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Teresa Margarida Cunha - One of the best experts on this subject based on the ideXlab platform.

Carlos Oliveira - One of the best experts on this subject based on the ideXlab platform.

Chefdeville Aude - One of the best experts on this subject based on the ideXlab platform.

  • L'encéphalite à auto-anticorps anti-NMDAR, un modèle de synaptopathie
    HAL CCSD, 2017
    Co-Authors: Chefdeville Aude
    Abstract:

    Anti-NMDA receptor (NMDAR) encephalitis is a rare but severe neuropsychiatric disorder initially described by J. Dalmau and colleagues in 2007. Anti-NMDAR encephalitis is defined by a clinical picture of encephalitis associated with the presence of IgG directed against the GluN1 subunit of NMDAR (NMDAR-Abs) in the cerebrospinal fluid (CSF) of patients. This disorder predominantly affects young women. Clinical presentation usually includes psychiatric symptoms and/or neurological symptoms often accompanied by decreased responsiveness and autonomic instabilities during the course of the disease . Despite the severity of the disease, 81% of patients recover fully or with mild sequels . 38% of patients had an underlying neoplasm, 94% of which were ovarian Teratomas , indicating a role for this tumor in the immunopathogenesis of the disease. Studies in vitro and on animal models have demonstrated the pathogenicity of NMDAR-Abs but more studies are required to decipher the pathological role of anti-NMDAR antibodies. Two main research focuses have emerged in our group: understanding the events leading to the immune dysregulation in the Ovary Teratoma and identifying the pathological element(s) and how they act at the molecular and cellular levels to cause the broad neurological spectrum of symptoms observed in patients. My PhD was especially focused on 1) understanding the involvement of the underlying Ovary Teratoma in the triggering of the immune response during anti-NMDAR encephalitis and 2) studying the impact of prolonged exposure of the neuronal network to patients’ NMDAR-Abs and the potential involvement of microglial cells in the physiopathology of the diseaseQue se passe-t-il quand le système immunitaire attaque le cerveau ? Dans l'encéphalite à autoanticorps dirigés contre les récepteurs NMDA, le système immunitaire des patients dysfonctionne : au lieu de produire des anticorps pour combattre des organismes pathogènes, le système immunitaire produit des anticorps qui attaquent une protéine spécifique dans le cerveau des patients, les récepteurs NMDA. Ces récepteur sont indispensables à la mémoire et sont impliqués dans diverses maladies (schizophrénie, maladie d'Alzheimer). Les patients atteints d'encéphalite à autoanticorps dirigés contre les récepteurs NMDA souffrent de troubles neuropsychiatriques sévères (hallucinations, paranoïa, mouvements anormaux, épilepsie, amnésie, etc.) et la gravité de leur état de santé nécessite une prise en charge en réanimation. Malgré cette sévérité, 8 patients sur 10 récupèrent avec un traitement adapté. Les patients souffrant de cette maladie sont majoritairement des jeunes femmes porteuses d'une tumeur des ovaires. Le premier objectif de ma thèse est de comprendre le rôle de cette tumeur dans le dysfonctionnement du système immunitaire de ces patientes. Mon second objectif est de comprendre comment les autoanticorps attaquant les récepteurs NMDA vont perturber le fonctionnement du cerveau. Apporter des éléments de réponse à ces questions permettra à terme d'améliorer la prise en charge des patient

  • NMDAR Encephalitis, a model of synaptopathy
    2017
    Co-Authors: Chefdeville Aude
    Abstract:

