Publications by authors named "Zekeridou A"
Defining the CSF cytokine/chemokine and injury biomarker signature of glial fibrillary acidic protein (GFAP) autoimmunity can inform immunopathogenesis. CSF GFAP-IgG-positive samples (N = 98) were tested for 17 cytokines/chemokines, neurofilament light chain (NfL), and GFAP (ELLA, Bio-Techne). Controls included non-inflammatory (N = 42), AQP4-IgG-positive (N = 83), CNS infections (N = 13), and neurosarcoidosis (N = 32).
View Article and Find Full Text PDFAutoimmune encephalitis: recovery, residual symptoms and predictors of long-term sequelae.
J Neurol Neurosurg Psychiatry
January 2025
Background: Data regarding long-term recovery from autoimmune encephalitis (AE) remain limited.
Methods: This retrospective observational study investigated outcomes in 182 patients who met the 2016 criteria for definite AE. Recovery data were available in 172 patients.
Objectives: To report myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) epidemiology in two American regions using 2023 diagnostic criteria.
Patients And Methods: We compared age- and sex-adjusted incidence and prevalence of MOGAD per 2023 diagnostic criteria in Olmsted County (Minnesota [USA]) and Martinique (Caribbean [FR]) (01/01/2003-12/31/2018, prevalence day) using Poisson regression. Archived sera in 68-85% were available for MOG-IgG testing by live cell-based assay at Mayo Clinic.
Objective: We describe neurologic phenotype, clinical associations, and outcomes in autoimmune brainstem encephalitis.
Methods: Medical records of neural-IgG positive autoimmune brainstem encephalitis patients diagnosed at Mayo Clinic (January 1, 2006-December 31, 2022) were reviewed.
Results: Ninety-eight patients (57 male) were included.
Introduction: Paraneoplastic neurological syndromes (PNS) can worsen with immune checkpoint inhibitor (ICI) cancer immunotherapy.
Case Report: A 66-year-old female with paraneoplastic Lambert-Eaton Myasthenic Syndrome (LEMS), which led to the diagnosis of metastatic neuroendocrine carcinoma, was treated with intravenous immune globulin (IVIg) (with minimal response), chemotherapy, and radiation, resulting in neurological improvement. However, sclerodermatous changes developed after a year.
Objective: To describe the phenotypes, oncological associations, biomarker profiles, and outcomes across different age groups in patients with ANNA1 (anti-Hu) autoimmunity.
Methods: A retrospective review of patients with ANNA1-IgG in serum/CSF between January 1, 2001, and December 31,2019 was performed. Patients were classified into three groups based on the age of symptom onset.
Objective: This study aimed to evaluate the diagnostic accuracy of dried blood spot (DBS) compared with conventional serum Aquaporin-4-IgG (AQP4-IgG) testing.
Methods: Prospective multicenter diagnostic study was conducted between April 2018 and October 2023 across medical centers in the United States, Uganda, and the Republic of Guinea. Neuromyelitis optica spectrum disorder (NMOSD) patients and controls collected blood on filter paper cards along with concurrent serum samples.
Article Synopsis
- * Methods: Researchers conducted a retrospective review of 45 adult patients seen between 2006 and 2020, all following specific diagnostic criteria and monitored for at least a year, examining various clinical and diagnostic factors.
- * Results: Most patients had significant disabilities at the start, but a high percentage showed improvement with treatment; however, many experienced lingering memory issues and other cognitive challenges, indicating varying degrees of long-term impact despite initial recovery efforts.
Comprehensive Analysis of Paraneoplastic Neurologic Syndrome and PNS-CARE Diagnostic Criteria in Clinical Practice.
Neurol Neuroimmunol Neuroinflamm
December 2024
Article Synopsis
- The 2021 PNS-CARE score, an updated diagnostic tool for Paraneoplastic Neurologic Syndrome (PNS), was assessed for its effectiveness and application in a cohort of patients at the Mayo Clinic.
