title: Detection of autoantibodies against hypocretin, hcrtrl, and hcrtr2 in narcolepsy: anti-Hcrt system antibody in narcolepsy.
abstract: OBJECTIVE
  The impairment of hypocretin neurotransmission system is considered to play a major role in the pathophysiology of narcolepsy. It has been hypothesized that autoimmune abnormalities underlie the etiology of narcolepsy, based on the tight association with HLA-DRB1*1501/ DQB1*0602. It remains unclear if autoantibodies against hypocretin receptors (hcrtrl and hcrtr2) are involved in narcolepsy.
  
  
  METHODS
  We have developed a novel radioligand binding assay to address this question. Sera from 181 patients with narcolepsy, 10 patients with other hypersomnias, and 91 control subjects were used. Human [35S]-Hcrt, hcrtrl, and hcrtr2 were synthesized by in vitro transcription/translation system. The immune complex of autoantibody and each [35S]-protein were immunoprecipitated and quantified using a radioligand-binding assay.
  
  
  RESULTS
  We detected autoantibodies against hypocretin in 3 patients, hcrtrl in 1 patient, and hcrtr2 in 5 patients with narcolepsy. Positive reactions were also found against hcrtrl in 2 and hcrtr2 in 1 control subjects. No relationships were found between these autoantibodies and HLA-DRB1*1501/DQB1*0602 haplotypes, presence of cataplexy, presence of subjective nocturnal sleep disruption, or the score on the Epworth Sleepiness Scale.
  
  
  CONCLUSIONS
  Although we have detected autoantibodies against the hypocretin neurotransmission system, our results do not support the hypothesis that autoantibody-mediated dysfunction in the hypocretin system underlies the pathophysiology of narcolepsy.
authors.affiliation: The Sleep Disorders Project, Department of Sleep Disorders Research, Tokyo Institute of Psychiatry, Setagaya-ku, Tokyo, Japan. stanaka@prit.go.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Honda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Inoue
authors.forename: Makoto
authors.initials: M
authors.lastname: Honda
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D017931:DNA Primers / Q000235:genetics; D005260:Female; D006683:HLA-DQ Antigens / Q000276:immunology; D059866:HLA-DQ beta-Chains; D006684:HLA-DR Antigens / Q000276:immunology; D059811:HLA-DRB1 Chains; D006239:Haplotypes / Q000276:immunology; D006624:Hippocampus / Q000166:cytology; D006801:Humans; D007031:Hypothalamus / Q000166:cytology; D047468:Immunoprecipitation; D066298:In Vitro Techniques; D008297:Male; D008562:Membrane Glycoproteins / Q000276:immunology; D009290:Narcolepsy / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology*; D064446:Orexin Receptors; D043562:Receptors, G-Protein-Coupled / Q000235:genetics* / Q000276:immunology*; D018013:Receptors, Neuropeptide / Q000235:genetics* / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D017931:DNA Primers; D006683:HLA-DQ Antigens; D059866:HLA-DQ beta-Chains; C069051:HLA-DQB1 antigen; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; C489631:HLA-DRB1*15:01 antigen; D008562:Membrane Glycoproteins; D064446:Orexin Receptors; D043562:Receptors, G-Protein-Coupled; D018013:Receptors, Neuropeptide