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Kister I, Curtin R, Piquet AL, Borko T, Pei J, Banbury BL, Bacon TE, Kim A, Tuen M, Velmurugu Y, Nyovanie S, Selva S, Samanovic MI, Mulligan MJ, Patskovsky Y, Priest J, Cabatingan M, Winger RC, Krogsgaard M, Silverman GJ. Longitudinal study of immunity to SARS-CoV2 in ocrelizumab-treated MS patients up to 2 years after COVID-19 vaccination. Ann Clin Transl Neurol 2024. [PMID: 38713096 DOI: 10.1002/acn3.52081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES (1) To plot the trajectory of humoral and cellular immune responses to the primary (two-dose) COVID-19 mRNA series and the third/booster dose in B-cell-depleted multiple sclerosis (MS) patients up to 2 years post-vaccination; (2) to identify predictors of immune responses to vaccination; and (3) to assess the impact of intercurrent COVID-19 infections on SARS CoV-2-specific immunity. METHODS Sixty ocrelizumab-treated MS patients were enrolled from NYU (New York) and University of Colorado (Anschutz) MS Centers. Samples were collected pre-vaccination, and then 4, 12, 24, and 48 weeks post-primary series, and 4, 12, 24, and 48 weeks post-booster. Binding anti-Spike antibody responses were assessed with multiplex bead-based immunoassay (MBI) and electrochemiluminescence (Elecsys®, Roche Diagnostics), and neutralizing antibody responses with live-virus immunofluorescence-based microneutralization assay. Spike-specific cellular responses were assessed with IFNγ/IL-2 ELISpot (Invitrogen) and, in a subset, by sequencing complementarity determining regions (CDR)-3 within T-cell receptors (Adaptive Biotechnologies). A linear mixed-effect model was used to compare antibody and cytokine levels across time points. Multivariate analyses identified predictors of immune responses. RESULTS The primary vaccination induced an 11- to 208-fold increase in binding and neutralizing antibody levels and a 3- to 4-fold increase in IFNγ/IL-2 responses, followed by a modest decline in antibody but not cytokine responses. Booster dose induced a further 3- to 5-fold increase in binding antibodies and 4- to 5-fold increase in IFNγ/IL-2, which were maintained for up to 1 year. Infections had a variable impact on immunity. INTERPRETATION Humoral and cellular benefits of COVID-19 vaccination in B-cell-depleted MS patients were sustained for up to 2 years when booster doses were administered.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Ryan Curtin
- Laura and Isaac Perlmutter Cancer Center and Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Amanda L Piquet
- Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tyler Borko
- Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jinglan Pei
- Genentech, Inc., South San Francisco, California, USA
| | | | - Tamar E Bacon
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Angie Kim
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Tuen
- NYU Langone Vaccine Center and Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Yogambigai Velmurugu
- Laura and Isaac Perlmutter Cancer Center and Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Samantha Nyovanie
- Laura and Isaac Perlmutter Cancer Center and Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Sean Selva
- Rocky Mountain MS Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marie I Samanovic
- NYU Langone Vaccine Center and Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark J Mulligan
- NYU Langone Vaccine Center and Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Yury Patskovsky
- Laura and Isaac Perlmutter Cancer Center and Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | | | | | - Ryan C Winger
- Genentech, Inc., South San Francisco, California, USA
| | - Michelle Krogsgaard
- Laura and Isaac Perlmutter Cancer Center and Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Gregg J Silverman
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
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Jellins TS, Borko TL, Otero-Bell R, Arnett K, Saunders S, Poisson SN, Orjuela KD, Salehi Omran S, Jones WJ, Leppert M, Madera A, Carlson A, Pastula DM, Sauer BM, Piquet AL, Gonzales NR. Diversity, equity, and inclusion (DEI) in medical education: DEI at the bedside. J Neurol Sci 2024; 459:122946. [PMID: 38493733 DOI: 10.1016/j.jns.2024.122946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The ability to recognize and address bias is an important communication skill not typically addressed during training. We describe the design of an educational curriculum that aims to identify and change behavior related to diversity, equity, and inclusion (DEI). "DEI at the Bedside" uses the existing infrastructure of bedside teaching and provides a tool to normalize DEI discussions and develop skills to address bias during a neurology inpatient rotation. METHODS As part of traditional clinical rounds, team members on an inpatient service shared experiences with DEI topics, including bias. The team developed potential responses should they encounter a similar situation in the future. We report the results of our needs assessment and curriculum development to evaluate the feasibility of incorporating a DEI educational curriculum in the neurology inpatient setting. RESULTS Forty-two DEI experiences were recorded. Medical students were the most frequent discussants (44%). Direction of bias occurred between healthcare team members (33%), against patients (31%), and patients against healthcare team members (28%). Experiences ranged from microaggressions to explicit comments of racism, sexism, and homophobia. CONCLUSIONS Based on needs assessment data, we developed a DEI educational curriculum for the inpatient neurology setting aimed to improve knowledge and skills related to DEI topics as well as to normalize conversation of DEI in the clinical setting. Additional study will demonstrate whether this initiative translates into measurable and sustained improvement in knowledge of how bias and disparity show up in the clinical setting and behavioral intent to discuss and address them.
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Affiliation(s)
- Tennyson S Jellins
- University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Tyler L Borko
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - RayLee Otero-Bell
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Kelly Arnett
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Scott Saunders
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Sharon N Poisson
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Karen D Orjuela
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Setareh Salehi Omran
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - William J Jones
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Michelle Leppert
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Ashley Madera
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Aaron Carlson
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Daniel M Pastula
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America.
| | - Brian M Sauer
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Amanda L Piquet
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - Nicole R Gonzales
- Department of Neurology, Neurohospitalist & Stroke Section, University of Colorado School of Medicine, Aurora, CO, United States of America.
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Ardakani R, Chauhan L, Piquet AL, Tyler KL, Pastula DM. An Overview of Saint Louis Encephalitis. Neurohospitalist 2024; 14:230-231. [PMID: 38666278 PMCID: PMC11040620 DOI: 10.1177/19418744241228006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Rumyar Ardakani
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lakshmi Chauhan
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda L. Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth L. Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M. Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Vervloet Sollero CE, Piquet AL, Robinson C, Gyang TV, Carlson A. Anti-NMDA Receptor Encephalitis Related to Renal Cell Carcinoma: A Case Report. Neurohospitalist 2024; 14:189-194. [PMID: 38666271 PMCID: PMC11040629 DOI: 10.1177/19418744231216179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Anti-NMDA receptor (NMDAR) encephalitis is characterized by a well-defined neuropsychiatric syndrome and CSF antibodies against the GluN1 subunit of the NMDAR. 40% of cases are related to underlying tumors, the vast majority ovarian teratomas (94%). We report a case of anti-NMDAR encephalitis associated with renal cell carcinoma (RCC). A 20-year-old female presented to the ED with behavioral changes, involuntary movements, tachycardia, and alternating obtundation with agitation which progressed over 3 weeks. Involuntary movements were severe, requiring intubation and sedation for control, and were accompanied by rhabdomyolysis. Brain MRI showed bilateral mesiotemporal T2/FLAIR hyperintensities. Anti-NMDAR antibodies were present in the serum (1:640) and CSF (1:320). Malignancy screening revealed a renal mass concerning for RCC, which was confirmed upon resection. She was started on high dose IV methylprednisolone and plasmapheresis, followed by rituximab. Lack of response led to escalating immunotherapy with cyclophosphamide. Clinical course was complicated by prolonged ICU admission, prolonged sedation, severe dysautonomia and bacteremia. Improvement began 2 months after immunotherapy, and she was discharged to rehabilitation 100 days after admission with mild neuropsychiatric symptoms. Repeat malignancy screenings, including whole-body imaging and transvaginal ultrasound were consistently negative. Herein, we describe a case of definite anti-NMDAR encephalitis in the setting of newly diagnosed RCC. This case illustrates how tumors other than ovarian teratomas may act as immunological triggers, as well as the complex and prolonged symptomatic and immunosuppressive therapies required in severe presentations of anti-NMDAR encephalitis.
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Affiliation(s)
| | - Amanda L Piquet
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Christopher Robinson
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | | | - Aaron Carlson
- Department of Neurology, University of Colorado, Aurora, CO, USA
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5
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Celli SI, Nash R, Money KM, Garza M, Borko TL, Mizenko C, McMenamin C, Von Geldern G, Georges G, Piquet AL. Successful Autologous Hematopoietic Stem Cell Transplant in Glycine Receptor Antibody-Positive Stiff Person Syndrome: A Case Report. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200197. [PMID: 38170953 PMCID: PMC10766081 DOI: 10.1212/nxi.0000000000200197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVES To describe a case of glycine receptor (GlyR) antibody-positive stiff person syndrome (SPS) treated with autologous hematopoietic stem cell transplant (aHSCT). METHODS This was a multicenter collaboration for the treatment of a single patient who underwent aHSCT as part of a clinical trial (NCT00716066). To objectively assess the response to transplantation, several clinical outcome measures were evaluated pretransplant and up to 18 months post-transplant, including modified Rankin Score (mRS), stiffness index, Hauser Ambulation Score (HAS), hypersensitivity index, timed 25-foot walk, and Montreal Cognitive Assessment. RESULTS After transplant, the patient achieved sustained clinical improvement evidenced across various clinical scales, including mRS, stiffness index, HAS, and 25-foot walk time. DISCUSSION aHSCT represents a promising treatment option for SPS, including for GlyR-positive patients. In addition, this case represents the need to validate and standardize best clinical outcome measures for patients with SPS. CLASSIFICATION OF EVIDENCE Class IV; this is a single observational study without controls.
