title: Two new cases of anti-Ca (anti-ARHGAP26/GRAF) autoantibody-associated cerebellar ataxia.
abstract: Recently, we discovered a novel serum and cerebrospinal fluid (CSF) autoantibody (anti-Ca) to Purkinje cells in a patient with autoimmune cerebellar ataxia (ACA) and identified the RhoGTPase-activating protein 26 (ARHGAP26; alternative designations include GTPase regulator associated with focal adhesion kinase pp125, GRAF, and oligophrenin-1-like protein, OPHN1L) as the target antigen. Here, we report on two new cases of ARHGAP26 autoantibody-positive ACA that were first diagnosed after publication of the index case study. While the index patient developed ACA following an episode of respiratory infection with still no evidence for malignancy 52 months after onset, neurological symptoms heralded ovarian cancer in one of the patients described here. Our finding of anti-Ca/anti-ARHGAP26 antibodies in two additional patients supports a role of autoimmunity against ARHGAP26 in the pathogenesis of ACA. Moreover, the finding of ovarian cancer in one of our patients suggests that anti-Ca/anti-ARHGAP26-positive ACA might be of paraneoplastic aetiology in some cases. In conclusion, testing for anti-Ca/anti-ARHGAP26 should be included in the diagnostic work-up of patients with ACA, and an underlying tumour should be considered in patients presenting with anti-Ca/ARHGAP26 antibody-positive ACA.
authors: Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany. sven.jarius@med.uni-heidelberg.de
authors: Sven
authors: S
authors: Jarius
authors: Pedro
authors: P
authors: Martínez-García
authors: Adelaida León
authors: AL
authors: Hernandez
authors: Jan Christoph
authors: JC
authors: Brase
authors: Kathrin
authors: K
authors: Borowski
authors: Jens Ulrich
authors: JU
authors: Regula
authors: Hans Michael
authors: HM
authors: Meinck
authors: Winfried
authors: W
authors: Stöcker
authors: Brigitte
authors: B
authors: Wildemann
authors: Klaus-Peter
authors: KP
authors: Wandinger
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000096:biosynthesis*; D002524:Cerebellar Ataxia / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology*; D005260:Female; D020690:GTPase-Activating Proteins / Q000276:immunology*; D006801:Humans; D008297:Male
chemical_list: C115971:ARHGAP26 protein, human; D001323:Autoantibodies; D020690:GTPase-Activating Proteins