Research Focus Overview

Research Focus Overview

The Autoimmune Neurology Research Team

The Autoimmune Neurology Research Team aims to evaluate neurological disorders with antibody biomarkers including autoimmune encephalitis, paraneoplastic encephalitis, MOG-IgG associated disorder, and neuromyelitis optica spectrum disorder. We are also interested in neurological autoimmunity and inflammation augmented by biological therapies. There is limited longitudinal data to provide evidence based care for this population. Our main aim is to perform translational multimodal research leading to improved quality of care of patients with autoimmune neurological conditions. To address this, we are utilizing our longitudinal autoimmune neurology clinical registry and biorepository with advanced neuroimaging and neuropsychology to examine prognostication of clinical outcomes in this population.

Contact Information:

Amy Kunchok, MD
kunchoa@ccf.org

Funding Sources:

  • Cleveland Clinic Lerner Research Institute, Research Program Committee (RPC): Biomarkers of disease activity and clinical outcomes in autoimmune encephalitis.
  • Foundation of the Consortium of Multiple Sclerosis Centers: Characterizing Clinical, Cognitive, and Radiological Outcomes in Patients with MOG Antibody Disorder and Multiple Sclerosis.
  • Society for Clinical Neuropsychology: Investigating long-term cognitive and functional outcomes of patients with anti-LGI-1 encephalitis.
Publications

Publications

Mustafa R, Flanagan EP, Duffy DJ, Weinshenker BG, Soldán MMP, Kunchok A, Kaisey M, Solomon AJ. Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey. J Neurol Sci. 2023 Oct 15;453:120781. doi: 10.1016/j.jns.2023.120781.

Kim HJ, Aktas O, Patterson KR, Korff S, Kunchok A, Bennett JL, Weinshenker BG, Paul F, Hartung HP, Cimbora D, Smith MA, Mittereder N, Rees WA, She D, Cree BAC. Inebilizumab reduces neuromyelitis optica spectrum disorder risk independent of FCGR3A polymorphism. Ann Clin Transl Neurol. 2023 Dec;10(12):2413-2420. doi: 10.1002/acn3.51911.

Galioto R, Grezmak T, Swetlik C, Abbatemarco JR, Titulaer MJ, Finke C, Kunchok A. Neuropsychological Testing in Autoimmune Encephalitis: A Scoping Review. Neurol Neuroimmunol Neuroinflamm. 2023 Nov 10;11(1):e200179.

Aboseif A, Li Y, Amin M, Lapin B, Milinovich A, Abbatemarco JR, Cohen JA, Punia V, Rae-Grant AD, Galioto R, Kunchok A. Clinical Determinants of Longitudinal Disability in LGI-1-IgG Autoimmune Encephalitis. Neurol Neuroimmunol Neuroinflamm. 2023 Nov 10;11(1):e200178.

Yan C, Huang M, Swetlik C, Toljan K, Mahadeen AZ, Bena J, Kunchok A, Funchain P, McGinley M. Predictors for the Development of Neurological Immune-related Adverse Events of Immune Checkpoint Inhibitors and Impact on Mortality. Eur J Neurol. 2023 Jun 23. doi: 10.1111/ene.15942.

Majed M, Sanchez CV, Bennett JL, Fryer J, Mulligan MD, Redenbaugh V, McKeon A, Mills JR, Wingerchuk DM, Lennon VA, Weinshenker B, Chen JJ, Flanagan EP, Pittock SJ, Kunchok A. Alterations in aquaporin-4-IgG serostatus in 986 patients: a laboratory-based longitudinal analysis. Ann Neurol. 2023 Jun 14. doi: 10.1002/ana.26722.

Kunchok AC, Dalmau JO. Can NfL Be Utilized as a Biomarker of Disease Severity, Activity, and Outcomes in Anti-NMDAR Encephalitis? Neurology. 2023 Apr 4:10.1212/WNL.0000000000207310.

Toljan K, Mahadeen A, Amin M, Rensel M, Jones SE, Ontaneda D, Kunchok AC. Pearls & Oy-sters: Hemorrhagic Myelitis Following SARS-CoV-2 Infection. Neurology. 2023 Mar 29:10.1212/WNL.0000000000207213.

Chen JJ, Flanagan EP, Pittock SJ, Stern NC, Tisavipat N, Bhatti MT, Chodnicki KD, Tajfirouz DA, Jamali S, Kunchok A, Eggenberger ER, Nome MAD, Sotirchos ES, Vasileiou ES, Henderson AD, Arnold AC, Bonelli L, Moss HE, Navarro SEV, Padungkiatsagul T, Stiebel-Kalish H, Lotan I, Wilf-Yarkoni A, Danesh-Meyer H, Ivanov S, Huda S, Forcadela M, Hodge D, Poullin P, Rode J, Papeix C, Saheb S, Boudot de la Motte M, Vignal C, Hacohen Y, Pique J, Maillart E, Deschamps R, Audoin B, Marignier R. Visual Outcomes Following Plasma Exchange for Optic Neuritis: An International Multicenter Retrospective Analysis of 395 Optic Neuritis Attacks. Am J Ophthalmol. 2023 Feb 21:S0002-9394(23)00066-1. doi: 10.1016/j.ajo.2023.02.013.

