Expression of Various Glutamate Receptors Including N-Methyl-D-Aspartate Receptor (NMDAR) in an Ovarian Teratoma Removed from a Young Woman with Anti-NMDAR Encephalitis
A 21-year-old woman developed psychiatric symptoms, progressive unresponsiveness, generalized seizures, severe dyskinesia, marked fluctuation of blood pressure, and hypersalivation after a flu-like episode. Anti-glutamate receptor (GluR)ε2 and anti-N-methyl-D-aspartate receptor (NMDAR) antibodies we...
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| Veröffentlicht in: | Internal Medicine 2010, Vol.49(19), pp.2167-2173 |
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| creator | Tachibana, Naoko Shirakawa, Takashi Ishii, Keiko Takahashi, Yukitoshi Tanaka, Keiko Arima, Kunimasa Yoshida, Takuhiro Ikeda, Shu-ichi |
| description | A 21-year-old woman developed psychiatric symptoms, progressive unresponsiveness, generalized seizures, severe dyskinesia, marked fluctuation of blood pressure, and hypersalivation after a flu-like episode. Anti-glutamate receptor (GluR)ε2 and anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were positive in both her serum and CSF. After she recovered five months later she underwent surgery to remove a right ovarian teratoma. Immunohistochemical examinations of her teratoma disclosed abundant expression of various GluRs including NR2B subunit of NMDAR, GluR1, and GluR2/3. These immunoreactivities of GluRs were seen not only in small areas of neural tissue identified as anti-glial fibrillary acidic protein (GFAP)-immunoreactive areas but also in other large areas of undifferentiated neuroepithelial tissue without GFAP immunoreactivity. Our findings strongly support the recent idea that neural elements in ovarian teratoma play an important role in the production of antibodies to NMDARs in anti-NMDAR encephalitis. Additionally, the study of control ovaries clearly showed NR2B-related immunoreactivity in the cytoplasm of oocytes, indicating that the normal ovary itself has expression of NMDARs. This finding might provide a clue to understand the pathogenesis of this disease in female patients without ovarian teratoma. |
| doi_str_mv | 10.2169/internalmedicine.49.4069 |
| format | Article |
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Anti-glutamate receptor (GluR)ε2 and anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were positive in both her serum and CSF. After she recovered five months later she underwent surgery to remove a right ovarian teratoma. Immunohistochemical examinations of her teratoma disclosed abundant expression of various GluRs including NR2B subunit of NMDAR, GluR1, and GluR2/3. These immunoreactivities of GluRs were seen not only in small areas of neural tissue identified as anti-glial fibrillary acidic protein (GFAP)-immunoreactive areas but also in other large areas of undifferentiated neuroepithelial tissue without GFAP immunoreactivity. Our findings strongly support the recent idea that neural elements in ovarian teratoma play an important role in the production of antibodies to NMDARs in anti-NMDAR encephalitis. Additionally, the study of control ovaries clearly showed NR2B-related immunoreactivity in the cytoplasm of oocytes, indicating that the normal ovary itself has expression of NMDARs. This finding might provide a clue to understand the pathogenesis of this disease in female patients without ovarian teratoma.</description><identifier>ISSN: 0918-2918</identifier><identifier>ISSN: 1349-7235</identifier><identifier>EISSN: 1349-7235</identifier><identifier>DOI: 10.2169/internalmedicine.49.4069</identifier><identifier>PMID: 20930449</identifier><language>eng</language><publisher>Japan: The Japanese Society of Internal Medicine</publisher><subject>alpha -Amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors ; Antibodies ; Autoantibodies - blood ; Autoantibodies - cerebrospinal fluid ; Blood pressure ; Cerebrospinal fluid ; Cytoplasm ; Dyskinesia ; Encephalitis ; Female ; Glial fibrillary acidic protein ; glutamate receptor ; Glutamic acid receptors ; Glutamic acid receptors (ionotropic) ; Humans ; Immunohistochemistry ; Immunoreactivity ; limbic encephalitis ; N-methyl-D-aspartate receptor (NMDAR) ; N-Methyl-D-aspartic acid receptors ; Oocytes ; Ovarian Neoplasms - complications ; Ovarian Neoplasms - immunology ; Ovarian Neoplasms - metabolism ; Ovarian Neoplasms - pathology ; ovarian teratoma ; Ovaries ; paraneoplastic syndrome ; Paraneoplastic Syndromes, Nervous System - etiology ; Paraneoplastic Syndromes, Nervous System - immunology ; Paraneoplastic Syndromes, Nervous System - metabolism ; Receptors, AMPA - immunology ; Receptors, AMPA - metabolism ; Receptors, Glutamate - immunology ; Receptors, Glutamate - metabolism ; Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors ; Receptors, N-Methyl-D-Aspartate - immunology ; Receptors, N-Methyl-D-Aspartate - metabolism ; Seizures ; Surgery ; teratoma ; Teratoma - complications ; Teratoma - immunology ; Teratoma - metabolism ; Teratoma - pathology ; Young Adult</subject><ispartof>Internal Medicine, 2010, Vol.49(19), pp.2167-2173</ispartof><rights>2010 by The Japanese Society of Internal Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c603t-498cc7beb2d635b68078a9b40369d04e691ffbe576dd0a724b3b19e4a5df5b3c3</citedby><cites>FETCH-LOGICAL-c603t-498cc7beb2d635b68078a9b40369d04e691ffbe576dd0a724b3b19e4a5df5b3c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20930449$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tachibana, Naoko</creatorcontrib><creatorcontrib>Shirakawa, Takashi</creatorcontrib><creatorcontrib>Ishii, Keiko</creatorcontrib><creatorcontrib>Takahashi, Yukitoshi</creatorcontrib><creatorcontrib>Tanaka, Keiko</creatorcontrib><creatorcontrib>Arima, Kunimasa</creatorcontrib><creatorcontrib>Yoshida, Takuhiro</creatorcontrib><creatorcontrib>Ikeda, Shu-ichi</creatorcontrib><title>Expression of Various Glutamate Receptors Including N-Methyl-D-Aspartate Receptor (NMDAR) in an Ovarian Teratoma Removed from a Young Woman with Anti-NMDAR Encephalitis</title><title>Internal Medicine</title><addtitle>Intern. Med.