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Anti-NMDA Receptor Encephalitis

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Anti-NMDA Receptor Encephalitis. Core disease mechanisms, molecular and ce...

2026-05-16
Asta MONDO:0021081 Model: Asta Scientific Corpus Retrieval 18 citations

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Anti-NMDA Receptor Encephalitis. Core disease mechanisms, molecular and ce...

This report is retrieval-only and is generated directly from Asta results.

  • Papers retrieved: 18
  • Snippets retrieved: 20

Relevant Papers

[1] Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023

  • Authors: Xinyue Song, Zixin Luo, Duoqin Huang, Jialian Lv, Li Xiao et al.
  • Year: 2024
  • Venue: Frontiers in Neurology
  • URL: https://www.semanticscholar.org/paper/b57cb6594188ed0e2575076019dd6ad402d87ca0
  • DOI: 10.3389/fneur.2024.1387260
  • PMID: 38711554
  • PMCID: 11070467
  • Citations: 4
  • Summary: A bibliometric and visualization analysis from 2005 to 2023 shows that the number of studies on anti-NMDA encephalitis is generally increasing year by year, and it is a hot disease pursued by researchers.
  • Evidence snippets:
  • Snippet 1 (score: 0.553) > Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune-mediated disease characterized by a complex neuropsychiatric syndrome, and an antibody to cerebrospinal fluid (CSF) targeting the GluN1 subunit of NMDAR exists (14,15), a brain parenchymal inflammation associated with autoimmune-related neurologic dysfunction (16). Anti-NMDA receptor encephalitis was first reported in 2005, when symptoms of psychotic features, memory loss, and altered consciousness were found in four young women with ovarian teratomas (17). In 2007, a study found a new autoantibody in cerebrospinal fluid (CSF) or serum of 12 female patients with an early psychotic This discovery ushered in a new era of diagnostic medicine (18). The etiology of anti-NMDA encephalitis is, for the moment, uncertain, but some studies suggest that it may be able to be triggered by viruses, vaccines or tumors (19,20). IgG antibodies targeting the GluN1 subunit of the NMDA receptor (NMDAR) are key mediators in the pathogenesis of the disease (21). Antibody-mediated NMDAR dysfunction leads to severe psychiatric symptoms, including memory loss (22), dyskinesia (23), psychotic symptoms (24), drowsiness, seizures (25), impaired consciousness, and even coma in severe cases. Early recognition and rapid activation of a range of immunotherapies may be able to improve the prognosis of patients with anti-NMDA encephalitis. Clinical presentation, cerebrospinal fluid examination, neuroimaging, and electroencephalography can be used for diagnostic typing of encephalitis (26), and are important modalities for guiding the clinical approach to treatment and achieving a favorable outcome for patients. As research progresses, relevant animal models have begun to reveal underlying pathogenic mechanisms and will lead to the development of new therapies in addition to immunotherapy (3).
  • Snippet 2 (score: 0.406) > However, it is worth noting that there may be some differences between children and adults (33), and we believe that the most common clinical manifestations of anti-NMDA receptor encephalitis in children are epilepsy, movement disorders, and personality changes, as well as the incidence of comorbid tumors in pediatric patients is lower than in adults (17). The younger the age, the lower the likelihood of tumor development, suggesting that the pathogenesis may differ between children and adults (34). Research into potential clinical treatment modalities for anti-NMDA encephalitis has been an outbreak hotspot in recent years. The treatment of anti-NMDA receptor encephalitis mainly relies on searching for the relevant causes and treating the causes as much as possible, including receiving immunotherapy, supportive therapy, Second-line drug therapy, including rituximab and cyclophosphamide, can often be considered when patients with anti-NMDA receptor encephalitis do not respond significantly to first-line drug therapy, but overall immunotherapy for anti-NMDA receptor encephalitis remains the main effective approach at present. This study focuses on a new type of autoimmune encephalitis anti-NMDA encephalitis. And the discovery of NMDA receptor has opened up the research field of anti-NMDA encephalitis which reveals the pathogenesis of anti-NMDA encephalitis and also provides an important theoretical basis for the development of drugs targeting NMDA receptor which brings a new hope for the treatment of patients. Among the six clusters in the keyword timeline graph two are related to anti-NMDA encephalitis and two are related to anti-NMDA receptor just using different forms to convey the same meaning. In addition through the timeline we found that in recent years the research on anti-NMDA encephalitis has gradually shifted from the previous basic research to focus on the clinical direction including its clinical features outcomes and related case reports but there are still fewer research articles suggesting that future scholars can focus on the clinical aspect of the research to explore new manifestations and characteristics.
  • Snippet 3 (score: 0.402) > Keyword clustering mapping showed that studies in the field of anti-NMDA encephalitis were mainly centered on its definition, pathogenesis, clinical manifestations, diagnostic indicators, therapeutic modalities, and case reports, and the results confirmed that anti-NMDA encephalitis is an autoimmune-mediated disease manifesting as a complex neuropsychiatric syndrome, which results in a wide range of neurological symptoms, including psychiatric symptoms, movement disorders, memory disorders (14). And according to the clustering results, for cluster 2 we explored the specific clinical manifestations of anti-NMDA encephalitis, suggesting that patients with anti-NMDA receptor encephalitis present a characteristic stage-by-stage clinical course, and according to the course curve of classical anti-NMDAR encephalitis drawn by Kayser and Dalmau (32), we found that patients often have an antecedent infection 2 weeks before the onset of the disease, which leads to the development of certain antecedent symptoms, mainly viral cold symptoms; 1-2 weeks of progression of psychiatric symptoms, such as hallucinations, mania, delusions, anxiety, insomnia; weeks to months of neurological complications: disorders of consciousness, central hypoventilation, and even coma, often accompanied by dyskinesia and seizures; and months to years of neurological symptoms: executive functions, hypoparathyroidism and hyperventilation. Long-term deficits such as executive dysfunction, impulsivity and sleep disturbances are manifested over a period of months to years, and the critical but relatively reversible nature of the disease is an important feature. It was even found that the course of recovery from the disease was consistent with the course of disease progression, i.e., the first symptoms to appear disappeared last. However, it is worth noting that there may be some differences between children and adults (33), and we believe that the most common clinical manifestations of anti-NMDA receptor encephalitis in children are epilepsy, movement disorders, and personality changes, as well as the incidence of comorbid tumors in pediatric patients is lower than in adults (17).