Toljan K, Amin M, Kunchok A, Ontaneda D. New diagnosis of multiple sclerosis in the setting of mRNA COVID-19 vaccine exposure. J Neuroimmunol. 2022 Jan 15;362:577785.

Kunchok A, Lennon, V, Klein, C, Flanagan E, Dubey D, Zekeridou A, Mills, John R, McKeon A, Pittock S. Autoimmune encephalitis antibody biomarkers: Frequency, age and sex associations. Mayo Clinic Proceedings. 2022 Mar;97(3):547-559

Lambe J, McGinley M, Moss B, Mao-Draayer Y, Kassa R, Ciotti J, Mariotto S, Kunchok A. Myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD) following SARS-CoV-2 infection: a case series. Journal of Neuroimmunology. 2022 [in press]

Galioto R, Aboseif A, Krishnan K, Lace J, Kunchok A. Cognitive outcomes in anti-LGI-1 encephalitis. J Int Neuropsychol Soc. 2022 Sep 5:1-10.

Kunchok AC, Ontaneda D, Lee J, Rae-Grant A, Foldvary-Schaefer N, Cohen JA, Jones SE. Magnetic Resonance Imaging Features of Anti-Ma1/Ma2 Paraneoplastic Neurologic Syndrome. Neurology. 2022 Sep 7:10.1212

Valencia-Sanchez C, Guo Y, Krecke KN, Chen JJ, Redenbaugh V, Montalvo M, Elsbernd PM, Tillema JM, Lopez-Chiriboga S, Budhram A, Sechi E, Kunchok A, Dubey D, Pittock SJ, Lucchinetti CF, Flanagan EP. Cerebral cortical encephalitis in MOGAD. Ann Neurol. 2022 Nov 13.

Sechi E, Krecke KN, Messina SA, Buciuc M, Pittock SJ, Chen JJ, Weinshenker BG, Lopez-Chiriboga AS, Lucchinetti CF, Zalewski NL, Tillema JM, Kunchok A, Monaco S, Morris PP, Fryer JP, Nguyen A, Greenwood T, Syc-Mazurek SB, Keegan BM, Flanagan EP. Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders. Neurology. 2021 Jul 14:10.1212/WNL.0000000000012467. doi: 10.1212/WNL.0000000000012467. Epub ahead of print. PMID: 34261784.

Budhram A, Kunchok AC, Flanagan EP. Unilateral Leptomeningeal Enhancement in Myelin Oligodendrocyte Glycoprotein Immunoglobulin G-Associated Disease. JAMA Neurol. 2020 May 1;77(5):648-649. doi: 10.1001/jamaneurol.2020.0001. PMID: 32119057.

Kunchok A, Aksamit AJ Jr, Davis JM 3rd, Kantarci OH, Keegan BM, Pittock SJ, Weinshenker BG, McKeon A. Association Between Tumor Necrosis Factor Inhibitor Exposure and Inflammatory Central Nervous System Events. JAMA Neurol. 2020 Aug 1;77(8):937-946. doi: 10.1001/jamaneurol.2020.1162. PMID: 32421186; PMCID: PMC7235930.

Chen JJ, Flanagan EP, Bhatti MT, Jitprapaikulsan J, Dubey D, Lopez Chiriboga ASS, Fryer JP, Weinshenker BG, McKeon A, Tillema JM, Lennon VA, Lucchinetti CF, Kunchok A, McClelland CM, Lee MS, Bennett JL, Pelak VS, Van Stavern G, Adesina OO, Eggenberger ER, Acierno MD, Wingerchuk DM, Lam BL, Moss H, Beres S, Gilbert AL, Shah V, Armstrong G, Heidary G, Cestari DM, Stiebel-Kalish H, Pittock SJ. Steroid-sparing maintenance immunotherapy for MOG-IgG associated disorder. Neurology. 2020 Jul 14;95(2):e111-e120. doi: 10.1212/WNL.0000000000009758. Epub 2020 Jun 17. PMID: 32554760; PMCID: PMC7455322.

Kunchok A, Flanagan EP, Snyder M, Saadeh R, Chen JJ, Weinshenker BG, McKeon A, Pittock SJ. Coexisting systemic and organ-specific autoimmunity in MOG- IgG1-associated disorders versus AQP4-IgG+ NMOSD. Mult Scler. 2021 Apr;27(4):630-635. doi: 10.1177/1352458520933884. Epub 2020 Jul 7. PMID: 32633603.

Kunchok A, Lechner-Scott J, Granella F, Trojano M, Alroughani R, Sola P, Ferraro D, Lugaresi A, Onofrj M, Ozakbas S, Izquierdo G, Grammond P, Luis Sanchez-Menoyo J, Van Wijmeersch B, Boz C, Pucci E, McCombe P, Grand'Maison F, Spitaleri D, Vucic S, Hupperts R, Jokubaitis V, Sormani MP, Butzkueven H, Kalincik T; MSBase Study Group. Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score. Mult Scler. 2021 Apr;27(5):695-705. doi:10.1177/1352458520936823. Epub 2020 Jul 8. PMID: 32639855.

