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 aggressive behaviors using resident-intruder 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 infusion
Note: Catheters connected to osmotic pumps delivering either patients' or control cerebrospinal fluid
“C57BL6/J mice underwent placement of ventricular catheters connected to osmotic pumps that delivered a continuous infusion of patients' or control cerebrospinal fluid”
Osmotic pumps deliver continuous infusion of cerebrospinal fluid into mouse brain
Note: Flow rate maintained at 0.25 µl/h throughout infusion period
“osmotic pumps that delivered a continuous infusion of patients' or control cerebrospinal fluid (flow rate 0.25 µl/h, 14 days)”
Standardized behavioral test applied during and after infusion period to assess aggressiveness in mice
Note: Test conducted as part of comprehensive behavioral assessment battery
“During and after the infusion period standardized tests were applied, including tasks to assess aggressiveness (resident-intruder test)”
Standardized tests applied during and after infusion period including novel object recognition, sucrose preference, tail suspension, forced swimming, anxiety tests, and locomotor activity assessment
Note: Tests assess memory, anhedonic behaviors, depressive-like behaviors, anxiety, and locomotor activity
“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 specified timepoints for brain tissue analysis
Note: Sacrifice timepoints: 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 tissue for brain-bound antibodies and antibody effects on total and synaptic NMDAR clusters
Note: Analysis focused on hippocampus and effects on NMDAR clusters and protein concentration
“examined for brain-bound antibodies and the antibody effects on total and synaptic NMDAR clusters and protein concentration using confocal microscopy”
Biochemical analysis of brain tissue to assess NMDAR protein concentration and related proteins
Note: Analysis of 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 antibodies extracted and characterized using GluN1-expressing human embryonic kidney cells to confirm NMDAR specificity
Note: Confirms antibodies are directed against NMDAR
“after acid extraction and characterization with GluN1-expressing human embryonic kidney cells were confirmed to be against the NMDAR”
Underwent placement of ventricular catheters connected to osmotic pumps