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Persistence of parenchymal and perivascular T-cells in treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis.
Neuroreport. 2017 Sep 27; 28(14):890-895.N

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease mediated by IgG1 or IgG3 antibodies to the GluN1 subunit of the NMDAR, resulting in downregulation of NMDARs. Early diagnosis, prompt reduction of anti-NMDAR antibodies, and removal of associated ovarian tumors when identified are important drivers of prognosis. Immunohistochemical studies were carried out to evaluate B cell, plasma cell, and T-cell infiltrates in the brain of a 3-year-old patient with anti-NMDAR encephalitis who failed to show improvement after plasma exchange and Rituximab treatment. Complement activation was evaluated by C4d staining. Plasma cells and B-cells were rarely detected in the brain. In contrast, persistent intraparenchymal infiltrates and perivascular CD3+ T cells and evidence of complement activation were detected. Activated microglia and microglial nodules were also detected in the frontal lobes and the basal ganglia. The role of T cells and complement activation should be investigated in patients who do not respond to plasma exchange and Rituximab treatment.

Authors+Show Affiliations

Departments of aPathology bNeurology and Neurotherapeutics cPediatrics dImmunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28777260

Citation

Filatenkov, Alexander, et al. "Persistence of Parenchymal and Perivascular T-cells in Treatment-refractory anti-N-methyl-D-aspartate Receptor Encephalitis." Neuroreport, vol. 28, no. 14, 2017, pp. 890-895.
Filatenkov A, Richardson TE, Daoud E, et al. Persistence of parenchymal and perivascular T-cells in treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis. Neuroreport. 2017;28(14):890-895.
Filatenkov, A., Richardson, T. E., Daoud, E., Johnson-Welch, S. F., Ramirez, D. M., Torrealba, J., Greenberg, B., Monson, N. L., & Rajaram, V. (2017). Persistence of parenchymal and perivascular T-cells in treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis. Neuroreport, 28(14), 890-895. https://doi.org/10.1097/WNR.0000000000000851
Filatenkov A, et al. Persistence of Parenchymal and Perivascular T-cells in Treatment-refractory anti-N-methyl-D-aspartate Receptor Encephalitis. Neuroreport. 2017 Sep 27;28(14):890-895. PubMed PMID: 28777260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistence of parenchymal and perivascular T-cells in treatment-refractory anti-N-methyl-D-aspartate receptor encephalitis. AU - Filatenkov,Alexander, AU - Richardson,Timothy E, AU - Daoud,Elena, AU - Johnson-Welch,Sarah F, AU - Ramirez,Denise M, AU - Torrealba,Jose, AU - Greenberg,Benjamin, AU - Monson,Nancy L, AU - Rajaram,Veena, PY - 2017/8/5/pubmed PY - 2018/5/3/medline PY - 2017/8/5/entrez SP - 890 EP - 895 JF - Neuroreport JO - Neuroreport VL - 28 IS - 14 N2 - Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease mediated by IgG1 or IgG3 antibodies to the GluN1 subunit of the NMDAR, resulting in downregulation of NMDARs. Early diagnosis, prompt reduction of anti-NMDAR antibodies, and removal of associated ovarian tumors when identified are important drivers of prognosis. Immunohistochemical studies were carried out to evaluate B cell, plasma cell, and T-cell infiltrates in the brain of a 3-year-old patient with anti-NMDAR encephalitis who failed to show improvement after plasma exchange and Rituximab treatment. Complement activation was evaluated by C4d staining. Plasma cells and B-cells were rarely detected in the brain. In contrast, persistent intraparenchymal infiltrates and perivascular CD3+ T cells and evidence of complement activation were detected. Activated microglia and microglial nodules were also detected in the frontal lobes and the basal ganglia. The role of T cells and complement activation should be investigated in patients who do not respond to plasma exchange and Rituximab treatment. SN - 1473-558X UR - https://www.unboundmedicine.com/medline/citation/28777260/Persistence_of_parenchymal_and_perivascular_T_cells_in_treatment_refractory_anti_N_methyl_D_aspartate_receptor_encephalitis_ L2 - https://doi.org/10.1097/WNR.0000000000000851 DB - PRIME DP - Unbound Medicine ER -