Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA; Department of Cellular and Molecular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA; Kent State University School of Biomedical Sciences, Kent, OH, USA.
Neurobiol Dis. 2013 Nov;59:206-19. doi: 10.1016/j.nbd.2013.07.006. Epub 2013 Jul 21.
There are overwhelming data supporting the inflammatory origin of some epilepsies (e.g., Rasmussen's encephalitis and limbic encephalitis). Inflammatory epilepsies with an autoimmune component are characterized by autoantibodies against membrane-bound, intracellular or secreted proteins (e.g., voltage gated potassium channels). Comparably, little is known regarding autoantibodies targeting nuclear antigen. We tested the hypothesis that in addition to known epilepsy-related autoantigens, the human brain tissue and serum from patients with epilepsy contain autoantibodies recognizing nuclear targets. We also determined the specific nuclear proteins acting as autoantigen in patients with epilepsy. Brain tissue samples were obtained from patients undergoing brain resections to treat refractory seizures, from the brain with arteriovenous malformations or from post-mortem multiple sclerosis brain. Patients with epilepsy had no known history of autoimmune disease and were not diagnosed with autoimmune epilepsy. Tissue was processed for immunohistochemical staining. We also obtained subcellular fractions to extract intracellular IgGs. After separating nuclear antibody-antigen complexes, the purified autoantigen was analyzed by mass spectrometry. Western blots using autoantigen or total histones were probed to detect the presence of antinuclear antibodies in the serum of patients with epilepsy. Additionally, HEp-2 assays and antinuclear antibody ELISA were used to detect the staining pattern and specific presence of antinuclear antibodies in the serum of patients with epilepsy. Brain regions from patients with epilepsy characterized by blood-brain barrier disruption (visualized by extravasated albumin) contained extravasated IgGs. Intracellular antibodies were found in epilepsy (n=13/13) but not in multiple sclerosis brain (n=4/4). In the brain from patients with epilepsy, neurons displayed higher levels of nuclear IgGs compared to glia. IgG colocalized with extravasated albumin. All subcellular fractions from brain resections of patients with epilepsy contained extravasated IgGs (n=10/10), but epileptogenic cortex, where seizures originated from, displayed the highest levels of chromatin-bound IgGs. In the nuclear IgG pool, anti-histone autoantibodies were identified by two independent immunodetection methods. HEp-2 assay and ELISA confirmed the presence of anti-histone (n=5/8) and anti-chromatin antibodies in the serum from patients with epilepsy. We developed a multi-step approach to unmask autoantigens in the brain and sera of patients with epilepsy. This approach revealed antigen-bound antinuclear antibodies in neurons and free antinuclear IgGs in the serum of patients with epilepsy. Conditions with blood-brain barrier disruption but not seizures, were characterized by extravasated but not chromatin-bound IgGs. Our results show that the pool of intracellular IgG in the brain of patients with epilepsy consists of nucleus-specific autoantibodies targeting chromatin and histones. Seizures may be the trigger of neuronal uptake of antinuclear antibodies.
有大量数据支持某些癫痫是炎症起源的(例如,Rasmussen 脑炎和边缘性脑炎)。具有自身免疫成分的炎症性癫痫的特征是针对膜结合、细胞内或分泌蛋白的自身抗体(例如,电压门控钾通道)。相比之下,针对核抗原的自身抗体知之甚少。我们检验了以下假设:除了已知的与癫痫相关的自身抗原外,癫痫患者的脑组织和血清中还含有识别核靶标的自身抗体。我们还确定了癫痫患者中作为自身抗原的特定核蛋白。从接受脑切除术以治疗难治性癫痫发作的患者、动静脉畸形的大脑或多发性硬化症的死后大脑中获得脑组织样本。癫痫患者没有自身免疫性疾病的已知病史,也没有被诊断为自身免疫性癫痫。对组织进行免疫组织化学染色处理。我们还获得了亚细胞级分以提取细胞内 IgG。分离核抗体-抗原复合物后,通过质谱分析纯化自身抗原。使用自身抗原或总组蛋白进行 Western blot 检测以检测癫痫患者血清中的抗核抗体。此外,使用 HEp-2 测定和抗核抗体 ELISA 检测癫痫患者血清中的染色模式和特异性抗核抗体。在具有血脑屏障破坏的癫痫患者的大脑区域(通过漏出的白蛋白显示)中存在漏出的 IgG。在癫痫患者中发现了细胞内抗体(n=13/13),但在多发性硬化症患者的大脑中未发现(n=4/4)。在癫痫患者的大脑中,神经元的核内 IgG 水平高于神经胶质。IgG 与漏出的白蛋白共定位。癫痫患者的所有脑切除亚细胞级分均含有漏出的 IgG(n=10/10),但起源于癫痫发作的致痫皮质显示出最高水平的染色质结合 IgG。在核 IgG 池中,通过两种独立的免疫检测方法鉴定出抗组蛋白自身抗体。HEp-2 测定和 ELISA 证实癫痫患者血清中存在抗组蛋白(n=5/8)和抗染色质抗体。我们开发了一种多步骤方法来揭示癫痫患者大脑和血清中的自身抗原。该方法在癫痫患者的神经元中显示了抗原结合的抗核抗体,在血清中显示了游离的抗核 IgG。具有血脑屏障破坏而不是癫痫发作的情况的特征是漏出但不是染色质结合的 IgG。我们的结果表明,癫痫患者大脑中的细胞内 IgG 池由针对染色质和组蛋白的核特异性自身抗体组成。癫痫发作可能是神经元摄取抗核抗体的触发因素。