Human lupus autoantibodies against NMDA receptors mediate cognitive impairment

• Published in: Proceedings of the National Academy of Sciences - PNAS 2006-12, Vol.103 (52), p.19854-19859
• Main Authors: Kowal, Czeslawa, DeGiorgio, Lorraine A, Lee, Ji Y, Edgar, Mark A, Huerta, Patricio T, Volpe, Bruce T, Diamond, Betty
• Format: Article
• Language: English
• Subjects: Animals; Autoantibodies - blood; Autoantibodies - immunology; Biological Sciences; Blood brain barrier; Brain; Brain damage; Cognition & reasoning; Deoxyribonucleic acid; DNA; DNA - immunology; DNA damage; Female; Hippocampus - drug effects; Hippocampus - immunology; Hippocampus - pathology; Humans; Lipopolysaccharides - pharmacology; Lupus; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - immunology; Lupus Erythematosus, Systemic - pathology; Memory; Memory Disorders - blood; Memory Disorders - immunology; Mice; Mice, Inbred BALB C; Monoclonal antibodies; Neurons; Neurons - drug effects; Neurons - immunology; Neurons - pathology; Reactivity; Receptors, N-Methyl-D-Aspartate - immunology; Systemic lupus erythematosus
• ISSN: 0027-8424; 1091-6490
• DOI: 10.1073/pnas.0608397104

Neuropsychiatric systemic lupus erythematosus, which often entails cognitive disturbances and memory loss, has become a major complication for lupus patients. Previously, we developed a murine model of neuropsychiatric lupus based on Abs that cross-react with dsDNA and the NMDA receptor (NMDAR). We showed that these murine Abs impair cognition when they access the CNS through a breach in the blood-brain barrier (BBB) triggered by lipopolysaccharide. Because studies show that lupus patients possess anti-NMDAR Abs in their serum and cerebrospinal fluid, we decided to investigate whether these human Abs contribute to cognitive dysfunction. Here, we show that serum with reactivity to DNA and NMDAR extracted from lupus patients elicited cognitive impairment in mice receiving the serum intravenously and given lipopolysaccharide to compromise the BBB integrity. Brain histopathology showed hippocampal neuron damage, and behavioral testing revealed hippocampus-dependent memory impairment. To determine whether anti-NMDAR Abs exist in the brains of systemic lupus erythematosus patients, we eluted IgG from a patient's brain. The IgG bound DNA and NMDAR and caused neuronal apoptosis when injected into mouse brains. We examined four more brains of patients with neuropsychiatric lupus and found that they displayed endogenous IgG colocalizing with anti-NMDAR Abs. Our results indicate that lupus patients have circulating anti-NMDAR Abs capable of causing neuronal damage and memory deficit, if they breach the BBB, and that the Abs exist within patients' brains. Which aspects of neuropsychiatric lupus may be mediated by anti-NMDAR Abs, how often, and in which patients are now important clinical questions.