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Ectopic NMDAR expression in cancer unmasks germline-encoded autoimmunity

Abstract:
Autoimmunity and anG-cancer immunity lie on the same biological conGnuum1,2 , but their link remains obscure. The paraneoplasGc neurological syndrome anG-NMDA receptor (NMDAR) encephaliGs (ANRE) is a paradigm for their connecGvity3 given that intratumoral NMDAR expression correlates with the generaGon of anG-NMDAR anGbodies . Here, we verify ectopic expression of GluN1 and GluN2B NMDAR sub-units in triple-negaGve breast cancer (TNBC) and model this using orthotopic TNBC tumors with inducible expression of GluN1-GluN2B NMDARs. We show that NMDAR expression is sufficient to induce B cell recruitment and their affinity maturaGon, consistent with an integrated adapGve immune response. ReconstrucGon of extended intratumoral B cell phylogenies and cryo-EM structural analyses demonstrated that affinity-matured hypermutated and class-switched anGbodies emerged from pre-exisGng germline-configuraGon lower-affinity anG-NMDAR anGbodies. DisGnct matured anGbodies targeted specific epitopes and induced conformaGonal rearrangements within the NMDAR amino-terminal domain, predicGve of their funcGonal effects, ranging from inhibiGon to potenGaGon. Passive transfer of an NMDAR-potenGaGng anGbody caused autonomic dysregulaGon and lowered the seizure threshold in healthy female mice, recapitulaGng key diagnosGc criteria of ANRE. We further idenGfy a correlaGon between intratumoral NMDAR  expression and anG-NMDAR anGbody Gters in TNBC paGents. Taken together, our data establish a direct connecGon between intratumoral NMDAR expression, anGbody maturaGon, and the onset of autoimmunity. These findings suggest that germline-encoded anG-NMDAR anGbodies contribute to immune surveillance but can also trigger autoimmune disease upon maturaGon, revealing a mechanisGc tradeoff between cancer immunity and neurotoxicity.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1038/s41586-026-10278-0

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Institution:
University of Oxford
Division:
MSD
Department:
Clinical Neurosciences
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Clinical Neurosciences
Role:
Author
ORCID:
0000-0003-2985-8652


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Funder identifier:
https://ror.org/029chgv08
Grant:
104079/Z/14/Z
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Funder identifier:
https://ror.org/03x94j517
Grant:
MR/V007173/1


Publisher:
Springer Nature
Journal:
Nature More from this journal
Publication date:
2026-03-25
Acceptance date:
2026-02-13
DOI:
EISSN:
1476-4687
ISSN:
0028-0836


Language:
English
Keywords:
Pubs id:
2372282
Local pid:
pubs:2372282
Deposit date:
2026-02-13
ARK identifier:

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