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@ARTICLE{Weiser:280248,
author = {Weiser, Judith and Rau, Alexander and von Zedtwitz,
Katharina and Feige, Bernd and Nickel, Kathrin and Maier,
Simon J and Dressle, Raphael J and Venhoff, Nils and van
Elst, Ludger Tebartz and Schiele, Miriam A and Domschke,
Katharina and Prüss, Harald and Endres, Dominique},
title = {{S}ocial anxiety disorder and antibodies against glial
cells in the cerebrospinal fluid.},
journal = {Brain, behavior, $\&$ immunity - health},
volume = {48},
issn = {2666-3546},
address = {[Amsterdam]},
publisher = {Elsevier B.V.},
reportid = {DZNE-2025-00926},
pages = {101064},
year = {2025},
abstract = {Autoimmune social anxiety disorders have not yet been
described in the literature.Therefore, this case of a
patient with possible autoimmune-mediated social anxiety
disorder is presented. Due to treatment resistance and high
serum streptococcal antibody levels, a comprehensive
diagnostic work-up was performed.The 19-year-old female
patient presented with predominant social anxiety disorder
and secondary depression. Testing for all known
characterized neuronal and glial IgG antibodies identified
slightly positive ('+') recoverin IgG antibodies only in the
serum (using an immunoassay). Cerebrospinal fluid (CSF)
analysis using a tissue-based assay on unfixed mouse brain
slices revealed moderate immunoglobulin G (IgG) anti-nuclear
binding and a specific strong IgG binding against cell
nuclei of the Bergmann glia in the cerebellum. No clear
pathology was noted in conventional magnetic resonance
imaging (MRI), voxel-based morphometry, and cerebral blood
flow. Diffusion microstructure imaging (DMI) revealed a
substantial reduction of the intraneurite volume fraction in
the cerebellar gray and white matter. This was accompanied
by a compensatory increase in free fluid and the
extra-neurite volume fraction. Alterations in the striatum
were also observed with DMI. Electroencephalography (EEG)
showed intermittent generalized slowing with underlying left
frontal, right temporal, and left temporo-occipital
components (detected via independent component analysis of
the EEG). The [18F]fluorodeoxyglucose positron emission
tomography of the whole body detected a slight polyserositis
and no malignant tumor.This is the first description of a
case with evidence of a possible antibody-mediated
cerebellar dysfunction associated with social anxiety
disorder. The testing for all characterized neuronal/glial
antibodies showed only weakly positive recoverin antibodies
in the serum, which, however, were not detectable in the
CSF. Therefore, novel CSF antibodies directed against cell
nuclei of the Bergmann glia in the cerebellum could be
assumed. DMI alterations in the cerebellum were in principle
compatible with neuroinflammation with edematization and
cellular activation. In addition, the further DMI
alterations in the striatum and the fronto-temporal
generators of EEG slowing suggest an involvement of the
'anxiety network'. Further immunopsychiatric research in
anxiety disorders might contribute to identifying an
autoimmune subtype and potentially immunomodulatory
treatment options.},
keywords = {Anxiety (Other) / Autoimmune (Other) / Inflammation (Other)
/ Recoverin (Other) / Social phobia (Other)},
cin = {AG Prüß},
ddc = {610},
cid = {I:(DE-2719)1810003},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:40746968},
pmc = {pmc:PMC12312059},
doi = {10.1016/j.bbih.2025.101064},
url = {https://pub.dzne.de/record/280248},
}