title: IgA NMDA receptor antibodies are markers of synaptic immunity in slow cognitive impairment.
abstract: OBJECTIVE
  To report that antibodies to synaptic proteins may occur in association with slow, progressive cognitive decline.
  
  
  METHODS
  A total of 24 patients with progressive cognitive dysfunction of unclear etiology were examined for onconeuronal and synaptic receptor antibodies. The effect of serum was examined in cultures of dissociated mouse hippocampal neurons.
  
  
  RESULTS
  Seven patients had immunoglobulin A (IgA), but no immunoglobulin G (IgG), antibodies against NMDA receptor (NMDAR). Anti-NMDAR IgA positive patients' serum, but not serum from control individuals, caused dramatic decrease of the levels of NMDAR and other synaptic proteins in neurons, along with prominent changes in NMDAR-mediated currents. These effects correlated with the titer of IgA NMDAR antibodies and were reversed after removing patients' serum from the culture media. When available, comprehensive clinical assessment and brain metabolic imaging showed neurologic improvement after immunotherapy.
  
  
  CONCLUSIONS
  A subset of patients with slowly progressive cognitive impairment has an underlying synaptic autoimmunity that decreases the density of NMDAR and other synaptic proteins, and alters synaptic currents. This autoimmunity can be demonstrated examining patients' serum and CSF for NMDAR IgA antibodies, identifying possible candidates for immunotherapy.
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Berlin. harald.pruess@charite.de
authors.forename: H
authors.initials: H
authors.lastname: Prüss
authors.forename: M
authors.initials: M
authors.lastname: Höltje
authors.forename: N
authors.initials: N
authors.lastname: Maier
authors.forename: A
authors.initials: A
authors.lastname: Gomez
authors.forename: R
authors.initials: R
authors.lastname: Buchert
authors.forename: L
authors.initials: L
authors.lastname: Harms
authors.forename: G
authors.initials: G
authors.lastname: Ahnert-Hilger
authors.forename: D
authors.initials: D
authors.lastname: Schmitz
authors.forename: C
authors.initials: C
authors.lastname: Terborg
authors.forename: U
authors.initials: U
authors.lastname: Kopp
authors.forename: C
authors.initials: C
authors.lastname: Klingbeil
authors.forename: C
authors.initials: C
authors.lastname: Probst
authors.forename: S
authors.initials: S
authors.lastname: Kohler
authors.forename: J M
authors.initials: JM
authors.lastname: Schwab
authors.forename: W
authors.initials: W
authors.lastname: Stoecker
authors.forename: J
authors.initials: J
authors.lastname: Dalmau
authors.forename: K P
authors.initials: KP
authors.lastname: Wandinger
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000276:immunology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D001284:Atrophy; D015551:Autoimmunity; D015415:Biomarkers / Q000097:blood; D015153:Blotting, Western; D003072:Cognition Disorders / Q000276:immunology* / Q000378:metabolism / Q000628:therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D004594:Electrophysiology; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood* / Q000276:immunology*; D007150:Immunohistochemistry; D007167:Immunotherapy / Q000379:methods; D020961:Lewy Body Disease / Q000175:diagnosis / Q000276:immunology; D008279:Magnetic Resonance Imaging; D009474:Neurons / Q000276:immunology; D010951:Plasma Exchange; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals / Q000378:metabolism; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D000069283:Rituximab; D013569:Synapses / Q000276:immunology*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; D007070:Immunoglobulin A; D019275:Radiopharmaceuticals; D016194:Receptors, N-Methyl-D-Aspartate; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D003520:Cyclophosphamide