Metabotropic glutamate receptor type 1 autoimmunity

A. Sebastian Lopez-Chiriboga, Lars Komorowski, Tania Kümpfel, Christian Probst, Shannon R. Hinson, Sean J Pittock, Andrew B McKeon

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Objective: To describe retrospectively the clinical associations of immunoglobulin G (IgG) targeting metabotropic glutamate receptor 1 (mGluR1-IgG). Methods: Specimens of 9 patients evaluated on a service basis in the Mayo Clinic Neuroimmunology Laboratory by tissue-based immunofluorescence assay (IFA) yielded a robust, synaptic immunostaining pattern consistent with mGluR1-IgG (serum, 9; CSF, 2 available). Transfected HEK293 cell-based assay (CBA) confirmed mGluR1 specificity in all 11 specimens. A further 2 patients were detected in Germany primarily by CBA. Results: The median symptom onset age for the 11 patients was 58 years (range 33-81 years); 6 were male. All 9 Mayo Clinic patients had subacute onset of cerebellar ataxia, 4 had dysgeusia, 1 had psychiatric symptoms, and 1 had cognitive impairment. All were evaluated for malignancy, but only 1 was affected (cutaneous T-cell lymphoma). One developed ataxia post-herpes zoster infection. Head MRIs were generally atrophic or normal-appearing, and CSF was inflammatory in just 1 of 5 tested, though mGluR1-IgG was detected in both specimens submitted. Five patients improved (attributable to immunotherapy in 4, spontaneously in 1), 3 stabilized (attributable to immunotherapy in 2, cancer therapy in 1), and 1 progressively declined (untreated). The 2 German patients had ataxia, but fulfilled multiple sclerosis diagnostic criteria (1 relapsing-remitting, 1 progressive). However, both had histories of hematologic malignancy (acute lymphocytic leukemia and mantle cell lymphoma), and had mGluR1-IgG detected in serum by CBA (weakly positive on tissue-based IFA). Conclusions: mGluR1 autoimmunity represents a treatable form of cerebellar ataxia. Dysgeusia may be a diagnostic clue. Paraneoplastic, parainfectious, or idiopathic causes may occur.

Original languageEnglish (US)
Pages (from-to)1009-1013
Number of pages5
JournalNeurology
Volume86
Issue number11
DOIs
StatePublished - Mar 15 2016

ASJC Scopus subject areas

  • Clinical Neurology

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    Lopez-Chiriboga, A. S., Komorowski, L., Kümpfel, T., Probst, C., Hinson, S. R., Pittock, S. J., & McKeon, A. B. (2016). Metabotropic glutamate receptor type 1 autoimmunity. Neurology, 86(11), 1009-1013. https://doi.org/10.1212/WNL.0000000000002476