Feinstein researcher’s TEDMED talk focuses on lupus antibodies

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Dr. Betty Diamond (Photo courtesy of Northwell Health)

Dr. Betty Diamond of the Feinstein Institute for Medical Research said in a recent TEDMED talk that she and her fellow researchers believe how the body’s antibodies pass the blood brain barrier and affect the brain in lupus patients could be the key to increased understanding of brain diseases, such as autism and PTSD.

Diamond, who has been with the Feinstein Institute for a decade and working with lupus research for more than 40 years, focused her recent talk on how antibodies can flow through an adult’s injured blood brain barrier or a fetus’s underdeveloped blood brain barrier during the second and third trimesters.

About 10 percent of the population suffers from an autoimmune disease, Diamond said, and about 10 percent of the normal population has anti-brain antibodies similar to Susannah Cahalan, author of “Brain on Fire: My Month of Madness.”

Diamond said maternal antibodies don’t enter the fetal circulatory system until the second trimester. During the third trimester the barrier becomes fully developed and the risk of the mother’s antibodies interfering with the fetus decreases.

“If we try to protect the fetus, we only have to protect the fetus during a short window of time,” Diamond said. “What I discussed in the TEDMED talk is that one of the potential strategies is a decoy antigen, giving the mom an antigen that all of these potentially pathogenic anti-brain antibodies will bind to and you therefore make the antibodies bind to that antigen instead of moving across the placenta to the fetal brain.”

Diamond said some of the antibodies seen in lupus patients cross-react with a protein for those with neuropsychiatric lupus, which diminishes their quality of life and currently has no direct treatment.

Through those antibodies, Diamond said she found a potential window into factors contributing to neuropsychiatric lupus when a research student pondered the increased frequency of children with learning disabilities born to women with lupus.

Diamond said she was able to identity one antibody that seems to be involved with autism spectrum disorder, but it doesn’t mean every mother with lupus will bear an affected child.

“I’m a feminist, and I would never want to blame a mother for a problem in the child,” Diamond said. “I’ve worried very much about the kind of guilt this paradigm might engender in some people, but I think the way to look at it is as we understand more, the knowledge actually suggests the preventative or treatment strategies, and that’s what really needs to be emphasized.”

Diamond said a similar occurrence could connect some of those with post-traumatic stress disorder and an injured blood brain barrier.

“We’ve shown in some of our work that epinephrine will cause an impairment in the integrity of the blood brain barrier, so we know that’s one of the moments in an adult’s life when antibodies move from the circulation into the brain,” Diamond said. “Since, we have wondered if some, not all, cases of PTSD are mediated in part by the fact that the enormous stress of the moment will cause an impairment of the blood brain barrier and there may be some antibodies that disrupt normal neural function.”

The future of the team’s research, Diamond said, will be to work out prevention and therapeutic strategies for pregnant women and those with potentially injured blood brain barriers.

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