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Affiliation(s)
- Sofia I Celli
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Richard Nash
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Kelli M Money
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Madeline Garza
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Tyler L Borko
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Christopher Mizenko
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Constance McMenamin
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Gloria Von Geldern
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - George Georges
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
| | - Amanda L Piquet
- From the Department of Neurology (S.I.C., K.M.M., M.G., T.L.B., C. Mizenko, C. McMenamin, A.L.P.), University of Colorado, Aurora Colorado Blood Cancer Institute (R.N.), Presbyterian St. Luke's Medical Center, Denver, CO; Department of Neurology (G.V.G.); Fred Hutchinson Cancer Center (G.G.), University of Washington, Seattle, WA; and Northwestern University (G.G.), Feinberg School of Medicine, Chicago, IL
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6
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Baxter RM, Cabrera-Martinez B, Ghosh T, Rester C, Moreno MG, Borko TL, Selva S, Fleischer CL, Haakonsen N, Mayher A, Bowhay E, Evans C, Miller TM, Huey L, McWilliams J, van Bokhoven A, Deane KD, Knight V, Jordan KR, Ghosh D, Klarquist J, Kedl RM, Piquet AL, Hsieh EWY. SARS-CoV-2 Vaccine-Elicited Immunity after B Cell Depletion in Multiple Sclerosis. Immunohorizons 2024; 8:254-268. [PMID: 38483384 PMCID: PMC10985059 DOI: 10.4049/immunohorizons.2300108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
The impact of B cell deficiency on the humoral and cellular responses to SARS-CoV2 mRNA vaccination remains a challenging and significant clinical management question. We evaluated vaccine-elicited serological and cellular responses in 1) healthy individuals who were pre-exposed to SARS-CoV-2 (n = 21), 2) healthy individuals who received a homologous booster (mRNA, n = 19; or Novavax, n = 19), and 3) persons with multiple sclerosis on B cell depletion therapy (MS-αCD20) receiving mRNA homologous boosting (n = 36). Pre-exposure increased humoral and CD4 T cellular responses in immunocompetent individuals. Novavax homologous boosting induced a significantly more robust serological response than mRNA boosting. MS-α CD20 had an intact IgA mucosal response and an enhanced CD8 T cell response to mRNA boosting compared with immunocompetent individuals. This enhanced cellular response was characterized by the expansion of only effector, not memory, T cells. The enhancement of CD8 T cells in the setting of B cell depletion suggests a regulatory mechanism between B and CD8 T cell vaccine responses.
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Affiliation(s)
- Ryan M. Baxter
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | | | - Tusharkanti Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Cody Rester
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Miguel Guerrero Moreno
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Tyler L. Borko
- Department of Neurology, Sections of Neuroimmunology, Neuroinfectious Disease, and Neurohospitalist, University of Colorado School of Medicine, Aurora, CO
| | - Sean Selva
- Department of Neurology, Sections of Neuroimmunology, Neuroinfectious Disease, and Neurohospitalist, University of Colorado School of Medicine, Aurora, CO
| | - Chelsie L. Fleischer
- Department of Medicine, Division of Rheumatology, University of Colorado, School of Medicine, Aurora, CO
| | - Nicola Haakonsen
- Department of Medicine, Division of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO
| | - Ariana Mayher
- Allergy and Immunology Research, Research Institute, Children’s Hospital Colorado, Aurora, CO
| | - Emily Bowhay
- Allergy and Immunology Research, Research Institute, Children’s Hospital Colorado, Aurora, CO
| | - Courtney Evans
- Allergy and Immunology Research, Research Institute, Children’s Hospital Colorado, Aurora, CO
| | - Todd M. Miller
- Analytics Resource Center, Children’s Hospital Colorado, Aurora, CO
| | - Leah Huey
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO
| | - Jennifer McWilliams
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Adrie van Bokhoven
- Department of Pathology, Section of Pathology Shared Resource, University of Colorado, Aurora, CO
| | - Kevin D. Deane
- Department of Medicine, Division of Rheumatology, University of Colorado, School of Medicine, Aurora, CO
| | - Vijaya Knight
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO
| | - Kimberly R. Jordan
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Jared Klarquist
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Ross M. Kedl
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
| | - Amanda L. Piquet
- Department of Neurology, Sections of Neuroimmunology, Neuroinfectious Disease, and Neurohospitalist, University of Colorado School of Medicine, Aurora, CO
| | - Elena W. Y. Hsieh
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO
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7
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Xu J, Erlendsson S, Singh M, Holling GA, Regier M, Ibiricu I, Einstein J, Hantak MP, Day GS, Piquet AL, Smith TL, Clardy SL, Whiteley AM, Feschotte C, Briggs JAG, Shepherd JD. PNMA2 forms immunogenic non-enveloped virus-like capsids associated with paraneoplastic neurological syndrome. Cell 2024; 187:831-845.e19. [PMID: 38301645 PMCID: PMC10922747 DOI: 10.1016/j.cell.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/20/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
The paraneoplastic Ma antigen (PNMA) proteins are associated with cancer-induced paraneoplastic syndromes that present with an autoimmune response and neurological symptoms. Why PNMA proteins are associated with this severe autoimmune disease is unclear. PNMA genes are predominantly expressed in the central nervous system and are ectopically expressed in some tumors. We show that PNMA2, which has been co-opted from a Ty3 retrotransposon, encodes a protein that is released from cells as non-enveloped virus-like capsids. Recombinant PNMA2 capsids injected into mice induce autoantibodies that preferentially bind external "spike" PNMA2 capsid epitopes, whereas a capsid-assembly-defective PNMA2 protein is not immunogenic. PNMA2 autoantibodies in cerebrospinal fluid of patients with anti-Ma2 paraneoplastic disease show similar preferential binding to spike capsid epitopes. PNMA2 capsid-injected mice develop learning and memory deficits. These observations suggest that PNMA2 capsids act as an extracellular antigen, capable of generating an autoimmune response that results in neurological deficits.
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Affiliation(s)
- Junjie Xu
- Department of Neurobiology, University of Utah, Salt Lake City, UT, USA
| | - Simon Erlendsson
- The Medical Research Council Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge, UK; Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Manvendra Singh
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA
| | - G Aaron Holling
- Department of Biochemistry, University of Colorado Boulder, Boulder, CO, USA
| | - Matthew Regier
- Department of Neurobiology, University of Utah, Salt Lake City, UT, USA
| | - Iosune Ibiricu
- Department of Cell and Virus Structure, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Jenifer Einstein
- Department of Neurobiology, University of Utah, Salt Lake City, UT, USA
| | - Michael P Hantak
- Department of Neurobiology, University of Utah, Salt Lake City, UT, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Amanda L Piquet
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Tammy L Smith
- Department of Neurology, University of Utah and George E Wahlen VA Medical Center, Salt Lake City, UT, USA
| | - Stacey L Clardy
- Department of Neurology, University of Utah and George E Wahlen VA Medical Center, Salt Lake City, UT, USA
| | | | - Cédric Feschotte
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA
| | - John A G Briggs
- The Medical Research Council Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge, UK; Department of Cell and Virus Structure, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Jason D Shepherd
- Department of Neurobiology, University of Utah, Salt Lake City, UT, USA.
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8
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Lowe MC, Money KM, Matthews E, Pastula DM, Piquet AL. case of autoimmune GFAP astrocytopathy with eosinophils in the cerebrospinal fluid. J Neuroimmunol 2023; 385:578249. [PMID: 37992587 DOI: 10.1016/j.jneuroim.2023.578249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
Cerebrospinal fluid (CSF) eosinophilia is associated with a narrow differential, primarily including parasitic and fungal infections, neoplasm, and chemical meningitis. It has rarely been reported in neuroinflammatory conditions including as a finding of CSF cytology in two autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy cases. Here we describe a case of autoimmune GFAP astrocytopathy with classic clinical and radiographic features as well as presence of eosinophils in the CSF. This case highlights a potential association of eosinophils in the CSF with autoimmune GFAP astrocytopathy, which may suggest its inclusion in the differential diagnosis of eosinophilic meningitis, encephalitis, or myelitis.
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Affiliation(s)
- Mallory C Lowe
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kelli M Money
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Elizabeth Matthews
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Daniel M Pastula
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America
| | - Amanda L Piquet
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America.