[2] Symptomatologic pathomechanism of N-methyl D-aspartate receptor encephalitis

  • Authors: Woo-Jin Lee
  • Year: 2021
  • Venue: Encephalitis
  • URL: https://www.semanticscholar.org/paper/fe42ff1f42de5346c36c54b79c4684a07f88f107
  • DOI: 10.47936/encephalitis.2021.00017
  • PMID: 37469763
  • PMCID: 10295887
  • Summary: Those pathomechanistic hypotheses for NMDAR encephalitis support the rationale for the early introduction of combination immunotherapy and the use of adjuvant immunotherapy in patients with persisting symptoms in chronic disease phases.
  • Evidence snippets:
  • Snippet 1 (score: 0.517) > N-methyl D-aspartate receptor (NMDAR) encephalitis is a well-characterized clinical syndrome. The main molecular mechanism of NMDAR encephalitis is autoantibody-mediated NMDAR hypofunction in the neuronal synapse. Several pathomechanistic hypotheses might explain how NMDAR hypofunction causes the typical symptoms and prognosis of NMDAR encephalitis. Suppression of NMDAR-dependent gamma-aminobutyric acid interneurons provokes an accelerated activation of the positive feedback loops of the dorsolateral prefrontal cortex/subiculum–nucleus accumbens circuit in the striatum, the ventral tegmental area (VTA), and the nucleus reuniens in the thalamus–hippocampus–VTA loop. Dysregulated activation of the VTA and cortex via those positive feedback loops may explain the rapid clinical deterioration at acute stages of the disease and the well-characterized syndrome that includes limbic system dysfunction, intractable seizures, dyskinesia, coma, and the characteristic extreme delta brush. Progressive cerebellar atrophy is correlated with cumulative disease burden and is associated with worse long-term outcomes, which might be explained by the NMDAR-dependent pathways required to maintain neuronal survival. Those pathomechanistic hypotheses for NMDAR encephalitis support the rationale for the early introduction of combination immunotherapy and the use of adjuvant immunotherapy in patients with persisting symptoms in chronic disease phases.

[3] Recent advances in autoimmune encephalitis

  • Authors: J. Ferreira, C. Disserol, Bruna de Freitas Dias, Alexandre Coelho Marques, Marina Driemeier Cardoso et al.
  • Year: 2024
  • Venue: Arquivos de Neuro-Psiquiatria
  • URL: https://www.semanticscholar.org/paper/36759fd04ed2757c5112e8fa3f3dec5dfd4a4d47
  • DOI: 10.1055/s-0044-1793933
  • PMID: 39706227
  • PMCID: 11661894
  • Citations: 6
  • Summary: The clinical spectrum of anti-LGI1, anti-AMPAR, anti-CASPR2, and anti-IgLON5 was expanded, comprising new differential diagnoses, and a diagnostic algorithm was proposed, considering potential mimics and misdiagnosis of autoimmune encephalitis.
  • Evidence snippets:
  • Snippet 1 (score: 0.516) > Anti-N-methyl-D-aspartate receptor encephalitis is caused by ABs targeting the GluN1 subunit of the NMDA receptor, which causes cross-linking and internalization of those receptors, leading to impaired NMDAR electric currents. 13,14 nimal models showed that anti-NMDAR ABs modify CA1 pyramidal cells' excitability and hippocampal network activity. 15 Additionally, hippocampal proteomics revealed changes in components of glutamatergic, GABAergic, and central hubs of intracellular signaling, providing insights into molecular mechanisms for electrophysiological findings and pathophysiology. 15 ecently, the mean annualized incidence rate of anti-NMDARE was estimated at 1.00/million cases in the Netherlands. 8 Anti-NMDARE predominates in young women, with an ovarian teratoma found in nearly 50% of cases. 16 8][19] Moreover, one recent case series showed that 20% of patients were > 45 years, indicating that late presentation may be more common than previously expected. 10 These late-onset cases were associated with other tumors, mainly carcinomas, were oligosymptomatic, and had worse outcome. 10,16 he classic anti-NMDARE clinical syndrome starts with prodromal symptoms, followed by cognitive or psychiatric manifestations (delusions, psychosis, catatonia), movement disorders (orofacial dyskinesias, choreoathetosis), speech disorder, dysautonomia, seizures, and decreased level of consciousness. 12,16 substantial number of patients require ICU admission for management of status epilepticus, autonomic dysfunction, and mechanical ventilation. 4 Clinical variables from the acute presentation can be used to evaluate disease prognosis. The anti-NMDAR Encephalitis One-Year Functional Status (NEOS) score predicts functional outcomes after 1 year of symptoms onset and includes 5 clinical variables: This score also performed well for children, and preliminary findings indicate that it can also be used for cognitive outcomes. 21 n the post-acute phase, patients may present a neuropsychiatric syndrome that resembles schizophrenia, which improves gradually. 22

[4] First-episode psychosis in a 15 year-old female with clinical presentation of anti-NMDA receptor encephalitis: a case report and review of the literature