    Que se passe-t-il quand le système immunitaire attaque le cerveau ? Dans l'encéphalite à autoanticorps dirigés contre les récepteurs NMDA, le système immunitaire des patients dysfonctionne : au lieu de produire des anticorps pour combattre des organismes pathogènes, le système immunitaire produit des anticorps qui attaquent une protéine spécifique dans le cerveau des patients, les récepteurs NMDA. Ces récepteur sont indispensables à la mémoire et sont impliqués dans diverses maladies (schizophrénie, maladie d'Alzheimer). Les patients atteints d'encéphalite à autoanticorps dirigés contre les récepteurs NMDA souffrent de troubles neuropsychiatriques sévères (hallucinations, paranoïa, mouvements anormaux, épilepsie, amnésie, etc.) et la gravité de leur état de santé nécessite une prise en charge en réanimation. Malgré cette sévérité, 8 patients sur 10 récupèrent avec un traitement adapté. Les patients souffrant de cette maladie sont majoritairement des jeunes femmes porteuses d'une tumeur des ovaires. Le premier objectif de ma thèse est de comprendre le rôle de cette tumeur dans le dysfonctionnement du système immunitaire de ces patientes. Mon second objectif est de comprendre comment les autoanticorps attaquant les récepteurs NMDA vont perturber le fonctionnement du cerveau. Apporter des éléments de réponse à ces questions permettra à terme d'améliorer la prise en charge des patientsAnti-NMDA receptor (NMDAR) encephalitis is a rare but severe neuropsychiatric disorder initially described by J. Dalmau and colleagues in 2007. Anti-NMDAR encephalitis is defined by a clinical picture of encephalitis associated with the presence of IgG directed against the GluN1 subunit of NMDAR (NMDAR-Abs) in the cerebrospinal fluid (CSF) of patients. This disorder predominantly affects young women. Clinical presentation usually includes psychiatric symptoms and/or neurological symptoms often accompanied by decreased responsiveness and autonomic instabilities during the course of the disease . Despite the severity of the disease, 81% of patients recover fully or with mild sequels . 38% of patients had an underlying neoplasm, 94% of which were ovarian Teratomas , indicating a role for this tumor in the immunopathogenesis of the disease. Studies in vitro and on animal models have demonstrated the pathogenicity of NMDAR-Abs but more studies are required to decipher the pathological role of anti-NMDAR antibodies. Two main research focuses have emerged in our group: understanding the events leading to the immune dysregulation in the Ovary Teratoma and identifying the pathological element(s) and how they act at the molecular and cellular levels to cause the broad neurological spectrum of symptoms observed in patients. My PhD was especially focused on 1) understanding the involvement of the underlying Ovary Teratoma in the triggering of the immune response during anti-NMDAR encephalitis and 2) studying the impact of prolonged exposure of the neuronal network to patients’ NMDAR-Abs and the potential involvement of microglial cells in the physiopathology of the diseas

Isa Martins - One of the best experts on this subject based on the ideXlab platform.

Cui Li-ying - One of the best experts on this subject based on the ideXlab platform.

  • D-cycloserin, a NMDA-agonist may be a treatment option for anti-NMDAR encephalitis
    'OAE Publishing Inc.', 2016
    Co-Authors: Guan Hong-zhi, Du Tie-kuan, Xu Jin, Lv Xia, Zhu Hua-dong, Zhu Yi-cheng, Peng Bin, Cui Li-ying
    Abstract:

    Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is caused by reversible neuron dysfunction associated an autoantibody-mediated decrease of NMDAR in the entire brain. A N-methyl-D-aspartate (NMDA) -agonist treatment for anti-NMDAR encephalitis might have a role considering its specific mechanism. The authors used D-cycloserine, a partial NMDA-agonist in a refractory case with prolonged intensive care unit duration. A 13-year-old female presented with headache, cognitive deterioration, generalized seizures, coma and hypoventilation with required mechanical ventilation. Anti-NMDAR antibodies were identified in cerebrospinal fluid and serum confirming anti-NMDAR encephalitis. The patient was refractory to first-line and second-line immunotherapy and removal of Ovary Teratoma. D-cycloserine was then administered and her symptoms improved gradually and significantly. This is the first reported case in which D-cycloserine was applied to this disease. D-cycloserine might be a potential option as specific treatment in anti-NMDAR encephalitis