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9
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Bartley CM, Ngo TT, Duy Do L, Zekeridou A, Dandekar R, Muñiz-Castrillo S, Alvarenga BD, Zorn KC, Tubati A, Pinto AL, Browne WD, Hullett PW, Terrelonge M, Schubert RD, Piquet AL, Yang B, Montalvo Perero MJ, Kung AF, Mann SA, Shah MP, Geschwind MD, Gelfand JM, DeRisi JL, Pittock SJ, Honnorat J, Pleasure SJ, Wilson MR. Detection of High-Risk Paraneoplastic Antibodies against TRIM9 and TRIM67 Proteins. Ann Neurol 2023; 94:1086-1101. [PMID: 37632288 PMCID: PMC10842626 DOI: 10.1002/ana.26776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Co-occurring anti-tripartite motif-containing protein 9 and 67 autoantibodies (TRIM9/67-IgG) have been reported in only a very few cases of paraneoplastic cerebellar syndrome. The value of these biomarkers and the most sensitive methods of TRIM9/67-IgG detection are not known. METHODS We performed a retrospective, multicenter study to evaluate the cerebrospinal fluid and serum of candidate TRIM9/67-IgG cases by tissue-based immunofluorescence, peptide phage display immunoprecipitation sequencing, overexpression cell-based assay (CBA), and immunoblot. Cases in which TRIM9/67-IgG was detected by at least 2 assays were considered TRIM9/67-IgG positive. RESULTS Among these cases (n = 13), CBA was the most sensitive (100%) and revealed that all cases had TRIM9 and TRIM67 autoantibodies. Of TRIM9/67-IgG cases with available clinical history, a subacute cerebellar syndrome was the most common presentation (n = 7/10), followed by encephalitis (n = 3/10). Of these 10 patients, 70% had comorbid cancer (7/10), 85% of whom (n = 6/7) had confirmed metastatic disease. All evaluable cancer biopsies expressed TRIM9 protein (n = 5/5), whose expression was elevated in the cancerous regions of the tissue in 4 of 5 cases. INTERPRETATION TRIM9/67-IgG is a rare but likely high-risk paraneoplastic biomarker for which CBA appears to be the most sensitive diagnostic assay. ANN NEUROL 2023;94:1086-1101.
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Affiliation(s)
- Christopher M. Bartley
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, California
| | - Thomas T. Ngo
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Le Duy Do
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon and SynatAc Team, Institut MELiS, INSERM U1314/CNRS UMR 5284, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anastasia Zekeridou
- Department of Neurology, Center MS and Autoimmune Neurology, Mayo Clinic
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | - Ravi Dandekar
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon and SynatAc Team, Institut MELiS, INSERM U1314/CNRS UMR 5284, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bonny D. Alvarenga
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Kelsey C. Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, California
| | - Asritha Tubati
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Anne-Laurie Pinto
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon and SynatAc Team, Institut MELiS, INSERM U1314/CNRS UMR 5284, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Weston D. Browne
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Patrick W. Hullett
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Mark Terrelonge
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Ryan D. Schubert
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Amanda L. Piquet
- Department of Neurology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado
| | - Binxia Yang
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | | | - Andrew F. Kung
- University of California San Francisco, School of Medicine, San Francisco, California
| | - Sabrina A. Mann
- Chan Zuckerberg Biohub, San Francisco, California
- Department of Biochemistry and Biophysics, University of California, San Francisco, California
| | - Maulik P. Shah
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Michael D. Geschwind
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Jeffrey M. Gelfand
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Joseph L. DeRisi
- Chan Zuckerberg Biohub, San Francisco, California
- Department of Biochemistry and Biophysics, University of California, San Francisco, California
| | - Sean J. Pittock
- Department of Neurology, Center MS and Autoimmune Neurology, Mayo Clinic
- Department of Laboratory Medicine and Pathology, Mayo Clinic
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon and SynatAc Team, Institut MELiS, INSERM U1314/CNRS UMR 5284, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Samuel J. Pleasure
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
| | - Michael R. Wilson
- Weill Institute for Neurosciences, University of California, San Francisco, California
- Department of Neurology, University of California, San Francisco, California
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10
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Akkus S, Elkhooly M, Amatya S, Shrestha K, Sharma K, Kagzi Y, Khan E, Gupta R, Piquet AL, Jaiswal S, Wen S, Tapia M, Samant R, Sista SR, Sriwastava S. Autoimmune and paraneoplastic neurological disorders: A review of relevant neuroimaging findings. J Neurol Sci 2023; 454:120830. [PMID: 37856996 DOI: 10.1016/j.jns.2023.120830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Paraneoplastic neurologic syndromes (PNS) and autoimmune encephalitis (AIE) are immune-mediated disorders. PNS is linked to cancer, while AIE may not Their clinical manifestations and imaging patterns need further elucidation. OBJECTIVE/AIMS To investigate the clinical profiles, antibody associations, neuroimaging patterns, treatments, and outcomes of PNS and AIE. METHODS A systematic review of 379 articles published between 2014 and 2023 was conducted. Of the 55 studies screened, 333 patients were diagnosed with either PNS or AIE and tested positive for novel antibodies. Data on demographics, symptoms, imaging, antibodies, cancer associations, treatment, and outcomes were extracted. RESULTS The study included 333 patients (mean age 54 years, 67% males) with PNS and AIE positive for various novel antibodies. 84% had central nervous system issues like cognitive impairment (53%), rhombencephalitis (17%), and cerebellar disorders (24%). Neuroimaging revealed distinct patterns with high-risk antibodies associated with brainstem lesions in 98%, cerebellar in 91%, hippocampal in 98%, basal ganglia in 75%, and spinal cord in 91%, while low/intermediate-risk antibodies were associated with medial temporal lobe lesions in 71% and other cortical/subcortical lesions in 55%. High-risk antibodies were associated with younger males, deep brain lesions, and increased mortality of 61%, while low/intermediate-risk antibodies were associated with females, cortical/subcortical lesions, and better outcomes with 39% mortality. Associated cancers included seminomas (23%), lung (19%), ovarian (2%), and breast (2%). Treatments included IVIG, chemotherapy, and plasmapheresis. Overall mortality was 25% in this cohort. CONCLUSION PNS and AIE have distinct clinical and radiological patterns based on antibody profiles. High-risk antibodies are associated with increased mortality while low/intermediate-risk antibodies are associated with improved outcomes. Appropriate imaging and antibody testing are critical for accurate diagnosis.
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Affiliation(s)
- Sema Akkus
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne state University, Detroit, MI, USA; Department of Neurology, Southern Illinois university, Springfield, IL, USA; Department of Neuropsychiatry, Minia University, Egypt
| | - Suban Amatya
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kriti Shrestha
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kanika Sharma
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Yusuf Kagzi
- Mahatma Gandhi Memorial Medical College, Indore, India
| | - Erum Khan
- Department of Neurology, University of Alabama at Birmingham, Al, USA
| | - Rajesh Gupta
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Amanda L Piquet
- Neuroimmunology, Neuroinfectious Disease and Neurohospitalist Sections, University of Colorado School of Medicine, CO, USA
| | - Shruti Jaiswal
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sijin Wen
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Michaela Tapia
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Rohan Samant
- Department of Neuroradiology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sri Raghav Sista
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Shitiz Sriwastava
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA.
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11
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Kammeyer R, Ogbu EA, Cooper JC, Stolz E, Piquet AL, Fuhlbrigge RC, Bennett JL, Hutaff-Lee C. Cognitive dysfunction in pediatric systemic lupus erythematosus: current knowledge and future directions. Child Neuropsychol 2023:1-29. [PMID: 37902575 PMCID: PMC11058121 DOI: 10.1080/09297049.2023.2273573] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Cognitive dysfunction (CD) is a neurologic complication of pediatric systemic lupus erythematosus (SLE) that remains poorly understood and understudied, despite the potential negative effects of CD on long-term socioeconomic status and quality of life. Data regarding the prevalence and risk factors for CD in pediatric SLE as well as the optimal screening, treatment, and long-term outcomes for CD are lacking. In this review, we present current knowledge on CD in pediatric SLE with a focus on the application to clinical practice. We discuss the challenges in diagnosis, clinical screening methods, potential impacts, and interventions for this complication. Finally, we discuss the remaining gaps in our knowledge of CD in pediatric SLE, and avenues for future research efforts.