  • Authors: Maria Moura, Amílcar Silva-Dos-Santos, J. Afonso, M. Talina
  • Year: 2016
  • Venue: BMC Research Notes
  • URL: https://www.semanticscholar.org/paper/1646c9c0933489c5f3308172ec520d0e2a2e1133
  • DOI: 10.1186/s13104-016-2180-6
  • PMID: 27473459
  • PMCID: 4966559
  • Citations: 10
  • Summary: This case is presented of a 15 year-old female adolescent with first-episode psychosis with anti-NMDA receptor encephalitis not related to tumor, which manifested with delusion, hallucinations, panic attacks, agitation, and neurological symptoms, and later with autonomic instability.
  • Evidence snippets:
  • Snippet 1 (score: 0.503) > Anti-NMDA receptor encephalitis is an autoimmune disease that was first identified as a paraneoplastic syndrome in young women with ovarian teratomas, and can also occur as a rare manifestation of teratoma of the mediastinum, or due to testicular cancer or small-cell lung carcinoma [7,10]; however it can also be non-paraneoplastic [3,22]. The clinical presentation usually consists of three stages: a prodromal period that lasts up to 1 week with common cold-like symptoms, fever, headache, malaise or gastroenteritis; an intermediate period, lasting 1-3 weeks, with behavioral changes, psychiatric symptoms or mood changes. The most common clinical presentation resembles acute psychosis (anxiety, agitation, paranoia, auditory or visual hallucinations) [7,23], meaning that psychiatrists are usually the first physicians to observe these patients. The third stage can last from weeks to months, and consist of neurological and autonomic symptoms, including alteration in speech, catatonia, and seizures. The common autonomic symptoms include urinary incontinence or sleep dysfunction. The more severe autonomic symptoms, such as hypoventilation, dysrhythmia, tachycardia, and hyperthermia, are not frequent in children [11]. It has been shown that this condition is more frequent in children than was previously thought and that its clinical manifestations in the pediatric population are similar to those of adults [11]. > The exact pathophysiology of anti-NMDA receptor encephalitis is not fully understood. It is believed that NR1 subunits expressed by tumoral neural tissues may break the immune tolerance [10]. However, anti-NMDA receptor encephalitis is not always related to teratoma or other malignancies, and hence, other immunologic mechanisms might be involved. Hypotheses thus far proposed include the concept that there is an immunological response to a flu-like prodromal phase possibly related to a viral infection, and genetic susceptibility [10].

[5] Neuroleptic intolerance in patients with anti-NMDAR encephalitis

  • Authors: F. Lejuste, L. Thomas, G. Picard, V. Desestret, F. Ducray et al.
  • Year: 2016
  • Venue: Neurology® Neuroimmunology & Neuroinflammation
  • URL: https://www.semanticscholar.org/paper/9d6905fe5955e78d89679ebecd667546c084bbcc
  • DOI: 10.1212/NXI.0000000000000280
  • PMID: 27606355
  • PMCID: 5004531
  • Citations: 150
  • Influential citations: 13
  • Summary: Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti- NMDAREncephalitis.
  • Evidence snippets:
  • Snippet 1 (score: 0.500) > cephalitis. > Our results also outline that emergency physicians, neurologists, and psychiatrists must systematically search for associated discreet neurologic signs and symptoms relevant to encephalitis in young patients with psychiatric symptoms. Indeed, more than half (n 5 24) of the 45 patients hospitalized in psychiatric departments had neurologic signs at the first evaluation. Despite the presence of these comorbid elements, the patients were not correctly diagnosed or hospitalized in an appropriate unit and did not receive the medical investigations required for diagnosis of encephalitis. Many patients had a normal neuroimaging, which was misinterpreted to support a primary psychiatric etiology of symptoms and signs, but neuroimaging is frequently normal in anti-NMDAR encephalitis. 2,11 An interesting observation was the very high rate of possible antipsychotic drug intolerance in our 19 In particular, it should be stressed that one patient presented with 3 previous psychiatric episodes, separated by many years, and for each episode, she had experienced severe intolerance to antipsychotic drugs. DSM-5 20 and DSM-IV 21 do not provide an exact list of criteria for NMS, and we did not have enough information on the 21 patients to strictly confirm the diagnosis of NMS, but the significantly high rate of fever with abnormal biological data in our patients receiving antipsychotic drugs and the absence of such clinical presentation in the group of patients who were not treated with antipsychotic drugs suggests the existence of a pathophysiologic overlap between NMS, malignant catatonia, and anti-NMDAR encephalitis. > Interestingly, hypofunction of glutamatergic neurotransmission has been proposed in the etiology of NMS, 22 although amantadine, a weak NMDA receptor antagonist, improves NMS symptoms in a Parkinson disease model. 23,24 Beyond the apparent contradiction of glutamatergic functioning, the pathophysiologic interplay between the NMDAR and dopaminergic receptors, and more generally monoamine signaling, emerges as a core mechanism in several neuropsychiatric disorders. Any alteration in NMDAR signaling at the neuronal surface (as reported in anti-NMDAR encephalitis 25

[6] Deciphering the molecular landscape of NMDAR-E associated ovarian teratomas: a Multi-Omics approach

  • Authors: Lingwei Ma, Xinmeng Sun, Shaohua Zhang, Yinping Xiao, Haiyun Guan et al.
  • Year: 2025
  • Venue: Journal of Ovarian Research
  • URL: https://www.semanticscholar.org/paper/1e51dd97cee96f7970afd788203963afd0ddd878
  • DOI: 10.1186/s13048-025-01871-4
  • PMID: 41339905
  • PMCID: 12676869
  • Citations: 1
  • Summary: Key genes and proteins involved in ferroptosis and immune activation, including SLC40A1, GGH, FKBP11, CCDC80, and ANK3, showed significant expression differences, and changes were notable at the mRNA and protein levels in ovarian teratomas associated with NMDAR-E.
  • Evidence snippets:
  • Snippet 1 (score: 0.492) > Anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is an autoimmune disorder often associated with ovarian teratomas. It involves antibodies against the neuronal NMDAr1 subunits of NR1, but the pathogenesis and molecular mechanisms are not fully understood. To identify significantly differentially expressed genes and proteins and investigate the intricate molecular regulatory network underlying anti-NMDA receptor encephalitis (NMDAR-E) associated with ovarian teratomas. This retrospective study analyzed ovarian teratoma samples from patients with and without NMDAR-E. RNA sequencing and iTRAQ coupled LC-MS/MS analysis were used for gene and protein expression profiling. qPCR and western blotting were used to validate the gene and protein expression. We identified 2524 significantly differentially expressed genes and 34 proteins. The changes were notable at the mRNA and protein levels in ovarian teratomas associated with NMDAR-E. Functional enrichment analysis highlighted the extracellular matrix and immune activation pathways. Key genes and proteins involved in ferroptosis and immune activation, including SLC40A1, GGH, FKBP11, CCDC80, and ANK3, showed significant expression differences. Our findings provide preliminary insights into the pathophysiology of NMDAR-E associated with ovarian teratomas. These results may generate hypotheses for future mechanistic studies, and the candidate biomarkers identified warrant further validation before clinical translation.

