Post-streptococcal opsoclonus-myoclonus syndrome associated with anti-neuroleukin antibodies |
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Authors: | Candler P M Dale R C Griffin S Church A J Wait R Chapman M D Keir G Giovannoni G Rees J H |
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Affiliation: | Department of Neuroinflammation, Institute of Neurology, Queen Square, London, WC1N 3BG, UK. p.candler@ion.ucl.ac.uk |
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Abstract: | BACKGROUND: Adult opsoclonus-myoclonus (OM), a disorder of eye movements accompanied by myoclonus affecting the trunk, limbs, or head, is commonly associated with an underlying malignancy or precipitated by viral infection. METHODS: We present the first two reports of post-streptococcal OM associated with antibodies against a 56 kDa protein. Two young girls presented with opsoclonus and myoclonus following a febrile illness and pharyngitis. Protein purification techniques were employed. Amino acid sequences of human neuroleukin (NLK) and streptococcal proteins were compared using the protein-protein BLAST application. RESULTS: The antigen was identified as NLK (glucose-6-phosphate isomerase, GPI). GPI is present on the cell surface of streptococcus making the protein a candidate target for molecular mimicry. CONCLUSIONS: We have identified NLK as an antigenic target in two patients with post-streptococcal OM. The pathogenicity of the antibodies is uncertain. The potential role of anti-neuroleukin antibodies in the pathogenesis of OM is discussed. We propose that OM may represent a further syndrome in the growing spectrum of post-streptococcal neurological disorders. The role of streptococcus in OM and the frequency with which anti-NLK responses occur in both post-infectious and paraneoplastic OM should be investigated further. |
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Keywords: | antibodies opsoclonus‐myoclonus post‐infectious streptococcus |
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