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Affiliation(s)
- Ryan Kammeyer
- Departments of Pediatrics and Neurology, Sections of Child Neurology and Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ekemini A. Ogbu
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer C. Cooper
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Stolz
- Department of Child and Adolescent Psychiatry, Section of Pediatric Medical Psychology, John Hopkins Medicine, Baltimore, MA, USA
| | - Amanda L. Piquet
- Department of Neurology, Section of Neuroimmunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert C. Fuhlbrigge
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Department of Pediatrics, Section of Neurology-Neuropsychology, University of Colorado School of Medicine, Aurora, CO, USA
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12
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Borko TL, Baxter R, Cabrera-Martinez B, Thiruppathi E, Sabalza M, Venkataraman I, Selva S, Rester C, Sillau S, Pastula DM, Bennett JL, Alvarez E, Gross R, Shah A, Kammeyer R, Corboy JR, Kedl RM, Hsieh EWY, Piquet AL. SARS-CoV-2 mRNA vaccination induces an antigen-specific T cell response correlating with plasma interferon-gamma in B cell depleted patients. J Neuroimmunol 2023; 383:578192. [PMID: 37666038 PMCID: PMC10863651 DOI: 10.1016/j.jneuroim.2023.578192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/06/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
Emerging evidence is encouraging and suggests that a substantial proportion of patients without antibody responses (due to anti-CD20 therapy or other etiologies) to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines develop T cell responses. However, antigen-specific T cellular responses are notoriously difficult to assess clinically, given the lack of such assays under satisfactory CAP/CLIA regulation, and the laborious nature of the flow cytometric assessment. To evaluate the ability to apply a clinically feasible assay to measure T cellular responses to SARS-CoV-2 mRNA vaccination, we compared flow cytometric and enzyme-linked immunosorbent assay (ELISA) based assays in 24 participants treated with anti-CD20 therapy. T cellular activation (CD69 + CD137+ surface expression, i.e., activation induced markers [AIM]) and intracellular interferon gamma (INFγ) production via flow cytometry was compared to plasma Interferon Gamma Release Assay (IGRA) via ELISA. Plasma INFγ production measured by IGRA correlated with the percent of INFγ-producing AIM positive T cells, supporting the use of IGRA assay as a robust assessment of T cellular response to the SARS-CoV-2 vaccine for B-cell depleted patients that is clinically feasible, time efficient, and cost effective.
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Affiliation(s)
- Tyler L Borko
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Ryan Baxter
- Department of Immunology & Microbiology, University of Colorado Anschutz School of Medicine, United States of America
| | - Berenice Cabrera-Martinez
- Department of Immunology & Microbiology, University of Colorado Anschutz School of Medicine, United States of America
| | | | - Maite Sabalza
- Scientific Affairs, EUROIMMUN, United States of America
| | | | - Sean Selva
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Cody Rester
- Department of Immunology & Microbiology, University of Colorado Anschutz School of Medicine, United States of America
| | - Stefan Sillau
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Daniel M Pastula
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz School of Medicine, United States of America
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Robert Gross
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Anna Shah
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Ryan Kammeyer
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - John R Corboy
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America
| | - Ross M Kedl
- Department of Immunology & Microbiology, University of Colorado Anschutz School of Medicine, United States of America
| | - Elena W Y Hsieh
- Department of Immunology & Microbiology, University of Colorado Anschutz School of Medicine, United States of America; Department of Pediatrics, Section of Allergy and Immunology, University of Colorado Anschutz School of Medicine, United States of America
| | - Amanda L Piquet
- Department of Neurology, University of Colorado Anschutz School of Medicine, United States of America.
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13
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Wolf AB, Money KM, Chandnani A, Daley CL, Griffith DE, Chauhan L, Coffman N, Piquet AL, Tyler KL, Zimmer SM, Montague BT, Mann S, Pastula DM. Mycobacterium abscessus Meningitis Associated with Stem Cell Treatment During Medical Tourism. Emerg Infect Dis 2023; 29:1655-1658. [PMID: 37486227 PMCID: PMC10370854 DOI: 10.3201/eid2908.230317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Mycobacterium abscessus infections have been reported as adverse events related to medical tourism. We report M. abscessus meningitis in a patient who traveled from Colorado, USA, to Mexico to receive intrathecal stem cell injections as treatment for multiple sclerosis. We also review the management of this challenging central nervous system infection.
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14
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Money KM, Chauhan L, Piquet AL, Tyler KL, Pastula DM. An Overview of Japanese Encephalitis. Neurohospitalist 2023; 13:328-330. [PMID: 37441216 PMCID: PMC10334049 DOI: 10.1177/19418744231164810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Affiliation(s)
- Kelli M. Money
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Lakshmi Chauhan
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Amanda L. Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Kenneth L. Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Immunology-Microbiology, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel M. Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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15
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Barrera B, Simpson H, Engebretson E, Sillau S, Valdez B, Parra‐González J, Winger RC, Epperson LA, Banks A, Pierce K, Spotts M, O'Gean K, Alvarez E, Gross R, Piquet AL, Schreiner T, Corboy JR, Pei J, Vollmer TL, Nair KV. Safety and patient experience with at-home infusion of ocrelizumab for multiple sclerosis. Ann Clin Transl Neurol 2023; 10:579-588. [PMID: 36811392 PMCID: PMC10109340 DOI: 10.1002/acn3.51745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate safety (infusion-related reactions [IRRs]) and patient satisfaction (patient-reported outcomes [PROs]) for at-home ocrelizumab administration for patients with multiple sclerosis (MS). METHODS This open-label study included adult patients with an MS diagnosis who had completed a ≥ 600-mg ocrelizumab dose, had a patient-determined disease steps score of 0 to 6 and had completed PROs. Eligible patients received a 600-mg ocrelizumab home-based infusion over 2 h, followed by 24-h and 2-week post-infusion follow-up calls. IRRs and adverse events (AEs) were documented during infusions and follow-up calls. PROs were completed before and 2 weeks post infusion. RESULTS Overall, 99 of 100 expected patients were included (mean [SD] age, 42.3 [7.7] years; 72.7% female; 91.9% White). The mean (SD) infusion time was 2.5 (0.6) hours, and 75.8% of patients completed their ocrelizumab infusion between 2 to 2.5 h. The IRR incidence rate was 25.3% (95% CI: 16.7%, 33.8%)-similar to other shorter ocrelizumab infusion studies-and all AEs were mild/moderate. In total, 66.7% of patients experienced AEs, including itch, fatigue, and grogginess. Patients reported significantly increased satisfaction with the at-home infusion process and confidence in the care provided. Patients also reported a significant preference for at-home infusion compared with prior infusion center experiences. INTERPRETATION IRRs and AEs occurred at acceptable rates during in-home infusions of ocrelizumab over a shorter infusion time. Patients reported increased confidence and comfort with the home infusion process. Findings from this study provide evidence of the safety and feasibility of home-based ocrelizumab infusion over a shorter infusion period.
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Affiliation(s)
- Britney Barrera
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Haley Simpson
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Eric Engebretson
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Stefan Sillau
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Brooke Valdez
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - José Parra‐González
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | | | | | - Ashley Banks
- Amerita Specialty Infusion ServicesDenverColoradoUSA
| | | | | | - Katie O'Gean
- University of Colorado HospitalAuroraColoradoUSA
| | - Enrique Alvarez
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Robert Gross
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Amanda L. Piquet
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Teri Schreiner
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - John R. Corboy
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jinglan Pei
- Genentech, IncSouth San FranciscoCaliforniaUSA
| | - Timothy L. Vollmer
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Kavita V. Nair
- Department of Neurology, Rocky Mountain MS CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
- Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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16
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Xu J, Erlendsson S, Singh M, Regier M, Ibiricu I, Day GS, Piquet AL, Clardy SL, Feschotte C, Briggs JAG, Shepherd JD. PNMA2 forms non-enveloped virus-like capsids that trigger paraneoplastic neurological syndrome. bioRxiv 2023:2023.02.09.527862. [PMID: 36798413 PMCID: PMC9934673 DOI: 10.1101/2023.02.09.527862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The paraneoplastic Ma antigen (PNMA) genes are associated with cancer-induced paraneoplastic syndromes that present with neurological symptoms and autoantibody production. How PNMA proteins trigger a severe autoimmune disease is unclear. PNMA genes are predominately expressed in the central nervous system with little known functions but are ectopically expressed in some tumors. Here, we show that PNMA2 is derived from a Ty3 retrotransposon that encodes a protein which forms virus-like capsids released from cells as non-enveloped particles. Recombinant PNMA2 capsids injected into mice induce a robust autoimmune reaction with significant generation of autoantibodies that preferentially bind external "spike" PNMA2 capsid epitopes, while capsid-assembly-defective PNMA2 protein is not immunogenic. PNMA2 autoantibodies present in cerebrospinal fluid of patients with anti-Ma2 paraneoplastic neurologic disease show similar preferential binding to PNMA2 "spike" capsid epitopes. These observations suggest that PNMA2 capsids released from tumors trigger an autoimmune response that underlies Ma2 paraneoplastic neurological syndrome.