[7] Simultaneous serum aquaporin-4 antibody and CSF NMDA receptor antibody–positive encephalitis

  • Authors: Unknown authors
  • Year: 2015
  • Venue: Neurology® Neuroimmunology & Neuroinflammation
  • URL: https://www.semanticscholar.org/paper/ce7b01bd99ff2ef99c25ece6e5208893b23b7008
  • DOI: 10.1212/NXI.0000000000000101
  • PMID: 25884011
  • PMCID: 4396527
  • Citations: 2
  • Summary: A 29-year-old Hmong woman presented with 3 months of worsening imbalance and intermittent vertigo followed by right facial numbness, slurred/nonsensical speech, and memory impairment, which revealed impaired short-term memory, expressive aphasia, mild right appendicular ataxia, and profound abulia.
  • Evidence snippets:
  • Snippet 1 (score: 0.480) > disorder followed by NMDA receptor encephalitis was recently reported in 5 patients. 3 The simultaneous occurrence of these CNS pathogenic antibodies with pathologic findings has not been previously reported. Although we do not know to what extent the anti-NMO/AQP4 and the anti-NMDA receptor autoantibodies contributed to the presentation, the clinical and radiographic features in this case suggest features of both NMO spectrum disorder and NMDA receptor encephalitis. Clinical and radiographic features that could be consistent with NMO include the brainstem syndrome with anorexia and radiographic involvement of the brainstem, hypothalamus, and optic chiasm. Similarly, cognitive impairment and akinesia along with the radiographic features of encephalitis might be due to NMDA receptor antibodies. > Other autoimmune diseases, including systemic lupus erythematosus, Sjögren syndrome, and myasthenia gravis, occur in patients with NMO. Many patients with NMO test seropositive for other autoantibodies. 4 More recently, anti-myelin oligodendrocyte glycoprotein antibodies were associated with a Neurology.org/nn © 2015 American Academy of Neurology 1 clinical presentation consistent with NMO. 5 We speculate that a mechanism underlying a breach in immune tolerance could be shared by CNS autoantibody-mediated diseases, resulting in the sequential occurrence of NMO and NMDA receptor encephalitis and possibly explaining the co-occurrence of these autoantibodies in our patient. An immunodominant AQP4 peptide recognized by T cells in patients with NMO has a high degree of homology to an ABC transporter from Clostridium species, suggesting that molecular mimicry might be involved in NMO pathogenesis. 6 Colonization of Clostridium or other bacterial species in the gut could promote immune responses that cross-react with the AQP4 and NMDA receptor proteins. Alternately, we speculate that NMO-related inflammation could "reveal" CNS antigens to the immune system, resulting in a secondary inflammatory response similar to that proposed for HSV and NMDA There are scattered activated microglia with elongated comma-shaped nuclei (

[8] Immune inflammatory regulation in Anti-NMDAR encephalitis: insights from transcriptome analysis

  • Authors: Shan Qiao, Jia Wang, Shanchao Zhang, Aihua Wang, Hai-yun Li et al.
  • Year: 2025
  • Venue: Frontiers in Neurology
  • URL: https://www.semanticscholar.org/paper/cd426a7d25d9ae6141d60961d06697e6de2154d5
  • DOI: 10.3389/fneur.2025.1568274
  • PMID: 40417115
  • PMCID: 12098042
  • Citations: 2
  • Summary: Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a critical neurological disorder mediated by autoimmune mechanisms, Previous literature suggests that immune inflammatory responses may be involved in the progression of anti NMDAR encephalitis, but its molecular regulatory mechanisms still remain uncertain. We aimed to identify transcriptome-wide landscape of mRNAs and explore the potential pathogenesis for anti-NMDAR encephalitis. Methods Peripheral blood mononuclear cell...
  • Evidence snippets:
  • Snippet 1 (score: 0.464) > Background Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a critical neurological disorder mediated by autoimmune mechanisms, Previous literature suggests that immune inflammatory responses may be involved in the progression of anti NMDAR encephalitis, but its molecular regulatory mechanisms still remain uncertain. We aimed to identify transcriptome-wide landscape of mRNAs and explore the potential pathogenesis for anti-NMDAR encephalitis. Methods Peripheral blood mononuclear cells were obtained from six patients with anti-NMDAR encephalitis and six controls for RNA extraction and library creation. The Illumina HiSeq platform was used to do transcriptome sequencing. We utilized R software to identify differentially expressed genes (DEGs) and performed a functional enrichment analysis. Furthermore, random forest (RF) and support vector machine-recursive feature elimination (SVM-RFE) were employed to screen for and identify anti-NMDAR encephalitis diagnostic signatures. To verify the findings, we employed quantitative real-time polymerase chain reaction. Receiver operating characteristic curves were utilized to assess the diagnostic values. We evaluated the inflammatory state of anti-NMDAR encephalitis using cell-type identification by computing the relative subsets of RNA transcripts (CIBERSORT) and investigated the relationship between diagnostic biomarkers and immune cell subsets. Results 899 DEGs were identified (568 upregulated and 331 downregulated), of which 78 were immune-related genes. The DEGs were found to be considerably enriched in immunological inflammation-related pathways, according to the functional enrichment analysis. Insulin-like factor 3 [area under the curve (AUC) = 0.917] and tumor protein translationally controlled regulator 1 (AUC = 0.944) were considered potential diagnostic indicator candidates of anti-NMDAR encephalitis, with statistically significant variations in expression. An immune cell analysis of immune cell proportions suggests that monocytes, CD8+ T cells, and T regulatory cells may all be involved in the development of anti-NMDAR encephalitis. Conclusions Transcriptome analysis reveals significant activation of peripheral immune-inflammatory pathways in anti-NMDAR encephalitis. INSL3 and TPT1 may

