@phdthesis{Rauschenberger2021,
  author    = {Rauschenberger, Vera},
  title     = {Stiff-person syndrome - Pathophysiological mechanisms of glycine receptor autoantibodies},
  doi       = {10.25972/OPUS-20958},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-209588},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {The Stiff-person syndrome (SPS) is a rare autoimmune disease that is characterized by symptoms including stiffness in axial and limb muscles as well as painful spasms. Different variants of SPS are known ranging from moderate forms like the stiff-limb syndrome to the most severe form progressive encephalomyelitis with rigidity and myoclonus (PERM). SPS is elicited by autoantibodies that target different pre- or postsynaptic proteins. The focus of the present work is on autoantibodies against the glycine receptor (GlyR). At start of the present thesis, as main characteristic of the GlyR autoantibody pathology, receptor cross-linking followed by enhanced receptor internalization and degradation via the lysosomal pathway was described. If binding of autoantibodies modulates GlyR function and therefore contributes to the GlyR autoantibody pathology has not yet been investigated. Moreover, not all patients respond well to plasmapheresis or other treatments used in the clinic. Relapses with even higher autoantibody titers regularly occur. In the present work, further insights into the disease pathology of GlyRα autoantibodies were achieved. We identified a common GlyRα1 autoantibody epitope located in the far N-terminus including amino acids A1-G34 which at least represent a part of the autoantibody epitope. This part of the receptor is easily accessible for autoantibodies due to its location at the outermost surface of the GlyRα1 extracellular domain. It was further investigated if the glycosylation status of the GlyR interferes with autoantibody binding. Using a GlyRα1 de-glycosylation mutant exhibited that patient autoantibodies are able to detect the de-glycosylated GlyRα1 variant as well. The direct modulation of the GlyR analyzed by electrophysiological recordings demonstrated functional alterations of the GlyR upon autoantibody binding. Whole cell patch clamp recordings revealed that autoantibodies decreased the glycine potency, shown by increased EC50 values. Furthermore, an influence on the desensitization behavior of the receptor was shown. The GlyR autoantibodies, however, had no impact on the binding affinity of glycine. These issues can be explained by the localization of the GlyR autoantibody epitope. The determined epitope has been exhibited to influence GlyR desensitization upon binding of allosteric modulators and differs from the orthosteric binding site for glycine, which is localized much deeper in the structure at the interface between two adjacent subunits. To neutralize GlyR autoantibodies, two different methods have been carried out. Transfected HEK293 cells expressing GlyRα1 and ELISA plates coated with the GlyRα1 extracellular domain were used to efficiently neutralize the autoantibodies. Finally, the successful passive transfer of GlyRα1 autoantibodies into zebrafish larvae and mice was shown. The autoantibodies detected their target in spinal cord and brain regions rich in GlyRs of zebrafish and mice. A passive transfer of human GlyRα autoantibodies to zebrafish larvae generated an impaired escape behavior in the animals compatible with the abnormal startle response in SPS or PERM patients.},
  subject      = {Glycinrezeptor},
  language  = {en}
}
@phdthesis{Gruener2023,
  author    = {Gr{\"u}ner, Julia},
  title     = {Pathogenesis of anti-paranodal autoantibodies in peripheral neuropathies},
  doi       = {10.25972/OPUS-24865},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-248655},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2023},
  abstract  = {Autoantibodies against proteins of the node of Ranvier have been identified in a subset of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Main antigens targeted by autoantibodies are the paranodal proteins contactin 1 (CNTN1), neurofascin (NF) 155 or contactin associated protein (Caspr) as well as the nodal NF186. Several studies investigated the role of anti-paranodal autoantibodies in the pathophysiology of CIDP leading to the current knowledge that immunoglobulin G (IgG)4 deposition leads to detachment of myelin from the axon at the paranodes. However, many questions remain unsolved. Thus, autoantibodies against NF155 have been well studied and their pathogenicity has been proven in an animal model in vivo. However, in some patients, autoantibodies against all isoforms of NF are detectable. These anti-pan-NF autoantibodies occur more rarely and lead to a very severe clinical phenotype. As the pathogenesis of patient-derived autoantibodies against pan-NF has never been investigated in vivo before, we used an animal model to study the effect of acute exposure to anti-pan-NF IgG3 by intraneural injections to the rat sciatic nerve. In addition, we used anti-NF155 IgG4 from a seropositive patient. Behavioral testings as well as nerve conduction studies did not re- veal any deficits after injected neither for anti-NF155 nor for anti-pan-NF autoantibodies. This leads to the suspicion that the disease is more likely induced by a chronic process. A common symptom in patients with anti-CNTN1 associated neuropathy is sensory ataxia and therefore, an involvement of dorsal root ganglia (DRGs) is hypothesized. We show that sera from anti-CNTN1 positive patients specifically bind to DRG neurons in vitro and reduce surface expression of CNTN1. This is most probably due to internalization mediated by coexisting IgG3 although IgG4 is the predominant subclass of autoantibodies. As it is known that CNTN1 interacts with the β1 subunit of specific sodium channels we analyzed channel expression and sodium currents of DRG neurons after incubation with anti-CNTN1 positive patients' sera. We identified reduced sodium currents after long-term treatment with patients' material although surface channel expression remained stable. We therefore concluded that CNTN1 might influence channel properties indirectly through auxiliary β1 subunits. Moreover, we suggest an involvement of DRG neurons in the pathogenesis of anti-CNTN1 associated CIDP as medium-large size neurons are more affected than small neurons. However, the exact mechanism of how anti-CNTN1 autoantibodies influence sodium channels should be subject of further studies. Furthermore, preliminary results indicate that the epitope for anti-CNTN1 autoantibodies from seropositive patients might be associated with distinct clinical features. We could show that autoantibodies might be either directed against a conformational epitope as binding is prevented after deletion of the first immunoglobulin (Ig) domain of CNTN1 or against the fibronectin type III (FnIII) domains. Strikingly, both patients with FnIII do- main specificity had very high titers of anti-CNTN1 autoantibodies and a chronic disease progression, whereas patients binding to a conformational epitope or to the Ig domains are related to a relapsing-remitting or even monophasic disease course. However, these results need to be further confirmed before a clear statement can be made. In conclusion, the present study contributes to elucidate the pathogenesis of peripheral neuropathies associated with anti-paranodal autoantibodies. However, further studies are required including a higher number of patients as well as considering effects on structures like DRGs besides the node of Ranvier to fully understand the disease mechanisms.},
  subject      = {Autoantik{\"o}rper},
  language  = {en}
}