Investigation and Treatment of Undiagnosed Neuroinflammatory Diseases

项目总结 在所有神经系统疾病中，神经炎症性疾病是最具挑战性的。其中许多疾病仍未得到诊断，是发病率和死亡率的主要原因。多项研究表明，在任何三级护理机构的神经科服务中，近三分之一的患者患有未确诊的神经免疫疾病，其中许多人的住院时间延长了几个月，其中近三分之一的患者在入院期间死于这种疾病。这些患者经常接受广泛的调查和多次经验性治疗，但效果不佳。他们还在医生和主要医疗中心之间来回奔波，接受反复研究，而没有额外的好处。至关重要的是，我们必须开发一个结构化的程序来诊断这些患者，对这些疾病进行适当的分类，并制定合理的治疗方法。全面调查个别患者不仅可以澄清他们的基本诊断并导致更直接的治疗，而且还可以从根本上改变我们治疗神经炎性疾病的方式。例如，我们发现进行性多灶性白质脑病患者脑脊液中淋巴细胞上PD-1水平升高，这导致了这种致命疾病的新治疗方法的开发。尽管个别实验室作出了这些努力，但许多病例仍然没有得到诊断和治疗。这项内部和外部高度协作的建议首次将顶级学术和政府机构的内科科学家和科学家聚集在一起，他们致力于为特发性神经炎性疾病患者开发深入的临床表型鉴定方案，以及高通量和综合的工具，用于识别中枢神经系统中的微生物核酸、脑脊液中的病毒和自身抗体图谱、免疫细胞图谱和T细胞抗原图谱。这些研究不仅将导致在个别患者中识别新的疾病，而且还将作为如何更广泛地破译神经炎性疾病的模型。

PROJECT SUMMARY Of all neurological diseases, the neuroinflammatory diseases are the most challenging. Many of these remain undiagnosed and are a major cause of morbidity and mortality. Several studies have shown that nearly a third of the patients on the neurology service at any tertiary care facility have undiagnosed neuroimmune diseases, many of whom have prolonged hospitalizations over several months and nearly a third of these patients die from the illness during this admission. These patients often undergo extensive investigations and multiple empirical therapies with poor results. They also bounce between physicians and major medical centers undergoing repeated investigations with no additional benefit. It is critically necessary that we develop a structured program to diagnose these patients, properly classify these disorders and develop a rational approach to treatment. Comprehensively investigating individual patients cannot only clarify their underlying diagnosis and lead to more directed therapies, but it can also fundamentally alter how we treat a neuroinflammatory disease more generally. For example, we discovered elevated PD-1 levels on lymphocytes in CSF of patients with progressive multifocal leukoencephalopathy which led to the development of a novel treatment for this otherwise fatal illness. Despite these efforts by individual laboratories, many cases still remain undiagnosed and untreated. This intramural and extramural highly collaborative proposal brings together for the first time physician-scientists and scientists across top academic and government institutions who have dedicated their careers to developing deep clinical phenotyping protocols for patients with idiopathic neuroinflammatory diseases as well as high-throughput and comprehensive tools for identifying microbial nucleic acid in the central nervous system, viral and autoantibody antibody profiling in the cerebrospinal fluid, immune cell profiling and T-cell antigen profiling. These investigations will not only lead to the identification of novel diseases in individual patients but also serve as a model for how neuroinflammatory diseases can be deciphered more widely.