[9] The neuroinflammation collection: a vision for expanding neuro-immune crosstalk in Brain

  • Authors: S. Irani, A. Nath, F. Zipp
  • Year: 2021
  • Venue: Brain
  • URL: https://www.semanticscholar.org/paper/76ab9e302f17b1934b7a7e7440cc35418a9c1f5b
  • DOI: 10.1093/brain/awab187
  • PMID: 33983376
  • PMCID: 8370408
  • Citations: 10
  • Summary: A vision is offered of how anticipated developments in neuroinflammation are likely to impact the understanding of key elements of neurology, and lead to new treatments as well as some of the most exciting areas within this rapidly expanding, clinically relevant and highly translational field.
  • Evidence snippets:
  • Snippet 1 (score: 0.461) > The autoantibody-mediated diseases of the nervous system provide perhaps the most direct examples to connect an identified pathogenic agent with the corresponding disease process. In these conditions-ranging from myasthenia gravis and neuromyelitis optica to autoimmune encephalitis-autoantibodies target extracellular domains of neuroglial proteins and patients often show highly distinctive, even unique, clinical features. In autoimmune encephalitis, these include faciobrachial dystonic seizures and multiple frequent focal seizure semiologies in patients with leucine-rich glioma-inactivated 1 (LGI1) antibodies, 1 while a stereotyped multistage progression of inherently complex clinical features characterizes the phenotype of individuals with N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis. 2,3 In these patients, the highly characteristic nature of these-and other-clinical features provides persuasive evidence of a distinctive human pathology directly mediated by these antibodies. Further to these clinical observations, experimental data confirm these autoantibodies fulfil modified Koch's postulates for pathogenicity, both in vitro and in animal models. 4,5 Hence, a logical prediction is that inhibiting their end-target effects will reverse symptoms in patients. > To test this hypothesis at the molecular level, an allosteric modulator of the NMDAR-which crosses the blood-brain barrier-was applied to culture and in vivo model systems prior to application of patient NMDAR antibodies. 6 Administration of this drug to mice subsequently receiving a cerebroventricular transfer of NMDAR antibodies prevented all the antibody-mediated effects: memory alterations, a spatial redistribution of NMDARs and the abrogation of long-term potentiation. Yet, intriguingly, this drug did not fully abrogate NMDAR internalization, which is often characterized as the dominant mechanism of action of the human autoantibodies. However, this study lacked a key experiment: namely the application of the drug after the induction of antibodymediated pathology. Hence, its clinical relevance as a symptomatic therapy, alongside the observationally established value of immunotherapies, remains a key area for future work.

[10] Autoantibodies detection in anti-N-methyl-D-aspartate receptor encephalitis

  • Authors: Jiayu Li, Qi Wang, Honghao Wang
  • Year: 2021
  • Venue: Annals of Translational Medicine
  • URL: https://www.semanticscholar.org/paper/47c5272562cd73f4b7e9d0f24fc328e115f23a5a
  • DOI: 10.21037/atm-20-2279
  • PMID: 37090042
  • PMCID: 10116423
  • Citations: 7
  • Summary: It’s found that IHC got a higher positive rate than CBA in both serum and cerebrospinal fluid (CSF) when screening potential AE, while CBA was more specific.
  • Evidence snippets:
  • Snippet 1 (score: 0.457) > Autoimmune encephalitis (AE) covers a group of central nervous system diseases with clinical manifestations as neurological and/or psychiatric symptoms. AE is severe but treatable. It has gained increasing attention currently. The body's immune function can be disturbed under certain conditions such as tumor and infection, producing antibodies directed against neuronal autoantigens. Antineuronal antibodies include antibodies against cell surface, synaptic and intraneuronal antigens (1,2). Antibodies against cell surface antigens can directly influence the neurotransmission and excitability by targeting molecules including encephalitis: anti-N-methyl-D-aspartate (NMDA) receptor and α-amino-3-hydroxy-5-methyl-4isoxazolepropionic acid (AMPA) receptors via changing the function of the target protein (2,3). Antibodies may act as either agonist or antagonist on receptors (4), interfere with adjacent molecular interactions or reduce the expression of receptors on cell surface by altering the localization of membrane receptors or causing receptor internalization (i.e., anti-NMDAR antibodies) (5,6). Moreover, they can Review Article lead to the opening of transmembrane ion channels or cell death because of complement deposition and activation of natural killer cells. Antibodies against synaptic antigens are believed to alter the release or responsiveness of neurotransmitters (3). In contrast, antibodies against intraneuronal antigens (i.e., anti-Hu, anti-Yo and anti-Ma) are most likely not directly pathogenic, probably an epiphenomenon of T-cell-mediated immune response and classified as paraneoplastic neurological syndromerelated onconeural antibodies (7,8). Further discoveries showed that these antibodies caused cellular dysfunction or injury through multiple effector mechanisms. Intracellular antigens were not accessible to immune attack in situ; but upregulated major histocompatibility complex class I molecules in a pro-inflammatory cytokine milieu after proteasomal degradation, and then they were accessible to peptide-specific cytotoxic T cells (3).

