Source Paper
Jesús Planagumà, Frank Leypoldt, Francesco Mannara, Javier Gutiérrez-Cuesta, Elena Martín-García et al.
Brain • 2014
Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a severe neuropsychiatric disorder that associates with prominent memory and behavioural deficits. Patients' antibodies react with the N-terminal domain of the GluN1 (previously known as NR1) subunit of NMDAR causing in cultured neurons a selective and reversible internalization of cell-surface receptors. These effects and the frequent response to immunotherapy have suggested an antibody-mediated pathogenesis, but to date there is no animal model showing that patients' antibodies cause memory and behavioural deficits. To develop such a model, C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps that delivered a continuous infusion of patients' or control cerebrospinal fluid (flow rate 0.25 µl/h, 14 days). During and after the infusion period standardized tests were applied, including tasks to assess memory (novel object recognition in open field and V-maze paradigms), anhedonic behaviours (sucrose preference test), depressive-like behaviours (tail suspension, forced swimming tests), anxiety (black and white, elevated plus maze tests), aggressiveness (resident-intruder test), and locomotor activity (horizontal and vertical). Animals sacrificed at Days 5, 13, 18, 26 and 46 were examined for brain-bound antibodies and the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy and immunoblot analysis. These experiments showed that animals infused with patients' cerebrospinal fluid, but not control cerebrospinal fluid, developed progressive memory deficits, and anhedonic and depressive-like behaviours, without affecting other behavioural or locomotor tasks. Memory deficits gradually worsened until Day 18 (4 days after the infusion stopped) and all symptoms resolved over the next week. Accompanying brain tissue studies showed progressive increase of brain-bound human antibodies, predominantly in the hippocampus (maximal on Days 13-18), that after acid extraction and characterization with GluN1-expressing human embryonic kidney cells were confirmed to be against the NMDAR. Confocal microscopy and immunoblot analysis of the hippocampus showed progressive decrease of the density of total and synaptic NMDAR clusters and total NMDAR protein concentration (maximal on Day 18), without affecting the post-synaptic density protein 95 (PSD95) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. These effects occurred in parallel with memory and other behavioural deficits and gradually improved after Day 18, with reversibility of symptoms accompanied by a decrease of brain-bound antibodies and restoration of NMDAR levels. Overall, these findings establish a link between memory and behavioural deficits and antibody-mediated reduction of NMDAR, provide the biological basis by which removal of antibodies and antibody-producing cells improve neurological function, and offer a model for testing experimental therapies in this and similar disorders.
Objective: Assessment of depressive-like behaviors through forced swimming paradigm in mice receiving continuous cerebrospinal fluid infusion
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C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps for continuous cerebrospinal fluid delivery
Note: Catheters connected to osmotic pumps for continuous infusion
“C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps that delivered a continuous infusion”
Osmotic pumps delivered continuous infusion of patients' or control cerebrospinal fluid to mouse brain
Note: Flow rate maintained at 0.25 µl/h
“osmotic pumps that delivered a continuous infusion of patients' or control cerebrospinal fluid (flow rate 0.25 µl/h, 14 days)”
Standardized test applied during and after infusion period to assess depressive-like behaviors
Note: Conducted as part of behavioral assessment battery
“During and after the infusion period standardized tests were applied, including tasks to assess memory (novel object recognition in open field and V-maze paradigms), anhedonic behaviours (sucrose preference test), depressive-like behaviours (tail suspension, forced swimming tests)”
Standardized test applied during and after infusion period to assess depressive-like behaviors
Note: Conducted as part of behavioral assessment battery
“depressive-like behaviours (tail suspension, forced swimming tests)”
Memory assessment task conducted during and after infusion period
Note: Part of standardized behavioral test battery
“tasks to assess memory (novel object recognition in open field and V-maze paradigms)”
Memory assessment task conducted during and after infusion period
Note: Part of standardized behavioral test battery
“tasks to assess memory (novel object recognition in open field and V-maze paradigms)”
Test to assess anhedonic behaviors during and after infusion period
Note: Part of standardized behavioral test battery
“anhedonic behaviours (sucrose preference test)”
Anxiety assessment test conducted during and after infusion period
Note: Part of standardized behavioral test battery
“anxiety (black and white, elevated plus maze tests)”
Anxiety assessment test conducted during and after infusion period
Note: Part of standardized behavioral test battery
“anxiety (black and white, elevated plus maze tests)”
Test to assess aggressiveness during and after infusion period
Note: Part of standardized behavioral test battery
“aggressiveness (resident-intruder test)”
Tests to measure locomotor activity during and after infusion period
Note: Part of standardized behavioral test battery
“locomotor activity (horizontal and vertical)”
Animals sacrificed at specified timepoints for brain tissue analysis
Note: Sacrifice at Days 5, 13, 18, 26 and 46 post-infusion initiation
“Animals sacrificed at Days 5, 13, 18, 26 and 46 were examined for brain-bound antibodies”
Examination of brain-bound antibodies and effects on total and synaptic NMDAR clusters in brain tissue
Note: Analysis of hippocampus tissue
“Animals sacrificed at Days 5, 13, 18, 26 and 46 were examined for brain-bound antibodies and the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy and immunoblot analysis”
Analysis of NMDAR protein concentration and other synaptic proteins in brain tissue
Note: Examination of total NMDAR protein, PSD95, and AMPA receptors
“the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy and immunoblot analysis”
Brain tissue antibodies extracted and characterized using GluN1-expressing human embryonic kidney cells
Note: Confirmation of antibodies against NMDAR
“after acid extraction and characterization with GluN1-expressing human embryonic kidney cells were confirmed to be against the NMDAR”
Mice underwent placement of ventricular catheters connected to osmotic pumps