</addtitle><description>A 21-year-old woman developed psychiatric symptoms, progressive unresponsiveness, generalized seizures, severe dyskinesia, marked fluctuation of blood pressure, and hypersalivation after a flu-like episode. Anti-glutamate receptor (GluR)ε2 and anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were positive in both her serum and CSF. After she recovered five months later she underwent surgery to remove a right ovarian teratoma. Immunohistochemical examinations of her teratoma disclosed abundant expression of various GluRs including NR2B subunit of NMDAR, GluR1, and GluR2/3. These immunoreactivities of GluRs were seen not only in small areas of neural tissue identified as anti-glial fibrillary acidic protein (GFAP)-immunoreactive areas but also in other large areas of undifferentiated neuroepithelial tissue without GFAP immunoreactivity. Our findings strongly support the recent idea that neural elements in ovarian teratoma play an important role in the production of antibodies to NMDARs in anti-NMDAR encephalitis. Additionally, the study of control ovaries clearly showed NR2B-related immunoreactivity in the cytoplasm of oocytes, indicating that the normal ovary itself has expression of NMDARs. 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Med.</addtitle><date>2010-01-01</date><risdate>2010</risdate><volume>49</volume><issue>19</issue><spage>2167</spage><epage>2173</epage><pages>2167-2173</pages><issn>0918-2918</issn><issn>1349-7235</issn><eissn>1349-7235</eissn><abstract>A 21-year-old woman developed psychiatric symptoms, progressive unresponsiveness, generalized seizures, severe dyskinesia, marked fluctuation of blood pressure, and hypersalivation after a flu-like episode. Anti-glutamate receptor (GluR)ε2 and anti-N-methyl-D-aspartate receptor (NMDAR) antibodies were positive in both her serum and CSF. After she recovered five months later she underwent surgery to remove a right ovarian teratoma. Immunohistochemical examinations of her teratoma disclosed abundant expression of various GluRs including NR2B subunit of NMDAR, GluR1, and GluR2/3. These immunoreactivities of GluRs were seen not only in small areas of neural tissue identified as anti-glial fibrillary acidic protein (GFAP)-immunoreactive areas but also in other large areas of undifferentiated neuroepithelial tissue without GFAP immunoreactivity. Our findings strongly support the recent idea that neural elements in ovarian teratoma play an important role in the production of antibodies to NMDARs in anti-NMDAR encephalitis. Additionally, the study of control ovaries clearly showed NR2B-related immunoreactivity in the cytoplasm of oocytes, indicating that the normal ovary itself has expression of NMDARs. This finding might provide a clue to understand the pathogenesis of this disease in female patients without ovarian teratoma.</abstract><cop>Japan</cop><pub>The Japanese Society of Internal Medicine</pub><pmid>20930449</pmid><doi>10.2169/internalmedicine.49.4069</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Internal Medicine, 2010, Vol.49(19), pp.2167-2173 |
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| language | eng |
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| source | MEDLINE; J-STAGE (Japan Science & Technology Information Aggregator, Electronic) Freely Available Titles - Japanese |
| subjects | alpha -Amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors Antibodies Autoantibodies - blood Autoantibodies - cerebrospinal fluid Blood pressure Cerebrospinal fluid Cytoplasm Dyskinesia Encephalitis Female Glial fibrillary acidic protein glutamate receptor Glutamic acid receptors Glutamic acid receptors (ionotropic) Humans Immunohistochemistry Immunoreactivity limbic encephalitis N-methyl-D-aspartate receptor (NMDAR) N-Methyl-D-aspartic acid receptors Oocytes Ovarian Neoplasms - complications Ovarian Neoplasms - immunology Ovarian Neoplasms - metabolism Ovarian Neoplasms - pathology ovarian teratoma Ovaries paraneoplastic syndrome Paraneoplastic Syndromes, Nervous System - etiology Paraneoplastic Syndromes, Nervous System - immunology Paraneoplastic Syndromes, Nervous System - metabolism Receptors, AMPA - immunology Receptors, AMPA - metabolism Receptors, Glutamate - immunology Receptors, Glutamate - metabolism Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors Receptors, N-Methyl-D-Aspartate - immunology Receptors, N-Methyl-D-Aspartate - metabolism Seizures Surgery teratoma Teratoma - complications Teratoma - immunology Teratoma - metabolism Teratoma - pathology Young Adult |
| title | Expression of Various Glutamate Receptors Including N-Methyl-D-Aspartate Receptor (NMDAR) in an Ovarian Teratoma Removed from a Young Woman with Anti-NMDAR Encephalitis |
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