[11] Anti-NMDA Receptor Encephalitis: A Narrative Review

  • Authors: V. Pădureanu, D. Dop, R. Pădureanu, D. Pîrșcoveanu, Gabriela Olaru et al.
  • Year: 2025
  • Venue: Brain Sciences
  • URL: https://www.semanticscholar.org/paper/79ec541ca01050ca7b270282c4e37df10cf3c334
  • DOI: 10.3390/brainsci15050518
  • PMID: 40426689
  • PMCID: 12110449
  • Citations: 9
  • Influential citations: 2
  • Summary: Given its high prevalence, anti-NMDA receptor encephalitis should be included in the differential diagnosis in routine psychiatric treatment, and an overview of the research on the condition is provided.
  • Evidence snippets:
  • Snippet 1 (score: 0.454) > In light of this, the HLA genetic factors are the autoimmunity core, but the non-HLA genetic factor might influence the genetic risk and therapeutic response. To date, the non-HLA gene's role in anti-NMDAR encephalitis is less characterized. For the first time, recent studies on autoimmune encephalitis genetics report that the non-HLA gene is involved in the diseases' molecular mechanism. Gene mutation, such as single-nucleotide polymorphism (SNP), can increase the risk of developing anti-NMDAR encephalitis. A genome-wide association study (GWAS), aimed at identifying genetic risk factors for anti-NMDA receptor (anti-NMDAR) encephalitis, performed colocalization and gene variant analysis to identify causal genes or gene variants [30]. These variants and genes did not belong to the HLA system. In this genomics study, performed by Tietz and colleagues, two significant genetic loci located on chromosomes 15 and 11 were identified as potential risk factors for anti-NMDAR encephalitis (Table 1). Other genes related to immune system checkpoints or the cytokine signaling pathway which involve BBB could be key factors in anti-NMDAR encephalitis. The lysosomal acid phosphatase 2 (ACP2) gene encodes an enzyme from the lysosomal membrane which hydrolyzes orthophosphoric monoesters to alcohol and phosphate. About 37 single-nucleotide variants (SNVs) of this gene are reported according to clinvar, but no clear pathological association with immune response was found [30]. ACP2 is involved in the interaction between the host and pathogens, such as viruses [36]. The ACP2 gene involved in immune regulation and the inflammatory signaling pathway may influence antigen processing and potentiate autoantigen production. The mutation of the ACP2 gene may be used in personalized therapies and can sustain the potential benefit of antiinflammatory therapy.

[12] Progress in the preparation of an active immunization model of anti-N-methyl-D-aspartate receptor encephalitis in animals

  • Authors: Kuikui Zeng, Yuting Liu, Sai Yang, Lingjuan Liu
  • Year: 2025
  • Venue: Frontiers in Immunology
  • URL: https://www.semanticscholar.org/paper/d78fd3dcf8563d324f99f53d2dc4e26157a4c3f4
  • DOI: 10.3389/fimmu.2025.1585353
  • PMID: 41451196
  • PMCID: 12728017
  • Summary: This review aims to systematically classify existing active immunization models of anti-NMDAR encephalitis, with detailed discussion on their establishment protocols, respective advantages, current applications, and future prospects.
  • Evidence snippets:
  • Snippet 1 (score: 0.452) > Usually, antibody-mediated encephalitides are typically characterized by concomitant neuroinflammation and seizure activity. Unlike other neurological disorders or experimental models, these conditions provide direct evidence for synaptic dysfunction and neuronal hyperexcitability through their welldefined mechanisms involving specific antibody binding to synaptic receptors and proteins (41). The GluN1 peptide-induced NMDAR encephalitis model exhibits significant limitations: while linear peptides can directly activate B cells and generate high-titer antibodies, their inability to engage T cell assistance and relevant inflammatory signaling pathways prevents complete recapitulation of human disease pathology. This model fails to reproduce hallmark clinical manifestations of anti-NMDAR encephalitis (including movement disorders, psychiatric symptoms, and spontaneous seizures), while demonstrating marked deficiencies in investigating critical aspects such as disease pathogenesis, inflammatory cytokine networks, and immune cell interactions. These shortcomings substantially constrain the model's utility for comprehensive mechanistic studies of NMDAR encephalitis. > HSV infection of the central nervous system represents a significant trigger for anti-neuronal autoimmunity (42). Current scholarship predominantly supports the view that HSV infection serves as an indirect precipitating factor for anti-NMDAR encephalitis, which may explain the relative scarcity of such models in research. The pathogenic mechanism is not attributable to direct viral neurotoxicity, but rather stems from secondary immune-mediated damage following viral infection (35,43). This pathophysiological process involves three key interrelated mechanisms: First, molecular mimicry occurs between HSV-1 proteins (e.g., glycoprotein B) and human synaptic proteins (e.g., NMDA receptors), leading to cross-reactive autoantibody production (44). Second, viral PAMPs are recognized by microglial TLR3 receptors, triggering innate immune responses characterized by excessive IFN and proinflammatory cytokine (IL-6, TNF-a) release, blood-brain barrier disruption, and CD8+ T cell infiltration (45).

[13] Immuno-psychiatry: an agenda for clinical practice and innovative research

  • Authors: M. Leboyer, M. Berk, R. Yolken, R. Tamouza, D. Kupfer et al.
  • Year: 2016
  • Venue: BMC Medicine
  • URL: https://www.semanticscholar.org/paper/9b33161ac3fa0889a188af2fa167cf846ceb2553
  • DOI: 10.1186/s12916-016-0712-5
  • PMID: 27788673
  • PMCID: 5084344
  • Citations: 60
  • Influential citations: 2
  • Summary: The development of bio-signatures will allow clinicians to tailor interventions to the abovementioned biomarker subtypes – a major translational goal for research in this field.
  • Evidence snippets:
  • Snippet 1 (score: 0.423) > extracted from the above emerging models in derivation studies could serve to design new "educated chips" that will contain immune, neurobiological and genetic markers defining subtypes of patients that could be further refined in validation studies (Fig. 1). > The use of animal models could facilitate exploration of in-depth temporal and molecular pathways linking central and peripheral dysfunctions in psychiatric disorders. For instance, since the discovery that some NMDA receptor (NMDAR) blockers induce schizophrenia-like psychosis, reproducing both positive and negative symptoms, the NMDA glutamatergic model of psychosis and schizophrenia has been increasingly accepted as part of the disease's etiopathology [40]. The dysfunction of NMDAR signalling might originate, among other pathways, from genetic alteration, autoantibodies directed against extracellular epitopes [41][42][43][44][45][46], and/or altered levels of endogenous agonists/antagonists (kynurenine metabolites) [47]. Of note, the recent discovery that autoantibodies against extracellular epitopes of the NMDAR produce major psychosis [41][42][43][44][45][46] provides a unique opportunity to increase our understanding of psychotic disorders at the molecular, cellular and brain imaging levels. For instance, autoantibodies from anti-NMDA encephalitis patients altered NMDAR signalling by preventing molecular interaction and altering membrane trafficking of NMDAR, although without modulating the function of the NMDAR channel [43]. Thus, NMDAR dysfunction-induced psychosis could originate from a blockade of the channel (e.g. phencyclidine) or an altered trafficking of the receptor (e.g. autoantibodies). Future investigations in various psychotic disorders will thus shed new light on the mechanisms underlying these disorders and pave the way for new, innovative therapeutical strategies to restore proper NMDAR signaling. > Could a common dysfunction be at the origin of peripheral disorders? Theoretically, yes. Indeed, it is often forgotten that NMDAR is not only expressed in brain cells but also in many other organs and cell types; for example, NMDAR is expressed in pancreatic islets and in insulin-secreting beta cells whose functional

