 2022; 97:338-351. [PMID: 34981838 DOI: 10.1002/ajh.26452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022]
Abstract
Our study presents a novel germline c.1715G>T (p.G572V) mutation in the gene encoding Toll-like receptor 8 (TLR8) causing an autoimmune and autoinflammatory disorder in a family with monozygotic male twins, who suffer from severe autoimmune hemolytic anemia worsening with infections, and autoinflammation presenting as fevers, enteritis, arthritis, and CNS vasculitis. The pathogenicity of the mutation was confirmed by in vitro assays on transfected cell lines and primary cells. The p.G572V mutation causes impaired stability of the TLR8 protein, cross-reactivity to TLR7 ligands and reduced ability of TLR8 to attenuate TLR7 signaling. This imbalance toward TLR7-dependent signaling leads to increased pro-inflammatory responses, such as nuclear factor-κB (NF-κB) activation and production of pro-inflammatory cytokines IL-1β, IL-6, and TNFα. This unique TLR8 mutation with partial TLR8 protein loss and hyperinflammatory phenotype mediated by TLR7 ligands represents a novel inborn error of immunity with childhood-onset and a good response to TLR7 inhibition.
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Affiliation(s)
- Martina Fejtkova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Martina Sukova
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Katerina Hlozkova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Karolina Skvarova Kramarzova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Marketa Rackova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - David Jakubec
- Bioinformatics Group, Institute of Organic Chemistry and Biochemistry Czech Academy of Sciences Prague Czech Republic
- Department of Software Engineering, Faculty of Mathematics and Physics Charles University Prague Czech Republic
| | - Marina Bakardjieva
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Marketa Bloomfield
- Department of Paediatrics, First Faculty of Medicine Charles University and Thomayer University Hospital Prague Czech Republic
- Department of Immunology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Adam Klocperk
- Department of Immunology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Zuzana Parackova
- Department of Immunology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Anna Sediva
- Department of Immunology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Jahnavi Aluri
- Division of Rheumatology/Immunology, Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
| | - Michaela Novakova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Tomas Kalina
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Eva Fronkova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Ondrej Hrusak
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Hana Malcova
- Department of Paediatric and Adult Rheumatology University Hospital Motol Prague Czech Republic
| | - Petr Sedlacek
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Zuzana Liba
- Department of Paediatric Neurology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Martin Kudr
- Department of Paediatric Neurology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Jan Stary
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Megan A. Cooper
- Division of Rheumatology/Immunology, Department of Pediatrics Washington University School of Medicine St. Louis Missouri USA
| | - Michael Svaton
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
| | - Veronika Kanderova
- CLIP ‐ Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, Second Faculty of Medicine Charles University and University Hospital Motol Prague Czech Republic
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Liba Z, Kraus J, Necas T, Necas J, Klugar M, Krsek P. Movement disorders, cerebral palsy and vaccination. Eur J Paediatr Neurol 2022; 36:143-150. [PMID: 34979476 DOI: 10.1016/j.ejpn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
This review focused on vaccination in children with movement disorders, including cerebral palsy and the movement disorders triggered by vaccination in children with and without neurological disabilities. The following clinical questions were addressed: 1) Can children with movement disorders be vaccinated? 2) Can vaccination trigger movement disorders in children without neurological disabilities? 3) Can vaccination trigger movement disorders in children with neurological disabilities? and 4) Is there any consensus of care concerning vaccination in children with movement disorders? Following the PRISMA reporting guidelines, 1096 records were identified and 34 relevant papers were included. No evidence that vaccinations are contraindicated for children with movement disorders was noticed. Several reports of neurological adverse events, including movement disorders in children without neurological disabilities after various types of vaccination, were found. The reporting rates were low, the causality was controversial, and patient outcomes were mostly favourable. There was limited (if any) evidence in our search that any vaccination leads to any movement disorder exacerbation. Finally, no generally accepted consensus or standards of care concerning vaccination in patients with movement disorders were found. In summary, we found few precautions for vaccination in this group of patients and concluded that general best practice guidelines for immunization should be followed. In addition, influenza and pneumococcal vaccines are recommended because they can reduce morbidity and mortality in individuals severely affected by movement restrictions.
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Affiliation(s)
- Zuzana Liba
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Josef Kraus
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Tomas Necas
- Department of Paediatrics, Tomas Bata Regional Hospital, Havlickovo nabrezi 600, 76001, Zlin, Czech Republic.
| | - Jiri Necas
- General Practitioner, Masarykovo namesti 1130, 76012, Vizovice, Czech Republic.
