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 memory function using novel object recognition in an open field paradigm to evaluate cognitive deficits induced by anti-NMDAR antibodies
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C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps for continuous CSF infusion
Note: Catheters connected to osmotic pumps for continuous infusion
“C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps”
Osmotic pumps delivered continuous infusion of patients' or control cerebrospinal fluid into the 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 memory assessment task performed during and after the infusion period using novel object recognition in an open field paradigm
Note: Conducted during and after the 14-day infusion period
“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)”
Alternative memory assessment task performed during and after the infusion period using V-maze paradigm
Note: Conducted during and after the 14-day infusion period
“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)”
Standardized test to assess anhedonic behaviors during and after infusion period
Note: Measures anhedonia (loss of pleasure-seeking behavior)
“standardized tests were applied, including tasks to assess memory (novel object recognition in open field and V-maze paradigms), anhedonic behaviours (sucrose preference test)”
Standardized test to assess depressive-like behaviors during and after infusion period
Note: Measures depressive-like phenotype
“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 to assess depressive-like behaviors during and after infusion period
Note: Measures depressive-like phenotype
“depressive-like behaviours (tail suspension, forced swimming tests)”
Standardized test to assess anxiety-like behaviors during and after infusion period
Note: Measures anxiety phenotype
“anxiety (black and white, elevated plus maze tests)”
Standardized test to assess anxiety-like behaviors during and after infusion period
Note: Measures anxiety phenotype
“anxiety (black and white, elevated plus maze tests)”
Standardized test to assess aggressiveness during and after infusion period
Note: Measures aggressive behavior
“aggressiveness (resident-intruder test)”
Measurement of horizontal and vertical locomotor activity during and after infusion period
Note: Assesses general motor function and activity levels
“locomotor activity (horizontal and vertical)”
Animals sacrificed at designated timepoints for brain tissue analysis
Note: Sacrifice timepoints: Days 5, 13, 18, 26, and 46
“Animals sacrificed at Days 5, 13, 18, 26 and 46 were examined for brain-bound antibodies”
Analysis of brain tissue for presence and localization of brain-bound human antibodies
Note: Predominantly examined in hippocampus; maximal on Days 13-18
“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”
Examination of NMDAR clusters and protein concentration in hippocampal tissue using confocal microscopy
Note: Assessed total and synaptic NMDAR clusters; also examined PSD95 and AMPA receptors
“examined for brain-bound antibodies and the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy and immunoblot analysis”
Biochemical analysis of NMDAR protein concentration and other synaptic proteins in hippocampal tissue
Note: Measured total NMDAR protein concentration, PSD95, and AMPA receptors
“examined for brain-bound antibodies and the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy and immunoblot analysis”
Brain tissue subjected to acid extraction followed by characterization of antibodies using GluN1-expressing human embryonic kidney cells
Note: Confirmed antibodies were against NMDAR
“after acid extraction and characterization with GluN1-expressing human embryonic kidney cells were confirmed to be against the NMDAR”
Animals underwent placement of ventricular catheters connected to osmotic pumps
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