IFN-γ is a therapeutic target in paraneoplastic cerebellar degeneration

Paraneoplastic neurological disorders result from an autoimmune response against neural self-antigens that are ectopically expressed in neoplastic cells. In paraneoplastic disorders associated to autoantibodies against intracellular proteins, such as paraneoplastic cerebellar degeneration (PCD), current data point to a major role of cell-mediated immunity. In an animal model, in which a neo-self-antigen was expressed in both Purkinje neurons and implanted breast tumor cells, immune checkpoint blockade led to complete tumor control at the expense of cerebellum infiltration by T cells and Purkinje neuron loss, thereby mimicking PCD. Here, we identify 2 potential therapeutic targets expressed by cerebellum-infiltrating T cells in this model, namely alpha 4 integrin and IFN-gamma. Mice with PCD were treated with anti-alpha 4 integrin antibodies or neutralizing anti-IFN-gamma antibodies at the onset of neurological signs. Although blocking alpha 4 integrin had little or no impact on disease development, treatment using the anti-IFN-gamma antibody led to almost complete protection from PCD. These findings strongly suggest that the production of IFN-gamma by cerebellum-invading T cells plays a major role in Purkinje neuron death. Our successful preclinical use of neutralizing anti-IFN-gamma antibody for the treatment of PCD offers a potentially new therapeutic opportunity for cancer patients at the onset of paraneoplastic neurological disorders.