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, The Czech Republic Centre for Evidence-Based Healthcare, JBI Centre of Excellence, Masaryk University GRADE Centre, Institute of Biostatistics and Analyses, Masaryk University, 625 00, Brno, Czech Republic
| | - Pavel Krsek
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
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Pavelekova P, Jech R, Zech M, Krepelova A, Han V, Mosejova A, Liba Z, Urgosik D, Gdovinova Z, Havrankova P, Fecikova A, Winkelmann J, Skorvanek M. Atypical presentations of DYT1 dystonia with acute craniocervical onset. Parkinsonism Relat Disord 2021; 83:54-55. [PMID: 33476878 DOI: 10.1016/j.parkreldis.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/14/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
DYT1 gene mutations lead to early-onset dystonia that begins with focal limb onset and spreads to other body regions within 5 years, with typical sparing of the oromandibular muscles. In the present study, we describe two patients with an unusual presentation of the disease.
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Affiliation(s)
- P Pavelekova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.
| | - R Jech
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - M Zech
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute for Human Genetics, Technische Universität München, Munich, Germany
| | - A Krepelova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - V Han
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - A Mosejova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Z Liba
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - D Urgosik
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Z Gdovinova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - P Havrankova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - A Fecikova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - J Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany; Institute for Human Genetics, Technische Universität München, Munich, Germany; Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, SyNergy, Munich, Germany
| | - M Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
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Liba Z, Vaskova M, Zamecnik J, Kayserova J, Nohejlova H, Ebel M, Sanda J, Ramos-Rivera GA, Brozova K, Liby P, Tichy M, Krsek P. An immunotherapy effect analysis in Rasmussen encephalitis. BMC Neurol 2020; 20:359. [PMID: 32972372 PMCID: PMC7517818 DOI: 10.1186/s12883-020-01932-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/24/2020] [Accepted: 09/14/2020] [Indexed: 01/16/2023] Open
Abstract
Background Immune-mediated mechanisms substantially contribute to the Rasmussen encephalitis (RE) pathology, but for unknown reasons, immunotherapy is generally ineffective in patients who have already developed intractable epilepsy; overall laboratory data regarding the effect of immunotherapy on patients with RE are limited. We analyzed multiple samples from seven differently treated children with RE and evaluated the effects of immunotherapies on neuroinflammation. Immunotherapy was introduced to all patients at the time of intractable epilepsy and they all had to undergo hemispherothomy. Methods Immunohistochemistry, flow cytometry, Luminex multiplex bead and enzyme-linked immunosorbent assay techniques were combined to determine: 1) inflammatory changes and lymphocyte subpopulations in 45 brain tissues; 2) lymphocyte subpopulations and the levels of 12 chemokines/cytokines in 24 cerebrospinal fluid (CSF) samples and 30 blood samples; and 3) the dynamics of these parameters in four RE patients from whom multiple samples were collected. Results Sustained T cell-targeted therapy with cyclophosphamide, natalizumab, alemtuzumab, and intrathecal methotrexate (ITMTX), but not with azathioprine, substantially reduced inflammation in brain tissues. Despite the therapy, the distributions of CD8+ T cells and the levels of C-X-C motif ligand (CXCL) 10, CXCL13, and B cell activating factor (BAFF) in patients’ CSF remained increased compared to controls. A therapeutic approach combining alemtuzumab and ITMTX was the most effective in producing simultaneous reductions in histopathological inflammatory findings and in the numbers of activated CD8+ T cells in the brain tissue, as well as in the overall CD8+ T cell population and chemokine/cytokine production in the CSF. Conclusions We provide evidence that various T cell-targeted immunotherapies reduced inflammation in the brains of RE patients. The observation that intractable epilepsy persisted in all of the patients suggests a relative independence of seizure activity on the presence of T cells in the brain later in the disease course. Thus, new therapeutic targets must be identified. CXCL10, CXCL13 and BAFF levels were substantially increased in CSF from all patients and their significance in RE pathology remains to be addressed.
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Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.
