Absence of autoreactive CD4 T-cells targeting HLA-DQA1*01:02/DQB1*06:02 restricted hypocretin/orexin epitopes in narcolepsy type 1 when detected by EliSpot.

Narcolepsy type 1, a neurological sleep disorder strongly associated with Human Leukocyte Antigen (HLA-)DQB106:02, is caused by the loss of hypothalamic neurons producing the wake-promoting neuropeptide hypocretin (hcrt, also known as orexin). This loss is believed to be caused by an autoimmune reaction. To test whether hcrt itself could be a possible target in the autoimmune attack, CD4 T-cell reactivity towards six different 15-mer peptides from prepro-hypocretin with high predicted affinity to the DQA101:02/DQB106:02 MHC class II dimer was tested using EliSpot in a cohort of 22 narcolepsy patients with low CSF hcrt levels, and 23 DQB106:02 positive healthy controls. Our ELISpot assay had a detection limit of 1:10,000 cells. We present data showing that autoreactive CD4 T-cells targeting epitopes from the hcrt precursor in the context of MHC-DQA101:02/DQB106:02 are either not present or present in a frequency is <1:10,000 among peripheral CD4 T-cells from narcolepsy type 1 patients.