[14] Pediatric anti-N-methyl-d-aspartate receptor encephalitis in southern China: Analysis of 111 cases.

  • Authors: Xiaojing Li, C. Hou, Wen-lin Wu, Hui-ci Liang, Ke-lu Zheng et al.
  • Year: 2021
  • Venue: Journal of neuroimmunology
  • URL: https://www.semanticscholar.org/paper/1906f55fc6403a746429f3c2c2be5ee26c468cfe
  • DOI: 10.1016/j.jneuroim.2021.577479
  • PMID: 33486307
  • Citations: 19
  • Summary: Of pediatric anti-NMDAR encephalitis in southern China: median onset age around 7 years; girls more common; boys might have poor outcome than girls; seizure or movement disorder respectively being most common onset or course symptom; a few overlapped with other neuronal autoantibodies; rare combined with tumor.
  • Evidence snippets:
  • Snippet 1 (score: 0.419) > Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neuroinflammatory disease mainly mediated by autoantibodies against the GluN1 subunit of the receptor (Dalmau, 2016). Since it was first reported in 2007, a series of studies have been conducted on this disease during these years (Dalmau et al. , 2007, Gurrera, 2019. With regards to clinical evidence of inflammation, there are two stages. In the first stage (which has a duration of around 3 months or longer), patients develop severe symptoms (such as psychosis, movement disorders, seizures, dysautonomia, and coma) commonly accompanied by transient magnetic resonance image (MRI) abnormalities or pleocytosis. The second stage (which has a duration of around 6 months or longer) corresponds to the process of recovery. Patients' antibodies crosslink the NMDARs, altering their surface dynamics and interaction with other synaptic proteins, and causing their internalization along with severe impairment of synaptic plasticity and NMDAR network function. The clinical features in patients and animal models resemble those caused by genetic or pharmacological attenuation of NMDAR function (Dalmau, 2016, Lynch et al. , 2018. And regional clinical studies of anti-NMDAR encephalitis may promote the research on its mechanism and enrich the clinical phenotypes. However, regional studies with large samples of children are still limited. > In current study, we reported the clinical features of children recently diagnosed with anti-NMDAR encephalitis in a national regional tertiary medical center from southern China.

[15] Precision Therapeutics in Lennox–Gastaut Syndrome: Targeting Molecular Pathophysiology in a Developmental and Epileptic Encephalopathy

  • Authors: Debopam Samanta
  • Year: 2025
  • Venue: Children
  • URL: https://www.semanticscholar.org/paper/455479c1bfbea7b90b73c109228f67c813d13888
  • DOI: 10.3390/children12040481
  • PMID: 40310132
  • PMCID: 12025602
  • Citations: 19
  • Influential citations: 1
  • Summary: A narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies, receptor and ligand dysfunction, receptor and ligand dysfunction, cell signaling abnormalities, cell signaling abnormalities, synaptopathies, and the repurposing of existing medications with mechanism-specific effects.
  • Evidence snippets:
  • Snippet 1 (score: 0.408) > A key advantage of disease-modifying therapies is their potential to target pathogenic mechanisms early in the disease course, potentially preventing the progression of some infantile epileptic encephalopathies to LGS. > This narrative review explores precision therapeutic strategies based on specific monogenic causes and disease mechanisms relevant to LGS. A comprehensive literature search (PubMed, MEDLINE, ClinicalTrials.gov, conference abstracts from the American Academy of Neurology and American Epilepsy Society, and gray literature) was conducted through 19 February 2025 to identify established ASMs, repurposed and novel drugs, as well as various gene therapy approaches with potential relevance to LGS. Given that over 900 monogenic causes of DEEs have been identified-implicating diverse cellular components such as ion channels, receptors, synaptic proteins, signaling pathways, metabolic processes, and epigenetic regulators-this review discusses current and emerging precision therapeutics based on shared molecular mechanisms and the pathophysiology of select genes associated with LGS [17] (Table 1).

[16] Molecular Pathogenesis of Anti-NMDAR Encephalitis

  • Authors: Hao Ding, Z. Jian, C. Stary, W. Yi, Xiaoxing Xiong
  • Year: 2015
  • Venue: BioMed Research International
  • URL: https://www.semanticscholar.org/paper/653de9aedde40b75ffec353e4b4e33f0826d329f
  • DOI: 10.1155/2015/643409
  • PMID: 26221602
  • PMCID: 4499418
  • Citations: 21
  • Influential citations: 2
  • Summary: This review will provide a summary of the current literature on anti-NMDAR encephalitis, including the immunologic molecular mechanisms contributing to disease progression, and focus on the effect of anti- NMDAR on GluN2-N MDAR expression and the molecular transformation of B and T leukocytes in the loss of self-tolerance.
  • Evidence snippets:
  • Snippet 1 (score: 0.406) > Anti-NMDAR encephalitis is a recently identified autoimmune disease, described by an immune-mediated loss of NMDA glutamate receptors, resulting in progressive mental deterioration. To date, literature on anti-NMDAR encephalitis has been largely clinically oriented, including descriptions of the clinical presentation and course, diagnostic methods, and potential clinical treatments. However, the underlying molecular mechanisms contributing to the complex immunological cellular transformation that is associated with the progression of anti-NMDAR encephalitis remain to be adequately explored. This review will provide a summary of the current literature on anti-NMDAR encephalitis, including the immunologic molecular mechanisms contributing to disease progression. In particular this review will focus on the effect of anti-NMDAR on GluN2-NMDAR expression and the molecular transformation of B and T leukocytes in the loss of self-tolerance. Further research on the immunologic mechanisms contributing to anti-NMDAR encephalitis may provide an avenue for future novel diagnostic approaches, such as immunologic surveillance, as well as new therapeutic strategies for this recently identified autoimmune disease.