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Affiliation(s)
- Junjie Xu
- Department of Neurobiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Simon Erlendsson
- The Medical Research Council Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge, UK
- Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark
| | - Manvendra Singh
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA
| | - Matthew Regier
- Department of Neurobiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Iosune Ibiricu
- Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Amanda L. Piquet
- Department of Neurology, University of Colorado, Aurora, CO, USA
| | - Stacey L. Clardy
- Department of Neurology, Spencer Fox Eccles School of Medicine, University of Utah, and George E Wahlen VA Medical Center, Salt Lake City, UT, USA
| | - Cedric Feschotte
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA
| | - John A. G. Briggs
- The Medical Research Council Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge, UK
- Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Jason D. Shepherd
- Department of Neurobiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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17
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Borko TL, Selva S, Baxter R, Cabrera-Martinez B, Rester C, Sillau S, Pastula DM, Sabalza M, Venkataraman I, Thiruppathi E, Bennett JL, Alvarez E, Gross R, Shah A, Kammeyer R, Vollmer TL, Kedl R, Corboy JR, Hsieh E, Piquet AL. An Observational Study on the Humoral and Cellular Immune Response to SARS-CoV-2 mRNA Vaccination in Multiple Sclerosis and Other Autoimmune Neurological Disorders Treated With Anti-CD20 Therapies. Neurology 2022. [DOI: 10.1212/01.wnl.0000903428.98962.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
ObjectiveTo assess adaptive immunity to SARS-CoV-2 in anti-CD20 treated individuals with mRNA vaccination.BackgroundAnti-CD20 therapies attenuate humoral responses to vaccines. However, their effect on T cell responses is less clear. We examined B and T cell responses following COVID-19 vaccination in patients receiving anti-CD20 therapy for multiple sclerosis (MS) and other autoimmune inflammatory neurologic diseases (AINDs, e.g., autoimmune encephalitis, stiff person syndrome, etc.).Design/MethodsMS and AIND patients on anti-CD20 therapies were prospectively enrolled for longitudinal analysis of antibody and T cell responses after a 3rd COVID-19 vaccination. Serum antibodies against the receptor-binding domain of the S1 spike protein (RBD-S1 IgG), neutralizing antibodies, and SARS-CoV-2 CD8 T cell responses, using activation-induced markers (AIM) and INF-γ release assays (EUROIMMUN, Germany), were measured at various time points including pre-vaccination, post initial vaccination series, and 4 and 12 weeks after 3rd dose.ResultsThirty-four MS and AIND participants are enrolled. Results for these patients (mean age 52 years-old, 79% female, 21 Pfizer, 13 Moderna) demonstrated attenuated RBD IgG antibody responses. However, a robust CD8 T cell response was observed, following a two-dose series, compared to non-immunosuppressed, age-matched vaccinated controls or unvaccinated with severe SARS-CoV-2 infection (p = 0.01). T cell response was sustained long-term (>12 weeks post 3rd dose) in all 11 anti-CD20 patients analyzed thus far. Collections are completed for all participants at 12 weeks and analysis to be completed by 05/15/22. Further analysis includes correlation of the INF- γ release assay compared to RBD-CD8 T cell response detected by AIM assay.ConclusionsResults suggest that patients treated with anti-CD20 therapy generate a robust CD8 T cell response to SARS-CoV-2 mRNA after three doses but remain with attenuated humoral immune responses. Our observational study will provide important data to guide vaccine management in patients on or anticipating anti-CD20 therapy.
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18
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Matthews E, Beckham JD, Piquet AL, Tyler KL, Chauhan L, Pastula DM. Herpesvirus-Associated Encephalitis: an Update. Curr Trop Med Rep 2022; 9:92-100. [PMID: 36186545 PMCID: PMC9510386 DOI: 10.1007/s40475-022-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review Recent Findings Summary
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19
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Pastula DM, Copeland MJ, Hannan MC, Rapaka S, Kitani T, Kleiner E, Showler A, Yuen C, Ferriman EM, House J, O’Brien S, Burakoff A, Gupta B, Money KM, Matthews E, Beckham JD, Chauhan L, Piquet AL, Kumar RN, Tornatore CS, Padgett K, O’Laughlin K, Mangla AT, Kumar PN, Tyler KL, O’Connor SM. Two Cases of Monkeypox-Associated Encephalomyelitis — Colorado and the District of Columbia, July–August 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1212-1215. [PMID: 36136957 PMCID: PMC9531567 DOI: 10.15585/mmwr.mm7138e1] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Passeri M, Matthews E, Kammeyer R, Piquet AL. Update in autoimmune and paraneoplastic myelopathies: Newly described antigen targets and antibody testing. Front Neurol 2022; 13:972143. [PMID: 35968301 PMCID: PMC9366192 DOI: 10.3389/fneur.2022.972143] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Myelopathy is an increasingly recognized presentation of many antibody-mediated neuroinflammatory disorders. While specific features of certain autoimmune myelopathies such as aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein associated disorder (MOGAD) are well-characterized, other less commonly seen antibody-associated myelopathies are not as well-defined. These include but are not limited to, Hu/ANNA1, anti-glial fibrillary acidic protein (GFAP), anti-CV2/collapsin response mediator protein (CRMP5), and amphiphysin. Here, we review the mentioned more common antibody mediated myelopathies as well those that as less common, followed by a review of differentials that may mimic these disorders.
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Affiliation(s)
- Michlene Passeri
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth Matthews
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan Kammeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Pediatrics and Neurology, Children's Hospital Anschutz Medical Campus, Aurora, CO, United States
| | - Amanda L. Piquet
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Amanda L. Piquet
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21
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Krett JD, Beckham JD, Tyler KL, Piquet AL, Chauhan L, Wallace CJ, Pastula DM, Kapadia RK. Neurology of Acute Viral Infections. Neurohospitalist 2022; 12:632-646. [PMID: 36147750 PMCID: PMC9485684 DOI: 10.1177/19418744221104778] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As specialists in acute neurology, neurohospitalists are often called upon to diagnose and manage acute viral infections affecting the nervous system. In this broad review covering the neurology of several acute viral infections, our aim is to provide key diagnostic and therapeutic pearls of practical use to the busy neurohospitalist. We will review acute presentations, diagnosis, and treatment of human herpesviruses, arboviruses, enteroviruses, and some vaccine-preventable viruses. The neurological effects of coronaviruses, including COVID-19, are not covered in this review.
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Affiliation(s)
- Jonathan D Krett
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - J David Beckham
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Departments of Immunology & Microbiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Kenneth L Tyler
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Departments of Immunology & Microbiology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Amanda L Piquet
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
| | - Lakshmi Chauhan
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
| | - Carla J Wallace
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Daniel M Pastula
- Department of Neurology and Division of Infectious Diseases, Anschutz Medical Campus, University of Colorado Neurosciences Center, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Ronak K Kapadia
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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22
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Kammeyer R, Mizenko C, Sillau S, Richie A, Owens G, Nair KV, Alvarez E, Vollmer TL, Bennett JL, Piquet AL. Evaluation of Plasma Neurofilament Light Chain Levels as a Biomarker of Neuronal Injury in the Active and Chronic Phases of Autoimmune Neurologic Disorders. Front Neurol 2022; 13:689975. [PMID: 35309573 PMCID: PMC8924486 DOI: 10.3389/fneur.2022.689975] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/01/2021] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate plasma neurofilament light (NfL) levels in autoimmune neurologic disorders (AINDs) and autoimmune encephalitis (AE). Background Each particular neural autoantibody syndrome has a different clinical phenotype, making one unifying clinical outcome measure difficult to assess. While this is a heterogeneous group of disorders, the final common pathway is likely CNS damage and inflammation. Defining a biomarker of CNS injury that is easily obtainable through a blood sample and reflects a positive treatment response would be highly advantageous in future therapeutic trials. Measurement of blood concentration of neurofilament light (NfL) chain, however, may provide a biomarker of central nervous system (CNS) injury in AE and other AINDs. Here we provide an initial evaluation of plasma NfL levels in AE as well as other AINDs during active and chronic phases of disease and demonstrate its potential utility as a minimally-invasive biomarker for AE and AINDs. Design/Methods Patients were retrospectively identified who were enrolled in the biorepository at the Rocky Mountain MS Center at the University of Colorado, or were prospectively enrolled after initial presentation. Patients had a well-defined AIND and were followed between 2014 and 2021. NfL was tested using the Single Molecule Array (SIMOA) technology. Patients with headaches but without other significant neurologic disease were included as controls. Results Twenty-six plasma and 14 CSF samples of patients with AINDs, and 20 plasma control samples stored in the biorepository were evaluated. A positive correlation was found between plasma and CSF NfL levels for patients with an AIND (R2 = 0.83, p < 0.001). Elevated plasma levels of NfL were seen in patients with active AE compared to controls [geometric mean (GM) 51.4 vs. 6.4 pg/ml, p = 0.002]. Patients with chronic symptoms (>6 months since new or worsening symptoms) of AE or cerebellar ataxia (CA) showed a trend toward lower plasma NfL levels (GM 15.1 pg/ml) compared to active AE or CA. Six patients with longitudinal, prospective sampling available demonstrated a trend in decreased plasma NfL levels over time. Conclusions Our findings support the use of plasma NfL as a potential minimally-invasive biomarker of CNS injury.