Hassan MB, Stern C, Flanagan EP, Pittock SJ, Kunchok A, Foster RC, Jitprapaikulsan J, Hodge DO, Bhatti MT, Chen JJ. Population-Based Incidence of Optic Neuritis in the Era of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibodies. Am J Ophthalmol. 2020 Dec;220:110-114. doi: 10.1016/j.ajo.2020.07.014. Epub 2020 Jul 21. PMID: 32707199.

Kunchok A, Chen JJ, Saadeh RS, Wingerchuk DM, Weinshenker BG, Flanagan EP, Pittock SJ. Application of 2015 Seronegative Neuromyelitis Optica Spectrum Disorder Diagnostic Criteria for Patients With Myelin Oligodendrocyte Glycoprotein IgG-Associated Disorders. JAMA Neurol. 2020 Dec 1;77(12):1572-1575. doi: 10.1001/jamaneurol.2020.2743. PMID: 32777005; PMCID: PMC7418041.

Kunchok A, Flanagan EP, Krecke KN, Chen JJ, Caceres JA, Dominick J, Ferguson I, Kinkel R, Probasco JC, Ruvalcaba M, Santoro JD, Sieloff K, Timothy J, Weinshenker BG, McKeon A, Pittock SJ. MOG-IgG1 and co-existence of neuronal autoantibodies. Mult Scler. 2021 Jul;27(8):1175-1186. doi: 10.1177/1352458520951046. Epub 2020 Sep 10. PMID: 32907470.

Kunchok A, McKeon A. Opsoclonus in Anti-Ma2 Brain-Stem Encephalitis. N Engl J Med. 2020 Sep 24;383(13):e84. doi: 10.1056/NEJMicm1914516. PMID: 32966725.

Singh TD, Hajeb M, Rabinstein AA, Kunchok AC, Pittock SJ, Krecke KN, Bartleson JD, Black DF. SMART syndrome: retrospective review of a rare delayed complication of radiation. Eur J Neurol. 2021 Apr;28(4):1316-1323. doi:10.1111/ene.14632. Epub 2020 Dec 3. PMID: 33159349.

Pittock SJ, Alfugham N, O'Connor K, Hinson S, Kunchok A, Lennon VA, Komorowski L, Probst C, McKeon A. GTPase Regulator Associated with Focal Adhesion Kinase 1 (GRAF1) Immunoglobulin-Associated Ataxia and Neuropathy. Mov Disord Clin Pract. 2020 Sep 14;7(8):904-909. doi: 10.1002/mdc3.13036. PMID:33163561; PMCID: PMC7604666.

Banks SA, Morris PP, Chen JJ, Pittock SJ, Sechi E, Kunchok A, Tillema JM, Fryer JP, Weinshenker BG, Krecke KN, Lopez-Chiriboga AS, Nguyen A, Greenwood TM, Lucchinetti CF, Zalewski NL, Messina SA, Flanagan EP. Brainstem and cerebellar involvement in MOG-IgG-associated disorder versus aquaporin-4-IgG and MS. J Neurol Neurosurg Psychiatry. 2020 Dec 28:jnnp-2020-325121. doi:10.1136/jnnp-2020-325121. Epub ahead of print. PMID: 33372052.

Kunchok A, Zekeridou A, McKeon A. Autoimmune glial fibrillary acidic protein astrocytopathy. Curr Opin Neurol. 2019 Jun;32(3):452-458. doi:10.1097/WCO.0000000000000676. PMID: 30724768; PMCID: PMC6522205.

Waters PJ, Komorowski L, Woodhall M, Lederer S, Majed M, Fryer J, Mills J, Flanagan EP, Irani SR, Kunchok AC, McKeon A, Pittock SJ. A multicenter comparison of MOG-IgG cell-based assays. Neurology. 2019 Mar 12;92(11):e1250-e1255. doi: 10.1212/WNL.0000000000007096. Epub 2019 Feb 6. PMID: 30728305; PMCID: PMC6511109.

Kunchok A, Barnes D, Boyer M, Halmagyi GM. Paraneoplastic cerebellar ataxia with central hypoventilation. Neurol Neuroimmunol Neuroinflamm. 2016 Dec 8;4(1):e305. doi: 10.1212/NXI.0000000000000305. PMID: 27990459; PMCID: PMC5147015.

Members & Collaborations

Members & Collaborations

Members

Cleveland Clinic Affiliations

  • Jonathan Lee, MD (Diagnostic Radiology, Cleveland Clinic).
  • Rachel Galioto, PhD (Neuropsychology, Cleveland Clinic).
  • Justin Abbatemarco, MD (MS and Autoimmune Neurology, Cleveland Clinic).
  • Kunio Nakamura, PhD (Biomedical engineering, Cleveland Clinic).
  • Stephen Jones, MD, PhD (Diagnostic Radiology, Cleveland Clinic).
  • Alex Milinovich (Data analytics, Cleveland Clinic).