[17] Atypical Autoimmune Encephalitis: Diagnostic Challenges and Therapeutic Insights From a Case Series

  • Authors: Thummalagunta Prathyusha, G. Ambati, Abhijathya Chinta, P. Gowda, C. Bole
  • Year: 2025
  • Venue: Cureus
  • URL: https://www.semanticscholar.org/paper/4ec40ecc7baa4e8bade8692b965099244d3c5396
  • DOI: 10.7759/cureus.82384
  • PMID: 40385909
  • PMCID: 12083851
  • Citations: 1
  • Summary: This study provides a comprehensive overview of clinical presentations, treatment approaches, and patient outcomes of patients diagnosed with autoimmune encephalitis.
  • Evidence snippets:
  • Snippet 1 (score: 0.403) > CSF analysis was pivotal in confirming the diagnosis. In Case 3, viral encephalitis was ruled out, reinforcing the necessity of antibody testing in suspected autoimmune encephalitis and demonstrating positivity to anti-NMDA receptor antibodies, aligning with findings that the sensitivity of NMDA receptor antibody testing is higher in CSF compared to serum, as reported by Wang et al. [13]. Early and aggressive immunotherapy, including corticosteroids, intravenous immunoglobulin (IVIG), plasma exchange, and rituximab, was employed in all cases, leading to varying clinical improvement. However, treatment was complicated in Case 2, which developed drug-induced Stevens-Johnson syndrome and hepatitis, underscoring the risks of immunomodulatory therapy, with recurrent infections and a cardiac arrest further complicating management. > Studies indicate that first-line treatments, such as corticosteroids, IVIG, and plasma exchange, result in clinical improvement in approximately 50% of cases, with second-line agents such as rituximab and cyclophosphamide being required in refractory cases. The prognosis is highly dependent on early diagnosis and intervention, with up to 80% of patients achieving significant recovery if treated early, whereas delayed treatment is associated with worse neurological outcomes and prolonged hospital stays. > Challenges in management included pre-existing conditions such as obesity and obstructive sleep apnea in Case 1. Prolonged mechanical ventilation and tracheostomy in Cases 1 and 2 highlighted the severity of the disease, and the prolonged course of recovery with residual motor and speech impairments persisted, necessitating long-term rehabilitation. Case 3 demonstrated the best outcome, with seizure-free status and no significant residual deficits, as described by Nosadini et al., who reported symptom-free disease in follow-up [14]. > Given the spectrum of complications, a multidisciplinary approach involving neurology, psychiatry, critical care, and rehabilitation specialists is crucial to optimize patient outcomes. Furthermore, the co-occurrence of anti-NMDA and anti-MOG antibody positivity in Case 3 raises important questions about underlying immune mechanisms.

[18] Common immunopathogenesis of central nervous system diseases: the protein-homeostasis-system hypothesis

  • Authors: Kyung-Yil Lee
  • Year: 2022
  • Venue: Cell & Bioscience
  • URL: https://www.semanticscholar.org/paper/2984270ae67451b93007040848d9694d19714c9f
  • DOI: 10.1186/s13578-022-00920-5
  • PMID: 36384812
  • PMCID: 9668226
  • Citations: 9
  • Influential citations: 1
  • Summary: This article proposes a common immunopathogenesis of CNS diseases, including prion diseases, Alzheimer’s disease, and genetic diseases, through the PHS hypothesis, which proposes that the immune systems in the host control those substances according to the size and biochemical properties of the substances.
  • Evidence snippets:
  • Snippet 1 (score: 0.401) > There are hundreds of genetic diseases of the CNS. The defective proteins in genetic disorders include structural proteins for neurotransmitter receptors and other receptors or ion channels on CNS cells, and proteins involved in enzymatic process, metabolism (transport), or signal transduction pathways in various communication systems [98]. Because a discussion of each genetic disease is beyond the scope of this review, only crucial points about the pathogenesis of genetic diseases are discussed. Singlegene defect diseases of the CNS can be caused by a defective product from a gene, i.e., a protein deficiency or a malfunctioning protein. In general, autosomal dominant genetic diseases are caused by structural protein defects, and autosomal recessive diseases are caused by defects in enzymatic proteins. However, certain genetic diseases that involve an enzymatic or multifunctional protein defect can induce structural cell injury during the natural course of the illness. > Patients with genetic diseases, including HD, familial JCD, GSS, and the genetic forms of AD and PD, show different clinical manifestations from other affected people in their family, including the time of onset of neurological symptoms, speed of progression of the disease, and prognosis, suggesting that phenotypes can vary even when the genotypes are identical. Likewise, similar phenotypes of CNS symptoms can be found in different genetic diseases. In genetic animal models, the phenotypes of single gene knockout can vary by strain in mice, and the clinical manifestations of a gene defect can differ between mice and humans, and mice null for some genes have also no observable phenotypic abnormalities compared with controls [99]. These findings suggest that default of a protein might be at least partly controlled by individual's control systems and that there might exist a similar immune/repair system against cell injury in genetic diseases. > The pathophysiology of most genetic diseases in the CNS is complex because any affected gene is associated with numerous proteins and their corresponding activations of genes and epigenetic changes that occur during disease processes. Thus, the use of a genetic marker for diagnosing or predicting a prognosis remains impractical in clinical settings [100].

Notes

  • This provider combines search_papers_by_relevance with snippet_search.
  • No synthesis or second-stage model call is performed.