HLA Analysis in Autoimmune Encephalitis and Related Disorders: Part II

  • STATUS
    Recruiting
  • End date
    Dec 31, 2025
  • participants needed
    700
  • sponsor
    Hospices Civils de Lyon
Updated on 8 April 2021

Summary

Autoimmune encephalitis (AE) are characterized by subacute onset of memory deficits, altered mental status or psychiatric symptoms, frequently associated with seizures, inflammatory cerebrospinal fluid and in cases with prominent limbic involvement, typical magnetic resonance imaging. Several autoantibodies (Abs) may be detected in AE, although its detection is not mandatory to establish a diagnosis. These Abs mainly recognize different synaptic and cell-surface proteins in the central nervous system, and are thought to be pathogenic as they alter the normal location or function of its antigens. Paraneoplastic neurological syndromes (PNS) are immune-mediated, remote complications of cancer. The clinical presentation is highly diverse, from central nervous system disorders (limbic encephalitis, cerebellar ataxia) to peripheral neuropathies and neuromuscular junction diseases. Two different kinds of Abs are associated with PNS: a first group known as onconeural Abs, which recognize intracellular antigens and are thought not to be pathogenic; and a second one whose targeted synaptic and cell-surface antigens shared with some non-paraneoplastic AE.

The primary trigger of the immune response is unknown for most of AE. In addition to acquired susceptibility such as herpes simplex encephalitis, genetic predisposition may also be important in the pathogenesis of AE. Human leukocyte antigen (HLA) is the genetic factor most frequently associated with autoimmune diseases, due to its genetic complexity and key role in the adaptive immune response. Others and we already described the HLA haplotypes associated with three types different of AE: anti-leucine-rich glioma inactivated 1 (LGI1), anti-contactin-associated protein-like 2 (CASPR2), and anti-glutamic acid decarboxylase (GAD). Nevertheless, the genetic predisposition of many other AE has not been investigated yet.

Cancer is considered as the trigger of the immune response that lead to PNS development, as the neural antigens recognized by the onconeural Abs are also expressed by tumor cells. Nevertheless, it is still unknown why some patients develop PNS and others do not, even if they present the same histological type of tumor, suggesting that some particular, maybe genetic, characteristics of the patients may play a role in this susceptibility. Furthermore, there is already evidence that, for those neurological diseases that may appear either as PNS or as non-paraneoplastic autoimmune disorder (i.e. Lambert-Eaton myasthenic syndrome), HLA profiles are not the same.

Details
Condition Autoimmune Encephalitis, encephalitis autoimmune, Paraneoplastic Neurological Syndrome
Treatment Autoimmune encephalitis and paraneoplastic neurological syndromes
Clinical Study IdentifierNCT04823728
SponsorHospices Civils de Lyon
Last Modified on8 April 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Presence of well-characterized antibodies in serum or cerebrospinal fluid
Clinical picture compatible with the detected antibody based on the literature
For PNS, cancer detected and compatible with the detected antibody based on the literature

Exclusion Criteria

Absence of complete clinicobiological data
Incongruences between antibody-clinics or antibody-cancer
Clear my responses

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