Humoral signatures of Caspr2-antibody spectrum disorder track with clinical phenotypes and outcomes.

IF 12.8 Q1 MEDICINE, RESEARCH & EXPERIMENTAL Med Pub Date : 2024-10-03 DOI:10.1016/j.medj.2024.09.004

Paula Terroba-Navajas, Marianna Spatola, Omar Chuquisana, Bastien Joubert, Juna M de Vries, Andre Dik, Laura Marmolejo, Friederike Jönsson, Gordan Lauc, Stjepana Kovac, Harald Prüss, Heinz Wiendl, Maarten J Titulaer, Jérôme Honnorat, Jan D Lünemann

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Abstract

Background: Immunoglobulin (Ig) G4 auto-antibodies (Abs) against contactin-associated protein-like 2 (Caspr2), a transmembrane cell adhesion protein expressed in the central and peripheral nervous system, are found in patients with a broad spectrum of neurological symptoms. While the adoptive transfer of Caspr2-specific IgG induces brain pathology in susceptible rodents, the mechanisms by which Caspr2-Abs mediate neuronal dysfunction and translate into clinical syndromes are incompletely understood.

Methods: We use a systems-level approach combined with high-dimensional characterization of Ab-associated immune features to deeply profile humoral biosignatures in patients with Caspr2-Ab-associated neurological syndromes.

Findings: We identify two signatures strongly associated with two major clinical phenotypes, limbic encephalitis (LE) and predominant peripheral nerve hyperexcitability without LE (non-LE). Caspr2-IgG Fc-driven pro-inflammatory features, characterized by increased binding affinities for activating Fcγ receptors (FcγRs) and C1q, along with a higher prevalence of IgG1-class Abs, in addition to IgG4, are strongly associated with LE. Both the occurrence of Caspr2-specific IgG1 and higher serum levels of interleukin (IL)-6 and IL-15, along with increased concentrations of biomarkers reflecting neuronal damage and glial cell activation, are associated with poorer clinical outcomes at 1-year follow-up.

Conclusions: The presence of IgG1 isotypes and Fc-mediated effector functions control the pathogenicity of Caspr2-specific Abs to induce LE. Biologics targeting FcR function might potentially restrain Caspr2-Ab-induced pathology and improve clinical outcomes.

Funding: This study was funded by a German-French joint research program supported by the German Research Foundation (DFG) and the Agence Nationale de la Recherche (ANR) and by the Interdisciplinary Centre for Clinical Research (IZKF) Münster.

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Caspr2-抗体谱系障碍的体液特征与临床表型和结果的关系。

背景：针对接触素相关蛋白样 2（Caspr2）的免疫球蛋白（Ig）G4 自身抗体（Abs）是一种在中枢和外周神经系统中表达的跨膜细胞粘附蛋白。虽然Caspr2特异性IgG可诱导易感啮齿类动物出现脑部病变，但人们对Caspr2-Abs介导神经元功能障碍并转化为临床综合征的机制尚不完全清楚：方法：我们采用系统级方法，结合 Ab 相关免疫特征的高维表征，深入剖析 Caspr2-Ab 相关神经综合征患者的体液生物特征：我们发现了与两种主要临床表型（边缘性脑炎（LE）和无LE（非LE）的主要周围神经兴奋性减退）密切相关的两个特征。Caspr2-IgG Fc驱动的促炎特征与LE密切相关，其特点是与活化Fcγ受体（FcγRs）和C1q的结合亲和力增加，同时除IgG4外，IgG1类抗体的流行率也较高。Caspr2特异性IgG1的出现和较高的血清白细胞介素（IL）-6和IL-15水平，以及反映神经元损伤和胶质细胞活化的生物标记物浓度的增加，都与随访1年后较差的临床结果有关：结论：IgG1异型和Fc介导的效应器功能控制着Caspr2特异性Abs诱导LE的致病性。针对FcR功能的生物制剂可能会抑制Caspr2-Ab诱导的病理变化并改善临床预后：本研究由德国研究基金会（DFG）和法国国家研究署（ANR）支持的德法联合研究计划以及明斯特跨学科临床研究中心（IZKF）资助。

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来源期刊

Med MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

17.70

自引率

0.60%

发文量

102

期刊介绍： Med is a flagship medical journal published monthly by Cell Press, the global publisher of trusted and authoritative science journals including Cell, Cancer Cell, and Cell Reports Medicine. Our mission is to advance clinical research and practice by providing a communication forum for the publication of clinical trial results, innovative observations from longitudinal cohorts, and pioneering discoveries about disease mechanisms. The journal also encourages thought-leadership discussions among biomedical researchers, physicians, and other health scientists and stakeholders. Our goal is to improve health worldwide sustainably and ethically. Med publishes rigorously vetted original research and cutting-edge review and perspective articles on critical health issues globally and regionally. Our research section covers clinical case reports, first-in-human studies, large-scale clinical trials, population-based studies, as well as translational research work with the potential to change the course of medical research and improve clinical practice.