It seems possible that TH cells expressing CD154 (the very important B cell helper molecule) might not be required for NR1 antibody generation, thus extrafollicular B cell activation may occur independently of T cell help, e.g., directly in the brain or in some patients in NMDAR-expressing tumor cells in ovarian teratomas, a common association in women with NMDAR-E [8]. The gene discussed is CD40LG; the disease is ovarian teratoma.