Abstract
The objective of this study is to investigate whether chronic inflammatory demyelinating polyneuropathy (CIDP) and its subtypes differ in their type 1 T-helper (TH1) cell response against nodal/paranodal neurofascin (NF186, NF155) as well as myelin protein zero (P0 180-199) and myelin basic protein (MBP 82-100). Interferon-gamma (IFN-γ) enzyme-linked immunospot assay was used to detect antigen-specific T cell responses in 48 patients suffering typical CIDP (n = 18), distal acquired demyelinating polyneuropathy (n = 8), multifocal acquired demyelinating sensory and motor polyneuropathy (MADSAM; n = 9), and sensory CIDP (n = 13) compared to other non-immune polyneuropathy (ON; n = 19) and healthy controls (n = 9). Compared to controls, MADSAM and sensory CIDP patients showed broadest IFN-γ T cell responses to all four antigens. Positive IFN-γ responses against two or more antigens were highly predictive for CIDP (positive predictive value = 0.95) and were found in 77% of CIDP patients. Patients with limited antigen-specific response were females, more severely affected with neuropathic pain and proximal paresis. The area under the receiver operating characteristics curve (AUC) of NF186 in MADSAM was 0.94 [95% confidential interval (CI) 0.82-1.00] compared to ON. For sensory CIDP, AUC of P0 180-199 was 0.94 (95% CI 0.86-1.00) and for MBP 82-100 0.95 (95% CI 0.88-1.00) compared to ON. Cell-mediated immune responses to (para)nodal and myelin-derived antigens are common in CIDP. TH1 response against NF186 may be used as a biomarker for MADSAM and TH1 responses against P0 180-199 and MBP 82-100 as biomarkers for sensory CIDP. Larger multicenter studies study are warranted in order to establish these immunological markers as a diagnostic tools.
Highlights
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system and can be divided clinically into typical CIDP and atypical variants, such as distal acquired demyelinating polyneuropathy (DADS), multifocal acquired demyelinating sensory and motor polyneuropathy (MADSAM), and sensory CIDP (1, 2)
The IFN-γ response against neurofascin 186 (NF186) was significantly increased in MADSAM and to a lesser extent in typical CIDP compared to healthy control (HC) and other non-immune polyneuropathy (ON) (Figure 1B)
We found by trend an association between the NF186 response and conduction blocks (p = 0.06; Fisher’s exact test)
Summary
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system and can be divided clinically into typical CIDP and atypical variants, such as distal acquired demyelinating polyneuropathy (DADS), multifocal acquired demyelinating sensory and motor polyneuropathy (MADSAM), and sensory CIDP (1, 2). Due to its heterogeneous manifestation, different autoimmune targets are likely to be relevant in CIDP (3). T cell responses have been shown to be involved in the immunopathogenesis of CIDP (4, 5). We and others detected autoreactive T cell responses against the compact myelin antigenic epitopes P2, PMP-22 as well as myelin protein zero [180–199] (P0 180–199), myelin basic protein [82–100] (MBP 82–100) measured by enzyme-linked immunospot (ELISPOT) assay (6–8). We found differences between typical and atypical CIDP in antigenic response against P0 180–199 and MBP 82–100 (8). The purpose of this study was to investigate whether CIDP patients show autoreactive T cell responses against NF155 and NF186 and secondly whether CIDP and its clinical variants differ in their T cell response against NF155, NF186 as well as against the myelin epitopes P0 180–199 and MBP 82–100
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