- A retrospective study involving 484 patients suspected of having PNS found that 212 were confirmed to have the syndrome, with common autoantibodies including PCA1, KLHL11, and CRMP5.
- The newer criteria showed high sensitivity and specificity (93% and 100% respectively), outperforming the previous criteria from 2004, which had lower sensitivity (67%) but similar specificity (99%).
Background And Objective: Despite constituting one-third of suspected autoimmune encephalitis (AE) patients, antibody-negative cases without typical AE features are understudied. We aim to characterize the clinical phenotypes and long-term outcomes of "possible only" and "probable" AE cases.
Methods: We conducted a retrospective analysis of adult patients evaluated at Mayo Clinic's Autoimmune Neurology Clinic (01/01/2006-12/31/2020), meeting diagnostic criteria for "possible only" or "probable but antibody-negative" AE, with ≥ 1 year of follow-up.
Article Synopsis
- Up to 46% of patients with suspected autoimmune limbic encephalitis don’t test positive for known central nervous system antibodies, prompting the development of a new cell-based assay (CBA) for detecting novel neural antibodies using human-induced pluripotent stem cells (hiPSCs).
- The study involved testing serum and cerebrospinal fluid from 99 patients with inflammatory and non-inflammatory neurological diseases to identify IgG binding to hiPSC-derived neurons and astrocytes using advanced fluorescence techniques.
- The CBA successfully detected neural-specific antibodies in 19 out of 99 patients, with a higher prevalence in those with inflammatory neurological diseases compared to non-inflammatory cases, underscoring its potential in identifying previously unknown autoantibodies.
Article Synopsis
- Peripheral neuropathy in patients with excessive alcohol consumption is frequently misdiagnosed due to the lack of clear biomarkers and underlying biases against those with alcohol use disorder (AUD).
- Various mechanisms, including nutrient deficiencies and oxidative stress, contribute to alcohol-related nerve toxicity, but symptoms often resemble those of chronic idiopathic neuropathy, complicating diagnosis.
- The stigma surrounding AUD can harm patient care, as biases in healthcare may lead to inadequate treatment and social isolation, highlighting the need for increased awareness and better clinical practices.
Objective: This article reviews the clinical presentations, neural antibody associations, and oncologic accompaniments of paraneoplastic neurologic syndromes and neurologic autoimmunity in the context of immune checkpoint inhibitor (ICI) cancer immunotherapy.
Latest Developments: Neural antibody discovery has improved the diagnosis of paraneoplastic neurologic syndromes. Neural antibodies also delineate the underlying disease pathophysiology and thus inform outcomes and treatments.
Objective: To evaluate the cerebrospinal fluid (CSF) cytokine/chemokine profile of central nervous system (CNS) neurosarcoidosis (NS), and its utility in differential diagnosis, treatment, and prognostication.
Methods: In this case-control study, we validated 17 cytokines/chemokines (interleukin [IL]-1-beta, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p70, IL-13, IL-17A, BAFF, IL-8/CXCL8, CXCL9, CXCL10, CXCL13, GM-CSF, interferon-gamma, and tumor necrosis factor [TNF]-alpha) in a multiplexed automated immunoassay system (ELLA; Bio-Techne, Minneapolis, MN, USA), and assessed them in CSF and serum of symptomatic patients with probable or definite CNS NS (01/2011-02/2023) with gadolinium enhancement and/or CSF pleocytosis. Patients with multiple sclerosis, primary CNS lymphoma, aquaporin-4 immunoglobulin G positivity, non-inflammatory disorders, and healthy individuals were used as controls.
Diabetes mellitus (DM) poses a significant challenge to global health, with its prevalence projected to rise dramatically by 2045. This narrative review explores the bidirectional relationship between periodontitis (PD) and type 1 diabetes mellitus (T1DM), focusing on cellular and molecular mechanisms derived from the interplay between oral microbiota and the host immune response. A comprehensive search of studies published between 2008 and 2023 was conducted to elucidate the association between these two diseases.