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Affiliation(s)
- Ryan Kammeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher Mizenko
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stefan Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alanna Richie
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gregory Owens
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kavita V. Nair
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Timothy L. Vollmer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeffrey L. Bennett
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Amanda L. Piquet
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Amanda L. Piquet
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23
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Matthews E, Chauhan L, Piquet AL, Tyler KL, Pastula DM. An Overview of La Crosse Virus Disease. Neurohospitalist 2022; 12:587-588. [DOI: 10.1177/19418744221077738] [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: 11/17/2022] Open
Affiliation(s)
- Elizabeth Matthews
- Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lakshmi Chauhan
- Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda L. Piquet
- Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth L. Tyler
- Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M. Pastula
- Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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24
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Valencia-Sanchez C, Knight AM, Hammami MB, Guo Y, Mills JR, Kryzer TJ, Piquet AL, Amin A, Heinzelmann M, Lucchinetti CF, Lennon VA, McKeon A, Pittock SJ, Dubey D. Characterisation of TRIM46 autoantibody-associated paraneoplastic neurological syndrome. J Neurol Neurosurg Psychiatry 2022; 93:196-200. [PMID: 34921120 PMCID: PMC9597704 DOI: 10.1136/jnnp-2021-326656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To report the expanded neurological presentations and oncological associations of tripartite motif-containing protein 46 (TRIM46)-IgG seropositive patients. METHODS Archived sera/cerebrospinal fluid (CSF) were evaluated by tissue-based immunofluorescence assay to identify patients with identical axon initial segment (AIS)-specific staining pattern. Phage immunoprecipitation sequencing (PhIP-Seq) was used to identify the putative autoantigen. RESULTS IgG in serum (17) and/or CSF (16) from 25 patients yielded unique AIS-specific staining on murine central nervous system (CNS) tissue. An autoantibody specific for TRIM46 was identified by PhIP-Seq, and autoantigen specificity was confirmed by transfected COS7 cell-based assay. Clinical information was available for 22 TRIM46-IgG seropositive patients. Fifteen were female (68%). Median age was 67 years (range 25-87). Fifteen (68%) patients presented with subacute cerebellar syndrome (six isolated; nine with CNS accompaniments: encephalopathy (three), brainstem signs (two), myelopathy (two), parkinsonism (one)). Other phenotypes included limbic encephalitis (three), encephalopathy with/without seizures (two), myelopathy (two). Eighteen (82%) had cancer: neuroendocrine carcinomas (9; pancreatic (3), small-cell lung (4), oesophagus (1), endometrium (1)), adenocarcinomas (6; lung (2), ovarian (2), endometrial (1), breast (1)), sarcoma (2) and gastrointestinal tumour (1). Neurological symptoms in three followed immune checkpoint inhibitor (ICI) administration. CONCLUSIONS This study supports TRIM46-IgG being a biomarker of paraneoplastic CNS disorders and expands the neurological phenotypes, oncological and ICI-related adverse event associations.
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Affiliation(s)
| | - Andrew M Knight
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - M Bakri Hammami
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J Kryzer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda L Piquet
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anik Amin
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Morgan Heinzelmann
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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25
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Garza M, Piquet AL. Update in Autoimmune Movement Disorders: Newly Described Antigen Targets in Autoimmune and Paraneoplastic Cerebellar Ataxia. Front Neurol 2021; 12:683048. [PMID: 34489848 PMCID: PMC8416494 DOI: 10.3389/fneur.2021.683048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/19/2021] [Accepted: 07/28/2021] [Indexed: 12/29/2022] Open
Abstract
Movement disorders are a common feature of many antibody-associated neurological disorders. In fact, cerebellar ataxia is one of the most common manifestations of autoimmune neurological diseases. Some of the first autoantibodies identified against antigen targets include anti-neuronal nuclear antibody type 1 (ANNA-1 or anti-Hu) and Purkinje cell cytoplasmic antibody (PCA-1) also known as anti-Yo have been identified in paraneoplastic cerebellar degeneration. Historically these antibodies have been associated with an underlying malignancy; however, recently discovered antibodies can occur in the absence of cancer as well, resulting in the clinical syndrome of autoimmune cerebellar ataxia. The pace of discovery of new antibodies associated with autoimmune or paraneoplastic cerebellar ataxia has increased rapidly over the last few years, and pathogenesis and potential treatment options remains to be explored. Here we will review the literature on recently discovered antibodies associated with autoimmune and paraneoplastic cerebellar ataxia including adaptor protein-3B2 (AP3B2); inositol 1,4,5-trisphophate receptor type 1 (ITPR1); tripartite motif-containing (TRIM) proteins 9, 67, and 46; neurochondrin; neuronal intermediate filament light chain (NIF); septin 5; metabotropic glutamate receptor 2 (mGluR2); seizure-related 6 homolog like 2 (SEZ6L2) and homer-3 antibodies. We will review their clinical characteristics, imaging and CSF findings and treatment response. In addition, we will discuss two clinical case examples of autoimmune cerebellar ataxia.
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Affiliation(s)
- Madeline Garza
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Amanda L Piquet
- Department of Neurology, University of Colorado, Aurora, CO, United States
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26
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Mizenko C, Bennett JL, Owens G, Vollmer TL, Piquet AL. A Longitudinal, Observational Analysis of Neuronal Injury Biomarkers in a Case Report of a Patient With Paraneoplastic Anti-CRMP5 Antibody-Associated Transverse Myelitis. Front Neurol 2021; 12:691509. [PMID: 34349723 PMCID: PMC8328144 DOI: 10.3389/fneur.2021.691509] [Citation(s) in RCA: 3] [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: 04/06/2021] [Accepted: 06/21/2021] [Indexed: 01/13/2023] Open
Abstract
Biomarkers are needed to guide therapeutic decision making in autoimmune and paraneoplastic neurologic disorders. Here, we describe a case of paraneoplastic collapsing response-mediator protein-5 (CRMP5)-associated transverse myelitis (TM) where plasma neurofilament light (NfL) chain and glial fibrillary protein (GFAP) levels were observed over a 14-month clinical course, correlating with radiographical and clinical outcome measures in response to treatment. Blood and CSF samples obtained at diagnosis as well as 7 and 14 months into treatment. At the time of initial diagnosis, both plasma NfL (782.62 pg/ml) and GFAP (283.26 pg/ml) were significantly elevated. Initial treatment was with IV steroids and plasma exchange (PLEX) followed by neuroendocrine tumor removal, chemotherapy, and radiation. After initial improvement with chemotherapy, the patient experienced clinical worsening and transient elevation of plasma NfL (103.27 pg/ml and GFAP (211.58 pg/ml) levels. Whole body positron emission tomography PET scan did not demonstrate recurrence of malignancy. Repeat PLEX and rituximab induction resulted in improvements in patient function, neurologic exam, and plasma biomarker levels. To our knowledge, this is the first described longitudinal, prospective analysis of neuronal injury biomarkers and association of clinical treatment outcomes in CRMP5 myelitis. Our findings suggest that clinical improvement correlates with NfL and GFAP concentrations.
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Affiliation(s)
| | - Jeffrey L Bennett
- Department of Neurology, University of Colorado, Aurora, CO, United States.,Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gregory Owens
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Timothy L Vollmer
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Amanda L Piquet
- Department of Neurology, University of Colorado, Aurora, CO, United States
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27
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Piquet AL, Corboy JR, Vollmer TL. Correspondence to: Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies. Ther Adv Neurol Disord 2021; 14:17562864211019567. [PMID: 34104219 PMCID: PMC8170321 DOI: 10.1177/17562864211019567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amanda L Piquet
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17th Ave., Mail Stop B185, Aurora, CO 80045, USA
| | - John R Corboy
- Department of Neurology, University of Colorado, Aurora, CO, USA
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28
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High B, Hixon AM, Tyler KL, Piquet AL, Pelak VS. Neurology and the COVID-19 Pandemic: Gathering Data for an Informed Response. Neurol Clin Pract 2021; 11:e48-e63. [PMID: 33842072 PMCID: PMC8032425 DOI: 10.1212/cpj.0000000000000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The current coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is one of the greatest medical crises faced by our current generation of health care providers. Although much remains to be learned about the pathophysiology of SARS-CoV-2, there is both historical precedent from other coronaviruses and a growing number of case reports and series that point to neurologic consequences of COVID-19. RECENT FINDINGS Olfactory/taste disturbances and increased risk of strokes and encephalopathies have emerged as potential consequences of COVID-19 infection. Evidence regarding whether these sequelae result indirectly from systemic infection or directly from neuroinvasion by SARS-CoV-2 is emerging. SUMMARY This review summarizes the current understanding of SARS-CoV-2 placed in context with our knowledge of other human coronaviruses. Evidence and data regarding neurologic sequelae of COVID-19 and the neuroinvasive potential of human coronaviruses are provided along with a summary of patient registries of interest to the Neurology community.