| | - Martina Vaskova
- CLIP - Childhood Leukaemia Investigation Prague, Department of Pediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jana Kayserova
- Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,Imunale s.r.o, Prague, Czech Republic
| | - Hana Nohejlova
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic.,Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Matyas Ebel
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
| | - Jan Sanda
- Department of Radiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Gonzalo Alonso Ramos-Rivera
- Department of Pediatric Neurology, Comenius University Faculty of Medicine and National Institute of Children's Diseases, Bratislava, Slovak Republic
| | - Klara Brozova
- Department of Pediatric Neurology, Thomayer Hospital, Prague, Czech Republic.,Department of Neurology and Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Michal Tichy
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- Department of Pediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, 15006, Prague, Czech Republic
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Liba Z, Nohejlova H, Capek V, Krsek P, Sediva A, Kayserova J. Utility of chemokines CCL2, CXCL8, 10 and 13 and interleukin 6 in the pediatric cohort for the recognition of neuroinflammation and in the context of traditional cerebrospinal fluid neuroinflammatory biomarkers. PLoS One 2019; 14:e0219987. [PMID: 31356620 PMCID: PMC6663008 DOI: 10.1371/journal.pone.0219987] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 07/05/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The recognition of active inflammation in the central nervous system (CNS) in the absence of infectious agents is challenging. The present study aimed to determine the diagnostic relevance of five selected chemo/cytokines in the recognition of CNS inflammation and in the context of traditional cerebrospinal fluid (CSF) biomarkers (white blood cell [WBC] counts, oligoclonal bands, protein levels, CSF/serum albumin ratios) and clinical diagnoses. METHODS C-C and C-X-C motif ligands (CCL2, CXCL8, 10 and 13) and interleukin (IL) 6 levels in the CSF and serum from 37 control and 87 symptomatic children with ten different (mostly noninfectious) inflammatory CNS disorders (16 of which had follow-up samples after recovery) were determined using Luminex multiple bead technology and software. Nonparametric tests were used; p < 0.05 was considered statistically significant. Receiver operating characteristic curves were constructed to analyze controls and 1) all symptomatic samples or 2) symptomatic samples without CSF pleocytosis. RESULTS Compared with the control CSF samples, levels of all investigated chemo/cytokines were increased in symptomatic CSF samples, and only IL-6 remained elevated in recovery samples (p ≤ 0.001). CSF CXCL-13 levels (> 10.9 pg/mL) were the best individual discriminatory criterion to differentiate neuroinflammation (specificity/sensitivity: 97/72% and 97/61% for samples without pleocytosis), followed by CSF WBC counts (specificity/sensitivity: 97/62%). The clinical utility of the remaining CSF chemo/cytokine levels was determined in descending order of sensitivities corresponding to thresholds that ensured 97% specificity for neuroinflammation in samples without pleocytosis (pg/mL; sensitivity %): IL-6 (3.8; 34), CXCL8 (32; 26), CXCL10 (317; 24) and CCL2 (387; 10). Different diagnosis-related patterns of CSF chemo/cytokines were observed. CONCLUSIONS The increased CSF level of CXCL13 was the marker with the greatest predictive utility for the general recognition of neuroinflammation among all of the individually investigated biomarkers. The potential clinical utility of chemo/cytokines in the differential diagnosis of neuroinflammatory diseases was identified.
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Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- * E-mail:
| | - Hana Nohejlova
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
- Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vaclav Capek
- Bioinformatics Centre, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2 Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jana Kayserova
- Department of Immunology, 2 Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Liba Z, Sedlacek P, Sebronova V, Maulisova A, Rydenhag B, Zamecnik J, Kyncl M, Krsek P. Alemtuzumab and intrathecal methotrexate failed in the therapy of Rasmussen encephalitis. Neurol Neuroimmunol Neuroinflamm 2017; 4:e354. [PMID: 28534039 PMCID: PMC5427667 DOI: 10.1212/nxi.0000000000000354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Petr Sedlacek
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Vera Sebronova
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Alice Maulisova
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Bertil Rydenhag
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Josef Zamecnik
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Martin Kyncl
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Pavel Krsek
- Department of Pediatric Neurology (Z.L., V.S., A.M., P.K.), Department of Pediatric Hematology and Oncology (P.S.), Department of Pathology and Molecular Medicine (J.Z.), Department of Radiology (M.K.), Charles University, 2nd Faculty of Medicine and Motol University Hospital; Department of Clinical Psychology (A.M.), Charles University, Faculty of Arts, Prague, Czech Republic; and Institute of Neuroscience and Physiology (B.R.), Department of Clinical Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Sweden
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Liba Z, Kayserova J, Elisak M, Marusic P, Nohejlova H, Hanzalova J, Komarek V, Sediva A. Anti-N-methyl-D-aspartate receptor encephalitis: the clinical course in light of the chemokine and cytokine levels in cerebrospinal fluid. J Neuroinflammation 2016; 13:55. [PMID: 26941012 PMCID: PMC4776396 DOI: 10.1186/s12974-016-0507-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/10/2016] [Indexed: 12/16/2022] Open
Abstract
Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder of the central nervous system (CNS). Its immunopathogenesis has been proposed to include early cerebrospinal fluid (CSF) lymphocytosis, subsequent CNS disease restriction and B cell mechanism predominance. There are limited data regarding T cell involvement in the disease. To contribute to the current knowledge, we investigated the complex system of chemokines and cytokines related to B and T cell functions in CSF and sera samples from anti-NMDAR encephalitis patients at different time-points of the disease. One patient in our study group had a long-persisting coma and underwent extraordinary immunosuppressive therapy. Methods Twenty-seven paired CSF/serum samples were collected from nine patients during the follow-up period (median 12 months, range 1–26 months). The patient samples were stratified into three periods after the onset of the first disease symptom and compared with the controls. Modified Rankin score (mRS) defined the clinical status. The concentrations of the chemokines (C-X-C motif ligand (CXCL)10, CXCL8 and C-C motif ligand 2 (CCL2)) and the cytokines (interferon (IFN)γ, interleukin (IL)4, IL7, IL15, IL17A and tumour necrosis factor (TNF)α) were measured with Luminex multiple bead technology. The B cell-activating factor (BAFF) and CXCL13 concentrations were determined via enzyme-linked immunosorbent assay. We correlated the disease period with the mRS, pleocytosis and the levels of all of the investigated chemokines and cytokines. Non-parametric tests were used, a P value <0.05 was considered to be significant. Results The increased CXCL10 and CXCL13 CSF levels accompanied early-stage disease progression and pleocytosis. The CSF CXCL10 and CXCL13 levels were the highest in the most complicated patient. The CSF BAFF levels remained unchanged through the periods. In contrast, the CSF levels of T cell-related cytokines (INFγ, TNFα and IL17A) and IL15 were slightly increased at all of the periods examined. No dynamic changes in chemokine and cytokine levels were observed in the peripheral blood. Conclusions Our data support the hypothesis that anti-NMDAR encephalitis is restricted to the CNS and that chemoattraction of immune cells dominates at its early stage. Furthermore, our findings raise the question of whether T cells are involved in this disease. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0507-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
| | - Jana Kayserova
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Elisak
- Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Hana Nohejlova
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic.,Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jitka Hanzalova
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.,Department of Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vladimir Komarek
- Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Uvalu 84, Prague, 15006, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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Liba Z, Muthaffar O, Tang J, Minassian B, Halliday W, Branson H, Ann Yeh E. Rasmussen encephalitis: Response to early immunotherapy in a case of immune-mediated encephalitis. Neurol Neuroimmunol Neuroinflamm 2015; 2:e69. [PMID: 25738166 PMCID: PMC4335812 DOI: 10.1212/nxi.0000000000000069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/07/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Osama Muthaffar
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Joyce Tang
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Berge Minassian
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - William Halliday
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - Helen Branson
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
| | - E Ann Yeh
- Department of Pediatric Neurology (Z.L.), 2nd Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic; Division of Neurology (O.M., B.M., E.A.Y.), Division of Pathology (W.H.), and Division of Neuroradiology (H.B.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Pediatrics (O.M., B.M., E.A.Y.), Department of Internal Medicine (J.T.), Department of Laboratory Medicine & Pathobiology (W.H.), and Department of Medical Imaging (H.B.), University of Toronto, Ontario, Canada
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Liba Z, Kayserova J, Komarek V. Th1 and Th17 but no Th2-related cytokine spectrum in the cerebrospinal fluid of children with Borrelia-related facial nerve palsy. Fluids Barriers CNS 2013; 10:30. [PMID: 24093799 PMCID: PMC3851235 DOI: 10.1186/2045-8118-10-30] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 09/26/2013] [Indexed: 11/15/2022] Open
Abstract
Background Chemokines and cytokines in cerebrospinal fluid (CSF) and serum have been extensively studied in adults with neuroborreliosis (NB), whereas there are limited data about the pediatric population. In adults, T helper type 1 (Th1) and Th17-related cytokines were observed during acute NB. In children, the Th2 response is thought to moderate the disease course. The aim of this study was to determine the chemokine-cytokine profile in children with acute NB displaying Borrelia-related peripheral facial nerve palsy (PFNP). Methods Luminex multiple bead technology was used for the detection of twelve cytokines and chemokines in the CSF and serum of three groups: 1) children with Borrelia-related PFNP (BPFNP); 2) children with non-borrelial “idiopathic” PFNP (NIPFNP); and 3) age-related controls. Results In BPFNP, cytokines-chemokines related to a non-specific pro-inflammatory activity and specific Th1/Th17 responses were detected in CSF, and elevated IL-7 and IL-10 levels were observed in serum and CSF compared to NIPFNP and to controls. In NIPFNP, CSF findings were similar to controls; however, higher levels of IL-7 and MCP-1 were observed in serum. Higher IL-8, IL-15 and MCP-1 levels were detected in CSF compared to serum in all groups. MCP-1 and IL-8 levels in CSF were strikingly higher in BPFNP compared to the other two groups, while IL-15 levels in CSF showed no difference. In addition, in controls, increased IL-4 level was found in CSF compared to serum. Conclusion The chemokine-cytokine profile in the CSF of children with acute NB was similar to previous studies in adults. Our data suggests that higher levels of IL-4, IL-15 and MCP-1 levels in CSF compared to serum in controls might represent a potentially protective cytokine milieu in the CNS compartment.
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Affiliation(s)
- Zuzana Liba
- Department of Pediatric Neurology, University Hospital Motol, Prague, Czech Republic.
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