View Article and Find Full Text PDFObjectives: To study the frequency, causes, and consequences of seizure-related falls and near falls in LGI1-IgG autoimmune encephalitis.
Methods: We retrospectively reviewed 136 patients seen at Mayo Clinic with (1) LGI1-IgG seropositivity, (2) clinical phenotypes compatible with LGI1-IgG autoimmune encephalitis, and (3) falls or near falls related to seizures. The clinical documentation, MRI, and EEG data were collected and reviewed.
In patients with advanced periodontal disease, pathological tooth migration may occur, which may require subsequent orthodontic treatment for both aesthetic and functional purposes. When planning orthodontic treatment mechanics, intrusive or extrusive forces are frequently indicated. Understanding tissue reactions during these movements is essential for clinicians when devising a comprehensive orthodontic-periodontal treatment plan.
View Article and Find Full Text PDFArticle Synopsis
- MOGAD is a rare autoimmune disease linked to demyelination, and this case study focuses on a patient who also had metastatic melanoma.
- The patient, a 52-year-old man, showed high levels of MOG-IgG and had significant MRI findings, which indicated inflammation and demyelination, but no MOG presence in the tumor tissue itself.
- Treatment involved several approaches including steroids and immunotherapy for both MOGAD and melanoma, with tocilizumab ultimately leading to a strong and lasting improvement in his condition, highlighting its potential as a dual treatment option.
Objectives: To report an autoimmune paraneoplastic encephalitis characterized by immunoglobulin G (IgG) antibody targeting synaptic protein calmodulin kinase-like vesicle-associated (CAMKV).
Methods: Serum and cerebrospinal fluid (CSF) samples harboring unclassified antibodies on murine brain-based indirect immunofluorescence assay (IFA) were screened by human protein microarray. In 5 patients with identical cerebral IFA staining, CAMKV was identified as top-ranking candidate antigen.
Article Synopsis
- The study investigates the effectiveness of testing cerebrospinal fluid (CSF) for myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) to help diagnose certain neurological conditions, specifically MOG antibody-associated disease (MOGAD).
- Researchers analyzed data from multiple patients over 27 years, highlighting the sensitivity (90%) and specificity (98%) of the testing method used.
- Results show that CSF MOG-IgG testing is beneficial, especially for patients with negative serum tests or low positive serum MOG-IgG, suggesting it should be used in the right clinical situations for accurate diagnosis.
Purpose Of Review: The increasing recognition and diagnosis of autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS) is partly due to neural autoantibody testing and discovery. The past two decades witnessed an exponential growth in the number of identified neural antibodies. This review aims to summarize recent rare antibody discoveries in the context of central nervous system (CNS) autoimmunity and evaluate the ongoing debate about their utility.
View Article and Find Full Text PDFNeurologic manifestations of autoimmunity with immune checkpoint inhibitors.
Handb Clin Neurol
March 2024
Immune checkpoint inhibitors (ICIs) are cancer immunotherapies that enhance the body's own immune system to treat cancer. ICI treatment, however, can cause immune-related adverse events (irAEs) that can affect any organ, resulting in significant morbidity and mortality. Neurologic irAEs (nirAEs) are rare and can affect the peripheral nervous system more commonly than the central nervous system.
View Article and Find Full Text PDFImmune Checkpoint Inhibitor-Associated Kelch-Like Protein-11 IgG Brainstem Encephalitis.
Neurol Neuroimmunol Neuroinflamm
May 2024
Article Synopsis
- KLHL11-IgG has been linked to rhombencephalitis and seminoma, but its role as a neurologic immune checkpoint inhibitor-related adverse event for esophageal adenocarcinoma had not been previously identified.
- A 61-year-old man with metastatic esophageal adenocarcinoma developed severe neurological symptoms after undergoing treatment that included nivolumab.
- The patient's diagnosis of KLHL11-IgG rhombencephalitis as a novel adverse event was confirmed through various tests, leading to a change in his treatment plan to prevent further neurological decline.