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Affiliation(s)
- Brigit High
- Medical Scientist Training Program (BH, AMH), Rocky Mountain Taste and Smell Center (BH), Department of Neurology (KLT, ALP, VSP), and Department of Ophthalmology (VSP), University of Colorado School of Medicine, Aurora
| | - Alison M Hixon
- Medical Scientist Training Program (BH, AMH), Rocky Mountain Taste and Smell Center (BH), Department of Neurology (KLT, ALP, VSP), and Department of Ophthalmology (VSP), University of Colorado School of Medicine, Aurora
| | - Kenneth L Tyler
- Medical Scientist Training Program (BH, AMH), Rocky Mountain Taste and Smell Center (BH), Department of Neurology (KLT, ALP, VSP), and Department of Ophthalmology (VSP), University of Colorado School of Medicine, Aurora
| | - Amanda L Piquet
- Medical Scientist Training Program (BH, AMH), Rocky Mountain Taste and Smell Center (BH), Department of Neurology (KLT, ALP, VSP), and Department of Ophthalmology (VSP), University of Colorado School of Medicine, Aurora
| | - Victoria S Pelak
- Medical Scientist Training Program (BH, AMH), Rocky Mountain Taste and Smell Center (BH), Department of Neurology (KLT, ALP, VSP), and Department of Ophthalmology (VSP), University of Colorado School of Medicine, Aurora
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29
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Affiliation(s)
- Kyle J Coleman
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lakshmi Chauhan
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Deuel LM, Yu CH, Vaughan CL, Piquet AL. Oro-Bucco-Lingual Dyskinesia, Weight Loss, and Cognitive Decline in Anti-DPPX Antibody-Mediated Encephalitis. Mov Disord Clin Pract 2020; 7:S80-S82. [PMID: 33015231 DOI: 10.1002/mdc3.13058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lisa M Deuel
- Department of Neurology University of Vermont Medical Center SA, Burlington Vermont USA
| | - Cherry H Yu
- Department of Neurology University of Vermont Medical Center SA, Burlington Vermont USA
| | - Christina L Vaughan
- Department of Neurology University of Vermont Medical Center SA, Burlington Vermont USA
| | - Amanda L Piquet
- Department of Neurology University of Vermont Medical Center SA, Burlington Vermont USA
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Kapadia RK, Ney DE, Hannan M, Farley M, Pastula DM, Piquet AL. Glial fibrillary acidic protein (GFAP) associated autoimmune meningoencephalitis in a patient receiving nivolumab. J Neuroimmunol 2020; 344:577259. [PMID: 32416558 DOI: 10.1016/j.jneuroim.2020.577259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022]
Abstract
Immune checkpoint inhibitors (ICIs) represent a major development in cancer treatment, allowing for improved survival and disease control in an expanding number of cancer types. Due to their mechanism of disrupting immunologic homeostasis, ICIs are frequently associated with adverse effects, termed immune related adverse effects (irAE). These side effects can affect any organ system, including the central and peripheral nervous systems. We present a case of a 47 year old man with stage IIIc metastatic melanoma who received 3 cycles of nivolumab (a monoclonal antibody inhibitor of programmed cell death protein 1 (PD-1)). After completing the third cycle, he presented with a meningoencephalitis clinical picture with an inflammatory cerebrospinal fluid (CSF) and normal MRI. He was found to have a positive anti-glial fibrillary acidic protein (GFAP) autoantibody in his CSF by immunofluorescent assay (IFA) and cell based assay (CBA) which confirmed a diagnosis of anti-GFAP autoimmune encephalitis. He was treated with immunotherapy and made a full recovery. In this report, we present the first reported case of anti-GFAP autoimmune encephalitis associated with ICI therapy and provide a brief review of the literature.
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Affiliation(s)
- Ronak K Kapadia
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Neurology, University of Colorado, Aurora, CO, United States of America; Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, Alberta, Canada.
| | - Douglas E Ney
- Department of Neurology, University of Colorado, Aurora, CO, United States of America; Department of Neurosurgery, University of Colorado, Aurora, CO, United States of America
| | - Markus Hannan
- Department of Neurology, University of Colorado, Aurora, CO, United States of America
| | - Morgan Farley
- Department of Neurology, University of Colorado, Aurora, CO, United States of America
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Neurology, University of Colorado, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Neurology, University of Colorado, Aurora, CO, United States of America
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Macchi ZA, Kleinschmidt-DeMasters BK, Orjuela KD, Pastula DM, Piquet AL, Baca CB. Glioblastoma as an autoimmune limbic encephalitis mimic: A case and review of the literature. J Neuroimmunol 2020; 342:577214. [PMID: 32182452 DOI: 10.1016/j.jneuroim.2020.577214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 12/13/2022]
Abstract
A 43-year-old woman presented with cognitive decline, focal seizures, brain MRI showing non-enhancing, bilateral hippocampal lesions, but normal cerebrospinal fluid findings, which fulfilled the Graus et al., 2016 criteria for autoimmune limbic encephalitis (ALE). Subjective improvements were observed after immunotherapy. A repeat brain MRI showed new contrast enhancement and positron emission tomography revealed left hippocampal uptake. Biopsy of the right parahippocampus yielded high-grade glioma. Five similar cases, among the 14 with unilateral hippocampal lesions on MRI, were identified in the literature whereby suspected ALE preceded the high-grade glioma diagnosis. Gliomas confined to hippocampi can have clinical features overlapping with ALE.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America.
| | - B K Kleinschmidt-DeMasters
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Karen D Orjuela
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Daniel M Pastula
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America
| | - Amanda L Piquet
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Christine B Baca
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States of America
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Affiliation(s)
- Ronak K Kapadia
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lakshmi Chauhan
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Gill CM, Kapadia RK, Beckham JD, Piquet AL, Tyler KL, Pastula DM. Usutu virus disease: a potential problem for North America? J Neurovirol 2019; 26:149-154. [PMID: 31858483 DOI: 10.1007/s13365-019-00818-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/07/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Usutu virus is an emerging mosquito-borne flavivirus initially identified in South Africa in 1959 that is now circulating throughout parts of Africa, Europe, and the Middle East. It is closely related to West Nile virus, and has similar vectors, amplifying bird hosts, and epidemiology. Usutu virus infection can occur in humans and may be asymptomatic or cause systemic (e.g., fever, rash, and hepatitis) or neuroinvasive (e.g., meningitis and encephalitis) disease. Given few reported cases, the full clinical spectrum is not known. No anti-viral treatment is available, but it can be largely prevented by avoiding mosquito bites. Because of similar mosquitoes, birds, and climate to Europe, the potential for introduction to North America is possible.
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Affiliation(s)
- Christine M Gill
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Ronak K Kapadia
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - J David Beckham
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Immunology-Microbiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado School of Medicine, Mail Stop B182, Research Complex 2, 12700 East 19th Ave., Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
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Kammeyer R, Piquet AL. Multiple co-existing antibodies in autoimmune encephalitis: A case and review of the literature. J Neuroimmunol 2019; 337:577084. [PMID: 31655424 DOI: 10.1016/j.jneuroim.2019.577084] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/22/2019] [Accepted: 10/05/2019] [Indexed: 12/25/2022]
Abstract
A 66-year-old man with a history of chronic tobacco use presented with two months of progressive memory deficits, ataxia, diplopia, and opsoclonus. His brain magnetic resonance imaging (MRI) showed limbic and brainstem encephalitis, and antibody testing was positive for anti-Ma1/Ma2, anti-N-methyl-d-aspartate receptor (anti-NMDA-R) and anti-glutamic acid decarboxylase 65 (anti-GAD65) antibodies. His encephalitis improved with intravenous steroids, plasmapheresis, and rituximab initiation. His PET/CT was suspicious for lung malignancy, but a progressive deterioration of his respiratory status prevented full investigation. Multiple auto-antibodies may be produced in response to a malignancy and overlapping of clinical presentations may occur with multiple auto-antibodies.
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Affiliation(s)
- Ryan Kammeyer
- University of Colorado, Department of Neurology, 12700 E. 19th Ave, Aurora, CO 80045, USA.
| | - Amanda L Piquet
- University of Colorado, Department of Neurology, 12700 E. 19th Ave, Aurora, CO 80045, USA.
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Gill CM, Beckham JD, Piquet AL, Tyler KL, Pastula DM. Five Emerging Neuroinvasive Arboviral Diseases: Cache Valley, Eastern Equine Encephalitis, Jamestown Canyon, Powassan, and Usutu. Semin Neurol 2019; 39:419-427. [PMID: 31533182 DOI: 10.1055/s-0039-1687839] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are many arthropod-borne viruses (arboviruses) capable of neuroinvasion, with West Nile virus being one of the most well known. In this review, we highlight five rarer emerging or reemerging arboviruses capable of neuroinvasion: Cache Valley, eastern equine encephalitis, Jamestown Canyon, Powassan, and Usutu viruses. Cache Valley and Jamestown Canyon viruses likely circulate throughout most of North America, while eastern equine encephalitis and Powassan viruses typically circulate in the eastern half. Usutu virus is not currently circulating in North America, but has the potential to be introduced in the future given similar climate, vectors, and host species to Europe (where it has been circulating). Health care providers should contact their state or local health departments with any questions regarding arboviral disease surveillance, diagnosis, treatment, or prevention. To prevent neuroinvasive arboviral diseases, use of insect repellent and other mosquito and tick bite prevention strategies are key.
