A human antibody alters memory and behavior
In 2007 we discovered a human brain disease mediated by antibodies against the NMDA glutamate receptor (NMDAR). This disorder (named anti-NMDAR encephalitis) was the first of a new category of neuropsychiatric diseases mediated by antibodies against synaptic neurotransmitter receptors. The concept that an antibody could directly alter memory, behavior, cognition, and cause psychosis was novel, and changed the landscape of diagnostic and treatment approaches in neurology and psychiatry. Today, anti-NMDAR encephalitis is considered the most common antibody-mediated CNS disease, ranking in frequency above most viral encephalitis. Over the years, a pathogenic effect of the antibodies had been suggested in studies of cultured neurons and other in vitro models. This year, we reported an animal model that definitively established that patients’ antibodies alter memory and behavior. In this model patient antibodies were continuously infused over 14 days into the cerebroventricular system of mice using catheters connected to osmotic pumps. During and after the infusion multiple memory and behavioral tests were performed. The studies showed that patients’ NMDAR antibodies led to progressive memory impairment, anhedonia and depressive-like behaviors. Molecular studies in the hippocampus of the mice showed a decrease of clusters of total and synaptic NMDAR. These molecular effects, which paralleled behavioral symptoms, gradually reversed after the end of the antibody infusion. This model establishes a link between memory and behavioral deficits and antibody-mediated reduction of NMDAR, provides the biological basis by which removal of antibodies and antibody-producing cells improve neurological function, and offers a model for testing experimental therapies in this and similar disorders. The work was summarized on the cover of Brain: A Journal of Neurology (Jan 2015).