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Affiliation(s)
- Christine M Gill
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - J David Beckham
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Division of Infectious Diseases, Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado.,Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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Piquet AL, Khan M, Warner JEA, Wicklund MP, Bennett JL, Leehey MA, Seeberger L, Schreiner TL, Paz Soldan MM, Clardy SL. Novel clinical features of glycine receptor antibody syndrome: A series of 17 cases. Neurol Neuroimmunol Neuroinflamm 2019; 6:e592. [PMID: 31355325 PMCID: PMC6624144 DOI: 10.1212/nxi.0000000000000592] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
Objective To describe novel clinical features of GlyRα1-IgG-positive patients. Methods Patients with a positive serum GlyRα1-IgG were identified during a 2-year period from July 2016 to December 2018 at 2 academic centers and followed prospectively. All patients in this series were evaluated in the Neuroimmunology and Autoimmune Neurology clinics at the University of Utah or the University of Colorado. Results Thirteen of 17 patients had phenotypes more typically associated with glutamic acid decarboxylase (GAD65) antibody syndromes, consisting of stiff-person syndrome (SPS) with parkinsonism or cerebellar signs. One patient with parkinsonism had a presentation similar to rapidly progressive multiple system atrophy with severe dysautonomia. Ten of 17 patients had various visual symptoms including visual snow, spider web-like images forming shapes and 3-dimensional images, palinopsia, photophobia, visual hallucinations, synesthesia, and intermittent diplopia. Three of 17 patients presented with primarily autoimmune epilepsy accompanied by psychiatric symptoms. Conclusions Clinicians should consider testing for GlyR antibodies in GAD65 antibody-negative or low-positive GAD65 antibody patients with SPS-like presentations, especially in the setting of atypical features such as visual disturbances, parkinsonism, or epilepsy.
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Affiliation(s)
- Amanda L Piquet
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Murtaza Khan
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Judith E A Warner
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Matthew P Wicklund
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Jeffrey L Bennett
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Maureen A Leehey
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Lauren Seeberger
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Teri L Schreiner
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - M Mateo Paz Soldan
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Stacey L Clardy
- Department of Neurology (A.L.P., M.K., M.P.W., J.L.B., M.A.L., L.S., T.L.S.), University of Colorado, Aurora; Department of Neurology (A.L.P., J.E.A.W., M.M.P.S., S.L.C.), University of Utah; Department of Ophthalmology (J.E.A.W.), Moran Eye Center, University of Utah, Salt Lake City; Department of Ophthalmology and Program in Neuroscience (J.L.B.), University of Colorado; Department of Neurology (T.L.S.), Children's Hospital Colorado, Aurora; and Department of Veterans Affairs (M.M.P.S., S.L.C.), George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
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Khan M, Ney DE, Kleinschmidt-DeMasters BK, Horton L, Alvarez E, Piquet AL. CNS atypical T-cell lymphoproliferative disease following treatment with alemtuzumab. Neurol Clin Pract 2019; 9:273-276. [PMID: 31341717 DOI: 10.1212/cpj.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Murtaza Khan
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
| | - Douglas E Ney
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
| | - Bette K Kleinschmidt-DeMasters
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
| | - Lindsay Horton
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
| | - Enrique Alvarez
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
| | - Amanda L Piquet
- Department of Neurology (MK, DEN, BKK-D, LH, EA, ALP), Department of Neurosurgery (DEN, BKK-D), and Department of Pathology (BKK-D), University of Colorado, Aurora, CO
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Affiliation(s)
- Murtaza Khan
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - J David Beckham
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Amanda L Piquet
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Kenneth L Tyler
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA
| | - Daniel M Pastula
- Neuro-Infectious Diseases Group, Department of Neurology and Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Piquet AL, Corboy JR. Neuromyelitis Optica. Mult Scler Relat Disord 2018. [DOI: 10.1891/9780826125941.0039] [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: 11/25/2022]
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Abstract
When patients present with neurological syndromes, such as encephalopathy/encephalitis, meningitis, and/or myelopathy/myelitis, the differential diagnosis is often broad, including infectious, inflammatory, autoimmune, vascular, and neoplastic etiologies. Just with inflammatory and autoimmune etiologies alone, there are numerous causative diseases. A comprehensive history and physical examination investigating for extraneurologic manifestations of immune-mediated disease is often necessary. Moreover, evaluating for an underlying infection and/or immunodeficiency becomes a critical aspect to the workup. This article will focus on the association of viral infections and dysregulation of the immune system as triggers of autoimmunity, in addition to various systemic inflammatory diseases that can cause neurological disease either with or without an established rheumatological disorder.
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Affiliation(s)
- Amanda L Piquet
- Department of Neurology, University of Colorado, Aurora, Colorado
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, Utah
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Abstract
Encephalitis has various etiologies, but viral infections and autoimmune disorders are the most commonly identified. Clinical signs, geographical clues, and diagnostic testing-including cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities-can be helpful in identifying the cause. Certain forms of encephalitis have specific treatments; hence, establishing a diagnosis rapidly and accurately is crucial. Here, we describe the clinical approach to diagnosing several common etiologies of encephalitis as well as treatment strategies.
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Affiliation(s)
- Amanda L Piquet
- Department of Neurology, Massachusetts General Hospital, Wang ACC 835, 55 Fruit Street, Boston, MA, 02114, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Tracey A Cho
- Department of Neurology, Massachusetts General Hospital, Wang ACC 835, 55 Fruit Street, Boston, MA, 02114, USA.
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Abstract
The clinician who is evaluating a patient with a suspected central nervous system infection often faces a large differential diagnosis. There are several signs, symptoms, geographical clues, and diagnostic testing, such as cerebrospinal fluid abnormalities and magnetic resonance imaging abnormalities, which can be helpful in identifying the etiological agent. By taking a systematic approach, one can often identify life-threatening, common, and/or treatable etiologies. Here the authors describe some of the pearls and pitfalls in diagnosing and treating acute infectious meningitis and encephalitis.
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Affiliation(s)
- Amanda L Piquet
- Division of Neuroimmunology, Department of Neurology, University of Utah Hospital, Salt Lake City, Utah
| | - Jennifer L Lyons
- Division of Neurological Infections and Inflammatory Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Venkiteswaran K, Alexander DN, Puhl MD, Rao A, Piquet AL, Nyland JE, Subramanian MP, Iyer P, Boisvert MM, Handly E, Subramanian T, Grigson PS. Transplantation of human retinal pigment epithelial cells in the nucleus accumbens of cocaine self-administering rats provides protection from seeking. Brain Res Bull 2015; 123:53-60. [PMID: 26562520 DOI: 10.1016/j.brainresbull.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 01/05/2023]
Abstract
Chronic exposure to drugs and alcohol leads to damage to dopaminergic neurons and their projections in the 'reward pathway' that originate in the ventral tegmental area (VTA) and terminate in the nucleus accumbens (NAc). This damage is thought to contribute to the signature symptom of addiction: chronic relapse. In this study we show that bilateral transplants of human retinal pigment epithelial cells (RPECs), a cell mediated dopaminergic and trophic neuromodulator, into the medial shell of the NAc, rescue rats with a history of high rates of cocaine self-administration from drug-seeking when returned, after 2 weeks of abstinence, to the drug-associated chamber under extinction conditions (i.e., with no drug available). Excellent survival was noted for the transplant of RPECs in the shell and/or the core of the NAc bilaterally in all rats that showed behavioral recovery from cocaine seeking. Design based unbiased stereology of tyrosine hydroxylase (TH) positive cell bodies in the VTA showed better preservation (p<0.035) in transplanted animals compared to control animals. This experiment shows that the RPEC graft provides beneficial effects to prevent drug seeking in drug addiction via its effects directly on the NAc and its neural network with the VTA.
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Affiliation(s)
- Kala Venkiteswaran
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Danielle N Alexander
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Matthew D Puhl
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Anand Rao
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Amanda L Piquet
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Jennifer E Nyland
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Megha P Subramanian
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Puja Iyer
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Matthew M Boisvert
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Erin Handly
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thyagarajan Subramanian
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Piquet AL, Venkiteswaran K, Marupudi NI, Berk M, Subramanian T. The immunological challenges of cell transplantation for the treatment of Parkinson's disease. Brain Res Bull 2012; 88:320-31. [PMID: 22521427 DOI: 10.1016/j.brainresbull.2012.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/07/2012] [Accepted: 03/09/2012] [Indexed: 01/24/2023]
Abstract
Dopaminergic cell transplantation is an experimental therapy for Parkinson's disease (PD). It has many potential theoretical advantages over current treatment strategies such as providing continuous local dopaminergic replenishment, eliminating motor fluctuations and medication-induced dyskinesias, slowing down disease progression or even reversing disease pathology in the host. Recent studies also show that dopaminergic cell transplants provide long-term neuromodulation in the basal ganglia that simulates the combined effects of oral dopaminergic therapy and surgical therapies like deep brain stimulation, the contemporary therapeutic approach to advanced PD. However, dopaminergic cell transplantation in PD as not been optimized and current experimental techniques have many drawbacks. In published experiments to date of attempted dopaminergic grafting in PD, the major challenges are unacceptable graft-induced dyskinesias or failure of such grafts to exceed the benefits afforded by sham surgery. A deleterious host immune response to the transplant has been implicated as a major putative cause for these adverse outcomes. This article focuses on recent advances in understanding the immunology of the transplantation in PD and possible methods to overcome adverse events such that we could translate cell replacement strategies into viable clinical treatments in the future.
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Affiliation(s)
- Amanda L Piquet
- Department of Neurology, The Pennsylvania State University College of Medicine, Hershey, United States
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